The Merger of Hospitals - What You Need to Know

Initiation and Preparation 

A merger of hospitals, as in the case of St. Luke's Hospital, St. Catherine's Medical, and Hickman Hospital, comes forth with changes that may affect service delivery in considerable measures. The compound hospital mostly faces client inconvenience issues and integration challenges brought by differences and disparities of the unit hospitals. The hospital information management (HIM) department, among others, needs an elaborate strategy to fast-track such mergers. A strategic integration plan for the HIM department is vital in ensuring a smooth transition that takes care of patients, employees, suppliers, and any other affected stakeholders. Specie areas that the integrated strategic plan handles include patient information, employee productivity, compliance issues, and cultural diversity. Besides, unit hospitals, which had distinct missions and missions, require a merged mission and would benefit from a well-planned strategy for effective execution.

Summary 

The new and bigger HIM department will have merger-related issues from different perspectives. The issues, a sum of challenges from the unit hospitals, covers areas of compliance and cultural diversity. The unit hospitals, under the merger, have different levels of infrastructure development, technology, and quality of service delivery (Southern New Hampshire University [SNHU], n.d.). These differences contribute to differing compliance status for their HIM departments. The Gateway Hospital, therefore, faces the ultimate challenge of incorporating both the low and high standards of unit hospitals into a single high standard level for conformity to relevant regulations. Also, the three hospitals, located in regions of considerable social and racial disparities, present differing cultural and socio-economic challenges to the new HIM department (SNHU, n.d.). Besides, the unit hospitals have their HIM departments designed differently in line with their different missions and visions. Integrating the differences to form a single unanimous and effective hospital mission also presents a formidable task to the HIM.

Compliance 

The three hospitals under the merger are at different compliance levels. The U.S version of the International Classification of Diseases, the ICD-9-CM, is a system of classification that provides regulations related to coding of healthcare items such as diagnoses and health status. The system is executed on a real-time electronic health record (EHR) that capture relevant patient information. Under the system, the parameter of ‘time’ is vital to maintain data integrity. St. Catherine's inability to provide a time stamp on its EHR orders presents a compliance challenge for the HIM (Decision Health, n.d.). The hospital, also, falls short of the ICD-9-CM’s productivity regulation of four inpatient charts per hour with its two inpatient charts per hour (Smith, Bowman, & Dooling, 2019). St Luke's Hospital faces a similar noncompliance issue on productivity. At Hickman's, the noncompliance is at a critical level. The Joint Commission report (2020) indicates that the department lacks, in totality, the technology that would make it accessible to the ICD-9 for compliance considerations.

Cultural Diversity 

Cultural challenges are presented on fronts of social class disparities, religion, race, ethnicity, and disability. St. Luke’s, located in a cosmopolitan and socially heterogeneous region, presents the most diversified HIM that would require minimal changes. The hospital attends to the wealthy, the poor, and the middle class in equal measures. The other two units work with different sets of classes. St. Catherine is located among the affluent, while Hickman serves the poor community. Fortunately, St. Catherine has no previous record of discrimination on social terms, thus offering a more natural integration process.

On religious grounds, St. Catherine presents a rich Catholic heritage incorporated in its operations. Catholicism has also been linked to its efficiency and high customer satisfaction levels. On the other hand, St. Luke’s and Hickman have no spiritual affiliations in their existing operations.

St Catherine and St. Luke’s present a clean record of a disability, race, and ethnic challenges. The two units have a culture that maintains the dignity of employees and patients from all races, ethnicities, and those living with different disabilities. Hickman, however, presents an integration challenge on race and disability. The hospital, located in a Caucasian community, is on record of having discriminated against a qualified but disabled job applicant on color and disability status.

Mission and Vision 

St. Catherine’s Hospital 

HIM Mission Statement. To timely avail health information to patients through the right channels and formats to ensure patient satisfaction is achieved. According to the wording of the mission, St. Catherine shows the high value it places on patients. Emphasis is put on time, media, and forms of communication as key in handling patient information.

HIM Vision Statement . To handle patients’ health information with utmost privacy and sensitivity. Notably, the hospital falls short of implementing its vision, as demonstrated by employees’ negligence of the same. Disposing of documents without shredding or burning and leaving work stations unattended while logged in in the hospital's system displays insensitivity to patient's information.

St. Luke’s Hospital 

HIM Mission Statement. To share accurate information to stakeholders within the shortest possible time. Since the HIM at St. Luke’s uses manual coding, their mission is unattainable due to the slow and error-prone nature of manual data.

HIM Vision Statement . To promote research through modern, state-of-the-art technology. St. Luke’s uses an older version of the EHR system, thus facing challenges to provide advanced communication platforms.

Hickman Hospital 

HIM Mission Statement. To, at all times, stay committed to protecting the patients' health information. The hospital, however, shows a lack of commitment as depicted by hospital personnel announcing a psychiatric patient's condition in the presence of multiple patients.

HIM Vision Statement. To ensure the security of patient information. Hickman also shows little commitment to secure patient information since the hospital deploys manual coding, which is susceptible to third party access.

Gateway Healthcare/Merged Hospital 

HIM Mission Statement. To develop a policy-based system that ensures observance of privacy in the handling of patient information.

HIM Vision Statement. To exploit the current technology to aid in the complete automation of health information management . 

SWOT Analysis 

The three constituent hospitals have internal strengths and weaknesses, as well as external opportunities and threats, as depicted in the SWOT analysis matrix in Table 1.0, 2.0, and 3.0.

Table 1.0 St. Catherine Hospital SWOT Analysis Matrix

Table 2.0 St. Luke’s Hospital SWOT Analysis Matrix

Table 3.0 Hickman Hospital SWOT Analysis Matrix

SWOT Analysis Summary 

The SWOT analysis of the three hospitals indicates massive strengths that present the HIM with abilities to form a formidable department. High productivity linked to Catholicism at St. Catherine can be incorporated at Gateway HIM for efficiency and productivity. St Luke’s and Hickman also enjoy the cultural diversity and strong community recognition, thus presenting a vast clientele. The compound HIM will, however, face accumulated weaknesses and threats. St. Catherine's, for example, has a culture of indiscipline among staff while both St. Luke’s and Hickman present an HIM system with old-fashioned or lack of technology whatsoever. Competitors taking advantage of non-compliance and pay cuts may offer a formidable threat to the business interest of Gateway Healthcare. However, rife opportunities exist among all unit hospitals and present a chance for a more potent unified force. Among the opportunities include recent implementation of new technology at St Catherine, diversity and geographical location of St. Luke’s and the culture of unity among the staff of Hickman hospital.

Process Improvement Plan Phase 

Performance Measurement 

Establishing efficient performance measurement tools that observe best practices and compliance guidelines is essential for Gateway Healthcare. The tools provide a threshold for employee productivity and identify gaps in performance for training and continuous improvement. The driving force towards accurate measurement is to achieve customer satisfaction, increased efficiency, and provision of quality services at a minimal cost. Within the HIM department, target tools will seek to measure data transparency, data interoperability, integration, and transition of care. Therefore, to achieve the measurement initiative, targets and expectations shall be set, timeframes established, and assessment of employees and system output evaluated. Using a balanced scorecard, set parameters and units of measurement would identify gaps and factors linked to high productivity.

Employment Laws 

Evaluation of performance may push both the employer and employees into unlawful practices in their attempt to meet targets and optimize productivity. Laws affecting employee evaluation of performance include all laws regulating working hours, workplace environment, non-discriminatory regulations, and wages. The Wage and Hour Division has weekly working hours at 40, with extra hours subject to overtime payment. The evaluation process will rate employees within human working hours. Also, extra efforts put in by employees for the evaluation and continuous improvement purposes have to meet the wages regulations of the Employment Act. All non-discriminating procedures shall be adhered to in the evaluation process (Javidmehr & Ebrahimpour, 2015). Considering that Gateway Healthcare is a multi-cultured facility, the evaluation shall eliminate all possible forms of racial, gender, age, and socio-economic disparities.

Feedback 

Transparency will act as a critical element for the feedback process. Acceptable feedback achieves its credibility status from a transparent assessment and evaluation process. After attaining a perfect score through a fair scorecard platform, the outcome of each employee is then communicated timely and in a constructive approach. Through an open forum, employees will be talked into accepting their performance and asked to offer possible factors linked to their exemplary or below-average performance. The positive approach, with less criticism, will provide insight into valuable and implementable ideas for better results. The ideas will also present the hospital with corrective and preventive action (CAPA) plan checklist and training gaps for continuous improvement.

Accreditation Standards 

The modern technology resources at unit facilities such as St. Catherine’s will be utilized to establish a performance management system, which is a requirement for compliance. The system will be designed to fast track quality improvement and development. Details captured in the system include employees’ data and their performance track record. Set targets, timelines, and methodologies for continuous improvement are also captured. Secondly, the performance management system will incorporate automated timers to enforce scheduled feedback on performance, stages of execution, targets set, and targets met, and related projections (Murray, 2015). Transparency in the system will ensure high levels of trust.

Stakeholders 

Internal employees, hospital leadership, clients, suppliers, and government representatives form a strong team of stakeholders incorporated in the validation team. Clients, for example, will prove resourceful in validating measurements of customer satisfaction, quality of services, and cost. Government representatives will offer insights into issues related to employment laws and regulations. Internal employees will provide the bulk of the validation approval proposal since they link all the stakeholders and perform the actual execution of the plans. With that regard, employers will check the viability of productivity targets, cost reduction initiatives, and implementation timeframes. Suppliers are also vital in providing insights into their timely deliveries to enhance the implementation of the strategic plan.

Policy and Procedures 

Hickman and St. Luke’s facilities will acquire modern technology to first track compliance with ICD-9-CM on coding and EHR. New personnel will be obtained to improve the rate of inpatient charts. Patient information in the Gateway’s Healthcare electronic system shall be secured through a login system that is automated to log out after several inactive minutes. The technology will protect data leakage when an employee leaves their work stations unattended. Shredding of documents, as a clear role, will be handled by specified documentation assistants for accountability.

Cultural Diversity 

All new employees will undergo a cultural diversity training before starting their new roles. The training team will have a representative from every culture present at Gateway. The representatives will handle common communication challenges in a multi-cultured workplace, which will instill cultural diversity in the new setup (Schouler-Ocak et al., 2015). Each representative will provide knowledge of acceptable and unacceptable culture-oriented aspects in their respective cultures. A hospital representative will then emphasize the need to be culturally sensitive and accommodative. The team will instill a culture that believes in the strength of diversity.

Compliance Issues 

Existing employees with gaps in HIM knowledge will undergo new training conducted by the HIM department. The entire existing staff will also undergo training on HIPAA regulations. Emphasis will be put on the disposal of documents and the handling of the hospital’s credentials. The training on HIPAA regulations will also caution employees from all forms of workplace discrimination.

Change Management and Training Implementation Phase 

Workflow 

Project Management Tool 

Cultural Diversity 

A new recruitment policy will establish a non-technical culture-oriented team (the same diversified team that conducts culture orientation pieces of training) to work along with the Human Resource recruitment team. The culture oriented team that shall be involved at all stages of the recruitment process. The group, with a diverse representative, will eliminate all forms of discrimination in recruitment.

Training for HIPAA Security Laws 

The Health Insurance Portability and Accountability Act (HIPAA) 

The HIPPA law, enacted in 1996, ensures the privacy of protected health information (PHI) in healthcare industries. The security rule under HIPAA protects what it terms as electronically protected health information (e-PHI), thus not applicable to oral and handwritten data (U.S. Department of Health & Human Services, 2013). Non-electronic information is covered under the HIPAA privacy guidelines.

The security rule requires that all hospitals establish and maintain frameworks that facilitate the security of their electronic data. The structures mandated are in terms of administrative abilities, technical resources, and physical protection. The regulatory requirement is achieved through the hiring and training of personnel, while the technical part is achieved through the acquisition of relevant modern technology to facilitate information security. Physical requirements require the establishment of proper infrastructure to harbor the proposed system.

The law, in specific, requires entities to provide utmost confidentiality, integrity, and availability of e-PHI to regulators. All information created, transmitted, or received from third parties falls under HIPAA guidelines. Also, hospitals have to anticipate threats and put in preventive measures and train its workforce to ensure compliance.

Training for Policy and Procedure Changes 

The manual data protection policy at the former Hickman facility changes to capture the new electronic system in compliance with the regulators and internal regulations. A change from manual coding to an electronic system also changes the procedure of data capture and transmission. The new policy also introduces timers as a parameter that assures data integrity to avert the previously nonconformance at St. Catherine. To enhance security of online data on the hospital’s platform, the new policy features a system log out inclusion on accounts that have been logged in and remain dormant for specified minutes. Destruction of physical documents will follow a new procedure that demands approval and supervision of the destruction process.

Evaluate Success 

Any incidences contravening the diversity regulations shall be recorded and reported as they occur. A summary of recorded events shall be evaluated on a quarterly frequency to check progress. Customer and employee satisfaction levels linked to diversity issues shall be anonymously delivered into a suggestion box for impromptu evaluation by the leadership. Rates and trends of the data shall form the basis of evaluating the success of training and identifying training gaps.

Conclusion 

A merger of three hospitals into a single unit presents numerous compliance challenges and accumulation of weaknesses and threats. However, the process also enjoys a pool of opportunities and strengths that may be utilized to form a single formidable force. The transition process, yet, as to involve an elaborate strategic plan that handles all policy changes, compliance issues, and training. These changes and pieces of training are not only meant to ensure continuity, but also conformity to external regulations and laws. As observed in this case study, noncompliance of hospital units with ICD-9-CM and HIPAA calls for change in policies, acquisition of new resources, and employee training. Evaluation of employee productivity and performance of new policies is critical, as it gives insight on gaps and weaknesses. The most crucial element for a successful assessment is transparency (Wenzel et al., 2017). Employees trust a transparent system and become easily motivated with the feedback that such a system offers, thus a significant factor towards continuous improvement. Also, Schaerer, et. al. (2018) notes that accuracy in evaluation and feedback is vital. Accurate data provides reliable statistics that are useful in the quest for conformity and high productivity.

References

Decision Health. (n.d.).  Coding Productivity Benchmarks .  http://decisionhealth.com/static/whitepaper/Coding-Productivity-Benchmarks-whitepaper.pdf 

Javidmehr, M., & Ebrahimpour, M. (2015). Performance appraisal bias and errors: The influences and consequences.  International Journal of Organizational Leadership ,  4 (3), 286-302.  https://doi.org/10.33844/ijol.2015.60464 

Murray, K. (2015). Leadership Q&A.  Nursing Management (Springhouse) ,  46 (1), 56.  https://doi.org/10.1097/01.numa.0000459097.94352.5a 

Schaerer, M., Kern, M., Berger, G., Medvec, V., & Swaab, R. I. (2018). The illusion of transparency in performance appraisals: When and why accuracy motivation explains unintentional feedback inflation.  Organizational Behavior and Human Decision Processes ,  144 , 171-186.  https://doi.org/10.1016/j.obhdp.2017.09.002 

Schouler-Ocak, M., Graef-Calliess, I. T., Tarricone, I., Qureshi, A., Kastrup, M. C., & Bhugra, D. (2015). EPA guidance on cultural competence training.  European Psychiatry ,  30 (3), 431-440.  https://doi.org/10.1016/j.eurpsy.2015.01.012 

Southern New Hampshire University. (n.d.).  Gateway Healthcare Systems Case Study . snhu.  http://snhu-media.snhu.edu/files/course_repository/undergraduate/him/him440/him440_gateway_healthcare_systems_case_study.pdf 

The Joint Commission. (2020).  Joint Commission Resources Portal . Joint Commission Resources Portal.  https://e-dition.jcrinc.com/MainContent.aspx 

U.S. Department of Health & Human Services. (2013, July 26).  Summary of the HIPAA security rule .  https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html 

Wenzel, A., Krause, T. A., & Vogel, D. (2017). Making performance pay work: The impact of transparency, participation, and fairness on controlling perception and intrinsic motivation.  Review of Public Personnel Administration ,  39 (2), 232-255.  https://doi.org/10.1177/0734371x17715502