Melissa LaCour By the end of this chapter, the students should be able to: 1. Orient a new employee to the department and his or her job function. 2. Train an employee on a new job procedure. 3. Assess the training needs for the HIM department. 4. Prepare a development plan for HIM staff. 5. Identify inservice topics for HIM department personnel. 6. Create a presentation on an inservice topic. 7. Identify continuing education needs for HIM employees. 8. Document minutes from an inservice, a continuing education session, or a department meeting. 9. Organize an agenda for HIM department meetings. 10. Identify key aspects of effective communication. agenda continuing education (CE) credentials cross-training inservice memorandum (memo) minutes orientation training A well-managed health information management (HIM) department spends considerable time on the training and development of its employees. Training involves orientation, education, and practical application for a specific HIM job position. Development is the ongoing improvement of staff professionally. The HIM director is responsible for the hiring, training, development, and retention of employees who perform all department functions. Training is essential to the HIM department; well-trained employees provide high-quality service. Training is necessary at many times: at the beginning of employment, as procedures and policies change and processes are improved, and as technology and equipment are improved. Development is equally important because it improves the quality of service. A department that develops its employees is making an investment in the quality of its future service. The previous chapter discusses setting standards for job responsibilities, hiring the right candidate, and monitoring performance. In this chapter, we emphasize training and developing employees to be assets in the HIM department. When he or she begins a job at a health care facility, it is very important for an employee to learn about the environment and the new job, so an orientation is essential for employee success. The purpose of orientation is to make the employee familiar with the surroundings. Some facilities hold organization-wide orientations weekly, which are followed by second orientations specific to an employee’s job within the department, led by his or her direct supervisor. The organization-wide orientation is general and introduces the employee to the organization, its corporate structure, along with regulations, policies, and procedures that are required of all employees. Typically, before new employees report to their departments, they attend an organization-wide orientation in which they learn about the organization, mission, vision, or values and have an opportunity to ask questions regarding employment. In most cases, an organization orientation includes the organization chart for the entire facility and the following topics: Other topics may include incident reporting, compliance, and the phone and e-mail systems. This orientation should take place before employees begin their job activities; however, because these orientations are sometimes offered only once a month, employees may actually begin work before their organization orientation. It is important that all employees receive orientation, including those employees who work from home. vision The goal of the organization, above and beyond the mission. Health Insurance Portability and Accountability Act (HIPAA) Public Law 104-191, federal legislation passed in 1996 that outlines the guidelines of managing patient information in terms of privacy, security, and confidentiality. The legislation also outlines penalties for noncompliance. compliance Meeting standards. Also the development, implementation, and enforcement of policies and procedures that ensure that standards are met. Some of the first materials that employees receive during the orientation explain the benefits to which they are entitled as employees of the organization. During this part of the orientation, employees complete necessary forms for income tax purposes and learn about enrollment in other special savings plans, insurance, or retirement accounts. Because compensation for the job is important, orientation is an opportunity to ask about pay periods, proper completion of payroll forms, and use of the time clock. Employees are also informed of health care facility policies and procedures that affect their employment, and they must receive a copy of the employee handbook. Information in the employee handbook includes facility dress code, attendance policy, hours earned for vacation and sick leave (paid time off, or PTO), grievance procedures, and holidays. During the initial orientation, the new employee learns about the organization’s expectations in relation to all customers. Customer service is an important part of health care, and many facilities use this orientation as an opportunity to inspire a positive customer focus in all employees. Employees are encouraged to: 1. Identify all of their customers by name. 2. Greet each customer with a smile. 3. Provide assistance or find someone who can assist the customer. Employees may have an opportunity to participate in a role-playing exercise in which they learn how to deal with a disgruntled customer. As discussed in Chapter 11, quality is critical to all aspects of health care. Because of its importance, employees are informed about the expectations and methods that the organization uses to ensure quality. The orientation should introduce the employee to the performance improvement (PI) method used by the organization. New employees learn that everyone in the facility is responsible for quality. As appropriate, employees are encouraged to identify and report opportunities to improve quality. The health care environment should be safe for patients, visitors, and employees. Safety issues are covered in the organization orientation to make the employee aware of the policy and procedures for maintaining a secure environment and for handling situations in the event of an emergency (i.e., the disaster plan). Two commonly discussed topics are fire safety and response to “code” emergencies. A common fire response uses the acronym RACE—rescue, alarm, confine, and extinguish. Every employee learns to rescue patients, employees, or visitors from the area of the fire. He or she should go to the closest fire alarm and inform the operator of his or her name and the location and status of the fire. Then the employee should confine the fire by closing all doors in the area. If possible, he or she should extinguish the fire with a fire extinguisher or other appropriate device. During a visit to a health care facility, you may have heard the operator announce a “code” over the intercom system. Common codes are “code blue” for cardiac arrest and “code red” for fire. These codes alert the employees to an emergency that is occurring in the facility (Table 14-1). These codes may also be announced as fictitious physician names (e.g., Dr. Red instead of “code red,” or Dr. Strong for “security”). All employees must recognize the codes in the facility and know their roles in the response to the emergency. TABLE 14-1 By nature of the job environment, health care workers may be exposed to a number of infectious agents. For this reason, several significant issues are covered under the topic of infection control, including hepatitis, acquired immunodeficiency syndrome, and universal precautions for blood and body fluids. During this part of the orientation, new employees learn how to protect themselves and others from infection; the discussion provides information about how these infections are spread and then shares procedures that help protect employees. In a discussion about universal precautions for blood and body fluids, employees are informed that one of the best and easiest methods to prevent the spread of infection is by washing their hands. Employees are encouraged always to wash their hands before and after having contact with a patient, eating, and using the restroom. Universal precautions also include wearing masks and gloves when interacting with potentially infectious material and properly discarding needles and other contaminated objects. Because some blood-borne organisms can survive for days outside the body, health care workers are advised to exercise caution when handling items contaminated with body fluids. For example, a paper record contaminated with blood should be filed in a sealed plastic sheet protector. All employees should maintain proper body mechanics, particularly while sitting at the work station and when lifting, pushing, pulling, or transporting patients or equipment. Employees can be injured if they use poor body mechanics, and injuries are very costly to the entire organization; injuries could lead to missed work, workers’ compensation claims, and reduced productivity. The orientation may include demonstration of proper body mechanics for employees to use in their job duties. Confidentiality has always been an important part of the new health care employee orientation. HIPAA legislation increased the need for organizations to ensure that all employees and contractors receive training regarding the confidentiality and security of health information. Typically, this topic is presented by an HIM professional. All employees must recognize the sensitivity of confidential information in a health care facility and the proper manner in which it should be handled. The confidentiality policy is reviewed, and all employees are asked to sign a confidentiality statement, as discussed in Chapter 12 (see Figure 12-1). Additionally, all employees must be made aware of any applicable federal and state laws and organization policies regarding patient confidentiality and security. Security matters can include review of the information technology policy on password security and access to the organization’s electronic health information. All employees will be asked to review the guidelines for security and to sign statements acknowledging their understanding and compliance. health information Organized data that have been collected about a patient or a group of patients. Sometimes used synonymously with health data. Many facilities require a training session before a new employee is given access to its computer systems, and The Joint Commission (TJC) requires that new employees complete this training within 7 days. During orientation new employees receive their login or user names, even though access will be limited until training on the various computer systems is complete. They also are given information on rules for setting passwords and the frequency that passwords must be changed, and learn about the use policies surrounding the facility’s information systems. This information, along with training on the use of software applications, may be presented by an information technology (IT) professional, although the use of computer-based learning modules for this procedure is common. After the organization-wide orientation, employees report to their supervisors in their assigned departments for orientations specific to their jobs. Each employee is given an opportunity to become acclimated to the work environment, meet the employees who are part of the work group or team, and learn what is expected by management. During this orientation, a new employee in the HIM department is given a copy of the job description, performance standards, rules, and policies and procedures of the department. The employee becomes familiar with the physical layout of the HIM department, including the evacuation route in case of fire and other related departments within the organization. performance standards Set guidelines explaining how much work an employee must complete. One way to orient new employees is to have them sit with coworkers in each section of the department to allow them to familiarize themselves with everyone’s tasks. This experience helps new employees understand the impact of their roles in the department. Although the organization-wide orientation covers payroll issues (as discussed earlier), there may be more specific schedule policies within the department. HIM employees should know the hours (shift) that they are expected to work. HIM employees also need to understand which holidays they may be required to work and how to request time off. Another topic discussed in the organization-wide orientation is security of health information. HIM employees are given a password with access to appropriate systems that they will use to perform their job duties. In the HIM department orientation the employee is reminded of the rules associated with the password—for instance, employees cannot share passwords with others, and when they leave a computer station they should log out to prevent unauthorized access by someone who might try to access that computer after they walk away. Once their passwords are assigned, employees can begin training on the computer systems associated with their jobs. An excellent way to keep track of everything that must be covered with a new employee is to complete an orientation checklist (Figure 14-1). The employee should initial and date each item as it is completed. This form is kept in the employee’s file folder for future reference, as verification of the orientation. HIM department employees are not the only members of the organization who require an orientation about the department. Clinical staff, physicians, and members of other departments should be familiar with the functions and services of the HIM department. A general orientation explaining HIM department operations will help these members when they interact with the department. HIM customers need to know the requirements for requesting information or records and the procedures for completing or reviewing records. Physicians require orientation to the HIM department because they will visit the department to complete their health records and perform research. Physician orientation can be by personal appointment or in the form of a letter (Figure 14-2) introducing or explaining HIM department functions. Department managers must understand the proper way to request records from the HIM department. Managers often request records for a study or project in which they are involved or to obtain information for a meeting. They need to know how much notice the department needs to complete the request. Does the request need to be specific? Does the person requesting the information need to include the patient’s name, medical record number (MR#), and discharge dates on the request form? Covering these policies in an orientation eliminates a great deal of confusion and stress in the future. Training is an important part of all jobs. Employees obviously need training when they begin a job, but they need it just as much when processes, procedures, and equipment are changed. Training is the education of employees in new techniques and processes within the organization. It is provided to employees in the health care facility through inservice training sessions, seminars, workshops, and continuing education, to ensure the quality of service. Development is a term that can be used to describe training, but more specifically it indicates an investment by the organization—in an employee—with the expectation that the development will indeed pay off somehow in the future performance of the employee. For instance, an employee is hired to perform release of information (ROI). Over time and with experience, the managers recognize that this employee could be developed for a supervisor position. Development is an investment in the employee, enhancing skills and increasing his or her ability to perform necessary job duties. inservice Training provided to employees of an organization for continued or reinforced education. release of information (ROI) The term used to describe the HIM department function that provides disclosure of patient health information. Training sessions should be planned with specific goals in mind, because they are essential to successful staff development. The first step in planning a training session involves an assessment of current staff training needs. The assessment helps the HIM director identify which areas need focus. Training topics can be identified through the following means: In Chapter 13 we discuss performance standards. Performance standards tell employees the amount and the quality of work they are expected to accomplish. When performing employee evaluations, the manager may determine that additional training is needed in a particular area because of an employee’s low performance. Occasionally, employees may be asked to identify areas in which they would like to acquire more expertise. This is an opportunity for development. A survey can identify areas of interest to the employees, and training sessions can be developed accordingly. Surveys may also identify ideal areas for cross-training, which teaches employees how to perform job functions in the department that are not part of their job descriptions. Cross-training is a way to prepare a department to handle increased workloads and vacant positions when employees are on a break, are out sick, are on vacation, or leave their positions. It can also provide job enrichment for some employees. cross-training Training of employees for additional jobs or functions within the department so that they can help with those jobs when necessary.
Training and Development
Chapter Objectives
Vocabulary
HIM health information management
Orientation
orientation Training to familiarize a new employee with the job.
Organization-Wide Orientation
mission statement The strategic purpose of the organization documented in a formal statement.
Personnel Considerations
PTO paid time off
Customer Service
Quality
performance improvement (PI) Also known as quality improvement (QI) or continuous quality improvement (CQI). Refers to the process by which a facility reviews its services or products to ensure quality.
Building Safety and Security
RACE rescue, alarm, confine, extinguish
CODE
EMERGENCY
Dr. Strong
Security requested in a specific area of the facility
Black
Bomb threat
Red
Fire
Orange
Radiation disaster
Pink
Infant abduction
Blue
Cardiac arrest
Yellow
External disaster
Infection Control
Body Mechanics
Confidentiality
confidentiality Discretion regarding the disclosure of information.
Information Systems
TJC The Joint Commission
Health Information Management Department Orientation
job description A list of the employee’s responsibilities.
Clinical Staff Orientation
medical record number (MR#) A unique number assigned to each patient in a health care system; this code will be used for the rest of the patient’s encounters with that specific health system.
Training and Development
training Education in, instruction in, or demonstration of how to perform a job.
Planning a Training Session
Assessment of Education Needs
performance standards Set guidelines explaining how much work an employee must complete.
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