The Pros and Cons of Hospital Mergers

Hospital mergers affect the delivery and availability of patient care or associate data in different ways. The resulting compound unit requires effective strategies to effect greater efficiency in managing both patient care and patient information. Issues of compliance, workplace diversity, patient backgrounds, and the individual hospital's missions and visions must all be aligned in keeping with the greater goal of the merger. Gateway Healthcare Systems is a perfect showcase of this phenomenon. 

Summary 

The merger between St. Catherine's Medical center, St. Luke's hospital, and Hickman Hospital to form the Gateway Healthcare Systems comes with a number of implications for the management of patient health information. First, the three facilities have advanced differently regarding the implementation of technology in their respective human information management (HIM) systems ( Southern New Hampshire University [SNHU], n.d.) , which makes it difficult to link the three facilities in a single HIM system. Secondly, each of the facilities has different considerations in their workplace divert practices (SNHU, n.d.) , which implies the possibility of culture shock during workforce integration. Third, the hospitals serve patients from diverse backgrounds, including the heterogeneous city patients visiting St. Luke's, the low-class Caucasian community at Hickman, and the wealthy residents of the city suburbs who go to St. Catherine's (SNHU, n.d.) . 

Compliance 

St Catherine strives to remain compliant to the ICD-9 standards of HIM, but there is a noted failure to provide time stamp on orders in the EHR ( Decision Health, n.d.) . There is slack in the department compliance with the ICD-9 productivity standards of four inpatient charts an hour- the current productivity averages to two inpatient charts per hour per coder ( Smith, Bowman & Dooling, 2019) . Coding productivity at St Luke’s (two charts per hour per coder) is also below the compliance requirements of four charts per hour. Hickman’s is completely non-compliant with the specified human information management standards due to its complete inaccessibility and lack of integration of technology in its HIM systems ( The Joint Commission, 2020) . 

Cultural Diversity 

There are at least five issues of cultural diversity that impact information management quality and productivity at Gateway Healthcare systems. These include social class, spirituality, disability, race, and ethnicity. 

Social class is evident in St. Catherine's hospital, but it has not hindered the HIM department from realizing a responsive information management system. In fact, despite being situated in a wealthy suburb, the facility caters to the rich and the poor without discrimination. The same applies to the differences in spirituality in the institution, where despite 60% of the workforce ascribing to the catholic doctrines of Christianity, the department shares patient information without discrimination. However, spirituality seems to be a huge motivation for productivity. St Catherine's, where a majority of the workforce falls within the tents of Catholicism, performs better than St. Luke's, which was founded on spirituality but no longer observes spiritual tenets in the course of its history. Hickman performs poorly, and this could be attributed to its lack of spiritual grounds. 

Disability and racial disparities have been key issues of diversity that have impacted the quality and productivity at Hickman Hospital. The institution retained a non-credentialed acting manager and rejected a qualified applicant for the HIM manager's role because the applicant was African American and was disabled- not deemed fit to serve the Hickman community, which is predominately Caucasian. 

Mission and Vision 

St Catherine’s 

Mission 

St Catherine’s HIM department seeks to make all the patient health data available to them in the right formats, through the right channels, and at the required time to eliminate the possibilities of patient dissatisfaction with their health information. The department’s mission is, therefore, highly patient-centered. 

Vision 

The department’s vision of delivering health information to patients with utmost privacy and sensitivity is far from being realized, as evidenced by two instances of staff sloppiness. First, some staff at the facility disposed of papers containing patent information without having them shredded. Secondly, a majority of the staff also failed to log out of their computers while breaking for home. These simple acts of negligence are indictors that the staff does not make an effort to attain and maintain sensitivity and privacy when handing patients’ health information. 

St Luke’s 

Mission 

St. Luke's HIM department's mission requires that the organization shares accurate information with providers, residents, and staff within the shortest time possible. However, extended periods of time get wasted through the manual coding process, which implies that the department's practices are not aligned to its mission. 

Vision 

The department further fails to provide evidence of advancing towards its vision of promoting research through state-of-the-art HIM and technology. The slack is evidence in the current use of a first-generation EHR, which is antiquated and creates difficulty in communicating with other systems in the department. 

Hickman 

Mission 

The department's mission provides that it stays committed to the protection of patients' health information at all times. However, observations indicate a slack in attaining this commitment. The slack was particularly showcased when release-of-information clerk revealed of a psychiatric patient’s medical condition right in front of all other patients. 

Vision 

There is evidence of a stall towards the realization of the vision, which requires the firm to ensure that the patient information is secure. The organization relies on manual coding of patient data. Manual processes are error-prone and can be compromised by third parties. 

Unified Mission 

Develop a policy-based system that ensures observance of privacy in the handling of patient information. 

Unified Vision 

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

SWOT Analysis 

St. Catherine’s
Strengths  A richly diverse and inclusive workforce.  Has a strong record for employee retention, implying that vital employee talents are not lost.	Weaknesses  Poor staff discipline due to ineffective disciplinary measures  A certain percentage of employees lack formal education on health information management
Opportunities  The recent implementation of a new EHR to enhance the efficiency of information management.  Employing persons with physical needs	Threats  Recent pay cuts mean that the salary levels are lower than those of the competitors.  Low productivity after implementation of a new dictation system.

St. Luke’s
Strengths  Serves a diverse patient population  Easy accessibility due to its location within the city center	Weaknesses  The workplace is not diverse or inclusive, except in terms of age.  The EHR records are antiquated, leading to poor interoperability
Opportunities  A new supervisor to bring in a wind of a change in the management of the facility.  Ease of attracting new employees (although not retaining them for long enough)	Threats  High turnover rate leading to loss of good talents  The old-fashioned HIM system implies that it loses employees to competitors who are equipped with modern HIM tools.

Hickman
Strengths  Strong recognition at the community level due to its long-standing service provision.  Low employee turnover rate	Weaknesses  Does not value employee diversity and inclusion.  Old-fashioned HIM system
Opportunities  Initiating diversity practices following the recent rise in Muslim population visiting the facility.  Unity among the staff members	Threats  The facility is deemed non-compliant and can be closed indefinitely.  The staff is not AHIHA-credentialed, which lowers the hospital's reputation.

Unified HIM Department SWOT Analysis
Strengths  All facilities are geographically located within the same metropolis, which eases inter-facility commutation.  The combined total number of employees is satisfactory relative to the HIM needs.	Weaknesses  Disparities in implementing modern EHR technology.  Clash of principles regarding diversity and inclusion between the three facilities.
Opportunity  Opportunity to neutralize competition by synchronizing the quality of information management across the three different facilities	Threats  The differences in HIM systems can create new areas of management risks  High volumes of patient information can obscure the goals for patient information safety and quality.

Smart Goals 

Cultural Diversity 

Develop employee transfer programs between the three facilities to bring about workforce mixing. The same can be done through patient transfers 

Human Resources 

Encourage sharing skills and personnel across the three hospitals, which would lead to increased expertise 

Compliance 

Create a compliance enforcement team to preside over the compliance challenges in the institution. 

References 

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

Smith, C., Bowman, S. E., & Dooling, J. A. (2019). Measuring and Benchmarking Coding Productivity: A Decade of AHIMA Leadership.  Measuring and Benchmarking Coding Productivity: A Decade of AHIMA Leadership/AHIMA, American Health Information Management Association . 

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