MEDA 161 = 9, 4

Organizational Structure

chain of command

organizational chart

flow sheet that allows the manager and employees to
identify their team members and to see where they fit into the team.

The medical office manager
must be:

• multiskilled, multitalented
• able to prioritize a variety of issues
• juggle responsibilities
• communicate effectively with patients, staff, and physicians.

Important traits for manager:

•Flexible and honest/fair
•Positive role model
•Good communicator
•Good resource
•Supportive of management
•Well organized
•Able to focus on given task
•Able to resolve conflict
•Sees “big picture”
•Continuous learner

Responsibilities of the Medical Office Manager

o Communicating with patients, physicians, and staff
o Handling staffing issues
o Writing and revising policy and procedures manuals
o Developing promotional materials
o Handling financial concerns
o Handling office maintenance
o Managing supplies and inventory
o Ensuring that the staff receives appropriate education
o Maintaining budgets
o Enforcing HIPAA regulations and other accrediting agency regulations

Communicating with Patients

o Often must handle complaints and frustration
• Use diplomacy and patience
• Correct problem promptly

Communicating with Staff

o Staff meetings
o Bulletin boards in office
o Communication notebooks

Staff Meetings

Schedule at predictable time
Begin and end on time
Use agenda
Keep minutes
Hold in private area
Cover telephone calls with answering service or message
Have plan for patient emergencies
Make attendance policy very clear

Bulletin Boards

Allow employees to get quick, easy look at new polices or procedures; have them initial new messages
Make them attractive and well organized
Update regularly

Communication Notebooks

Two-way communication tool
Keep in staff lounge
Have staff initial new messages

Communicating Electronically

E-mail as an efficient method
Be sure to communicate positively on personal
level
o Thank you notes
o Recognition
o Birthdays/holidays

Writing Job Descriptions

Detail duties of every employee
Help in interviewing applicants and evaluating existing employees
 Each employee should receive a copy of his or her job description at the time of hiring and after any revisions to the description are made

Format for writing job descriptions

o Job title
o Supervisor
o Position summary
o Hours
o Location
o Employment requirements
o Physical requirements
o Duties
o Evaluation process
o Date written and dates of revisions

Finding applicants:

o Placement offices at local colleges
o Networking
o Employment agencies
o Newspaper classified ads

Application process:

o Types of questions — only job-related questions permitted (none related to age, sex, race, religion, or physical disability)
o Background checks
o Drug testing

Interview: Assess applicant’s ability to:

o Perform technical skills
o Treat patients in a caring manner
o Fit into your organization
o Communicate in a professional, friendly manner
o Remain flexible

Evaluating Employees (Performance appraisal)

Annual
Process should be positive for employee, if possible
Employee reads and signs — lists goals for upcoming year
New employees at 30 and 90 days

Taking Disciplinary Action

Good documentation essential
Verbal for first-time infraction — add note to employee file about verbal warning
Written for more serious and chronic problems — should be signed by employee
o Document can be used in firing

Terminating Employees

Must follow legal and other policies
Grounds for termination include:
o Excessive tardiness or absenteeism
o Inappropriate dress or behavior
o Alcohol or drug use
o Endangering patients
o Lying or stealing
o Falsifying medical records or time sheets
o Breaching patient confidentiality

Scheduling

Top priority — meet needs of office
Secondary — meet needs of employees
Must be done fairly
Requests for time off should be put in writing

Policy and Procedures Manuals

Required by regulating and accrediting agencies
Personnel manuals:
o Assist in orienting and training new employees
o Assist with current employee issues

procedure

a series of steps required to perform a given task; a medical service or test that is coded for reimbursement

policy

a statement that reflects the organization’s rules on a given topic

Types of Policies and Procedures

o Mission statement
o Organizational structure
o Human resources or personnel
o Quality improvement and risk management
o Clinical procedures
o Administrative procedures
o Infection control
o Safety measures
o Emergency preparedness

Mission Statement

a statement describing the goals of the medical office
and those it serves

Organizational Structure

Chain of command
How and when to contact various members of the team
Coverage for managers
Physician on-call policies

Human Resources or Personnel

Staff responsibilities
Benefits
Rules and regulations

Quality Improvement and
Risk Management

Who is in charge of QI
Steps for creating QI plan
Incident reporting explanation

quality improvement (QI)

plan that allows an organization to scientifically measure the quality of its product and service

Clinical Procedures

Tasks that involve patients
For each procedure:
o Infection control guidelines
o Patient education guidelines
o Instructions for documentation

Administrative Procedures

o Accounting and bookkeeping
o Appointment scheduling
o Collections
o Computer care and operations
o Insurance filings
o Medical records management
o Mail and postal machine operations

Infection Control

o Types of personal protection equipment available
o Biohazardous waste disposal
o Handling of various disease identities
o Handling of employee exposures and needlesticks
o Documentation required by the Occupational Safety and Health Administration (OSHA)
o Employee education for infection control

Emergency Preparedness

Information to be reviewed annually in order to prepare employees with assisting patients, coworkers and the
community if necessary during a disaster

Developing Promotional Materials

o Patient education
o Holiday and birthday cards
o Business cards
o Practice promotion
o Practice brochure

Financial Concerns

Budget: Purposes of budget
•Forces planning
•Causes managers and staff to become cost conscious
•Promote communication
•Helps organization achieve financial goal

Budget

financial planning tool that helps an organization estimate its anticipated expenditures and revenues

Operating budget

cost to run office
o Payroll
o Supplies
o Education
o Utilities

Capital budget

large outlays of money:
o Building maintenance or improvements
o Equipment

Risk factor

any situation or situation that poses a safety or liability
concern for given practice:
o Poor lighting
o Clutter
o Unlocked medication cabinets
identified through study of patterns

Risk management

is an internal process geared to identifying potential problems before they cause injury to patients or employees.

Liability Insurance

Doctors at risk for malpractice suits
o Must use sound practices to decrease risk
o Need malpractice insurance to protect from financial loss
Nurses and other allied professionals are now opting for coverage

malpractice insurance companies offer services

o Teaching preventative measures
o Identify problems before they become threats
o Conduct risk inspections
o Supply self-auditing tools
o Provide bulletins

Incident reports

a form used by an organization to document an unusual
occurrence to a patient, visitor, or employee

Reporting Occupational Injuries and Illnesses

Incident Reports
Insurance companies often require incident reports
Written by staff member involved or at scene of incident
Sent to central location
Hospital: goes to risk manager
Medical office: goes to physician or office
manager

examples of incident reports

o Medication errors
o Falls
o Drawing blood from wrong patient
o Mislabeling blood tubes or specimen
o Incorrect surgical instrument counts following
surgery
o Employee needlestick
o Workers compensation injuries

Information Included in an Incident Report

Name, address, and phone number of the injured party
Date of birth and sex of the injured party
Date, time, and location of the incident
Brief description of the incident and what was done to correct it
Any diagnostic procedures or treatments that were needed
Patient examination findings, if applicable
Names and addresses of witnesses, if applicable
Signature and title of person completing form
Physician’s and supervisor’s signatures as per policy

Guidelines for Completing an Incident Report

State only facts
Write legibly and sign name legibly
Complete in timely fashion
Do not leave blank spaces on the form
Never photocopy report for own personal
record
When in doubt, always complete an incident
report.

After incident reports are completed:

-Reviewed and tracked to highlight specific patterns
-Resulting date can identify problem areas
-Days of week when most events happen
-Common area for patient falls
-Medications routinely given incorrectly
-Age group most likely to have problems
-Reports should be kept in special file

Regulatory Agencies monitor medical practices to ensure

o Quality of care
o Protection of employees
o Sound practices

Regulatory Agencies challenge problem for risk manage=

preventing noncompliance with regulatory agencies

Regulatory Agencies rules and regulation change frequently:

o Stay up to date reading newsletters
o Attending meetings
o Visiting professional Web sites
o Most states publish monthly bulletin

Every regulatory agency's office should have legal counsel:

o Interpret legal issues
o Occupational Safety and Health Administration

Budget:

•Forces planning
•Causes managers and staff to become cost conscious
•Promote communication
•Helps organization achieve financial goal

budget

financial planning tool that helps an organization
estimate its anticipated expenditures and revenues

Operating budget=

cost to run office (small amounts):
o Payroll
o Supplies
o Education
o Utilities

Capital budget=

large outlays of money:
o Building maintenance or improvements
o Equipment

Risk factor

is any situation or situation that poses a safety or liability concern for given practice:
o Poor lighting
o Clutter
- Unlocked medication cabinets

Risk management

is an internal process geared to identifying potential problems before they cause injury to patients or employees.

Risk factors

are identified through study of patterns

Liability Insurance

Doctors at risk for malpractice suits
oMust use sound practices to decrease risk
oNeed malpractice insurance to protect from financial loss
Nurses and other allied professionals are now opting for coverage

Many malpractice insurance companies offer services such as:

o Teaching preventative measures
o Identify problems before they become threats
o Conduct risk inspections
o Supply self-auditing tools
o Provide bulletins

Office not just subject to liability
regarding patients:

•As public place, visitors could slip and fall
•Office manager should assess coverage needs of employees

Incident Reports

Insurance companies often require incident reports
Written by staff member involved or at scene of incident
Sent to central location
Hospital
Medical office
unsure, always make an incident report
manager

Hospital incident report

goes to risk manager

Medical office incident report

goes to physician or office

incident reports

a form used by an organization to document an unusual
occurrence to a patient, visitor, or employee

Risk management examples:

o Medication errors
o Falls
o Drawing blood from wrong patient
o Mislabeling blood tubes or specimen
o Incorrect surgical instrument counts following surgery
o Employee needlestick
o Workers compensation injuries

Information Included in an Incident Report:

Name, address, and phone number of the injured party
Date of birth and sex of the injured party
Date, time, and location of the incident
Brief description of the incident and what was done to correct it
Any diagnostic procedures or treatments that were needed
Patient examination findings, if applicable
Names and addresses of witnesses, if applicable
Signature and title of person completing form
Physician’s and supervisor’s signatures as per policy

Guidelines for Completing an Incident Report:

State only facts
Write legibly and sign name legibly
Complete in timely fashion
Do not leave blank spaces on the form
Never photocopy report for own personal record
When in doubt, always complete an incident report.

completing an incident report

State only the facts. Do not draw conclusions or
summarize the event.

After incident reports are completed:

o Reviewed and tracked to highlight specific patterns
o Resulting date can identify problem areas
o Days of week when most events happen
o Common area for patient falls
o Medications routinely given incorrectly
o Age group most likely to have problems
o Reports should be kept in special file

Centers for Medicare and Medicaid Services

 Division of United States Department of Health and Human Services
 Monitors and follows two key regulations:
o Clinical Laboratory Improvement Amendments Act (CLIA)
o Health Insurance Portability and Accountability Act (HIPAA)

CLIA

Clinical Laboratory Improvement Amendments Act

HIPAA

Health Insurance Portability and Accountability Act
(privacy)

Occupational Safety and Health
Administration (OSHA)

 Regulates health and safety concerns
 Requires QI programs be in place
 Mission is to save lives, prevent injures, and protect health of American’s workers

Examples of OSHA in health care

• Rules for bloodborne pathogen protection
• Personal protective equipment
• Tuberculosis prevention
• Management of biohazardous waste
• Ergonomic and laser protection
Make sure office has a poster posted prominently for
employees

The Occupational Safety and Health Administration (OSHA) and the Occupational Safety and Health (OSH) Act of 1970

guarantee your right to a workplace
that is free from serious hazards.

The Joint Commission

• was formerly the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)

JCAHO

 Before 1990 — primary focus was hospitals and nursing homes
 1996 — expanded jurisdiction to outpatient and
ambulatory care settings
 Change due to shift of patient care from inpatient to
outpatient
 Surveys and assigns accreditation title
 On-site survey

The Joint Commission

is a private agency that sets health care standards and evaluates an organization’s implementation of these standards for health care settings.

The Joint Commission time

Accreditation is good for 3 years

The Joint Commission

participation is voluntary for health care organizations; without accreditation, however, the health care organization may not be eligible to participate in particular federal- and state-funded programs, such as Medicare and Medicaid.

The National Committee on Quality Assurance

 Surveys and accredits 60% of all managed care organizations
 Mission — improve quality of health care
 New health care reform law connects to NCQA’s mission

Developing a Quality Improvement Program

Size and complexity depends on organizations needs
Emphasis of QI plans are:
Medical office and ambulatory care setting QI programs typically more informal

Emphasis of QI plans:

o Fall prevention
o Needlestick surveillance
o Laboratory contamination rates

Examples of quality issues that can be monitored in physician’s offices are:

 Patient waiting times
 Unplanned returned patient visits for same ailment or illness
 Misdiagnosed illnesses that are detected by another partner in practice
 patient or family complaints
 timely follow-up calls to patients
 Patient falls
 Mislabeled specimens
 Blood specimens that are coagulated or contaminated

Seven Steps for a Successful Program

 Identify problem or potential problem
 Form a task force
 Assign an expected threshold
 Explore the problem and propose solutions
 Implement the solution
 Establish a QI monitoring plan
 Obtain feedback

task force

a group of employees that works together to solve a
given problem

expected threshold

a numerical goal

Problems given top priority

are those that are high risk (most likely to occur) and those that are most likely to cause injury to patients, family members, or employee

Thresholds

must be realistic and achievable.

Safety in the Medical Office

Important to know safety measures
Have written plan for handling emergency situations
Also important to practice personal safety

Personal safety

It is important for you to recognize unsafe conditions, understand fire safety issues, and guide patients and
staff calmly in the event of an evacuation of the medical office.

OSHA identified these employee risk factors for body mechanics:

Force
Repetition

body mechanics:

using the correct muscles and posture to complete a task safely and efficiently

Ergonomics

the study of human physical characteristics and their environment to minimize the risk for injury through the use of appropriate equipment

Understanding and using principles of proper body mechanics and ergonomics can

help you avoid both short- and long-term injury as you carry out your routine medical assisting duties.

Force

—the amount of physical effort required to perform a task (such as heavy lifting) or to maintain control of equipment or tools

Repetition

—performing the same motion or series of motions continually or frequently

Following these basic principles when standing, moving, lifting, or reaching for objects may prevent injury:

• Maintain correct body alignment.
• Maintain a stable center of gravity.
• Maintain the line of gravity (close to your belly button).
• Maintain a strong base of support.