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  • Michael Jones
  • January 09, 2019 02:18:33 PM
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A Little About Us

Healthcare Career Resources is a blog for those who work in the healthcare industry. We cover topics ranging from current events to medical humor as well as more career focused topics such as job search and interview tips. We also publish articles written for healthcare human resources and physician recruiters.

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    Mergers & Acquisitions: Blending for Success

    Merger and acquisitions, in Health Care especially, are not going anywhere anytime soon. As laws and regulations continually change and strengthen within the industry, more and more companies will use this tactic to remain successful. However, a merger or acquisition cannot be successful without due diligence, open and honest communication, and the appropriate blending of the two organizations’...

    The Role of Human Resources in Mergers & Acquisitions
    Leo Wolfert/123RF.com

    As mergers and acquisitions become more and more common, it is important to understand best practices to ensure success. Culture and communication are two critical gauges of success in any merger or acquisition. If either side is missing, there is a strong chance the merger or acquisition will ultimately fail. Human Resources should be a key player in the merger or acquisition from the very start.

    Due Diligence… Due Diligence… and more Due Diligence

    A critical aspect of a successful merger or acquisition is due diligence. This involves a deep dive into the acquiring company – review of financials, understanding of staffing, transparent conversation on pain points and successes. By doing the initial investigation up front, the risk of coming across liabilities down the road decreases immensely.

    It is imperative that Human Resources be included in discovery from the start. This will better assist in assuring a smooth merger of culture and people. Human Resources can also dig deeper into any potential employee relations issues, such as EEOC or Labor Board claims against the merging company. Human Resources will also be able to assess potential obstacles in regards to merging cultures between the organizations and staff feedback on both sides regarding the possible merger or acquisition.

    Communication & Transparency

    So, you have decided to move forward, now what? While the legal side of the merger pushes forward, leadership must remain transparent on both sides. Leadership teams from each organization should frequently meet to ensure they are on the same page and relaying the same information to their staff. The acquiring organization must be careful not to force their culture down the other company’s throat. Allow the staff to share their likes and dislikes about the current situation and blend processes, cultures, and ideas as much as possible for the maximum buy-in.

    It is almost a guarantee that staff will be apprehensive regarding the merger. They may have questions relating to how their role might change, if they will have growth opportunities, any potential changes to their compensation package, etc. This is when it is most important to communicate openly, frequently, and as a team to address these areas of concern. A good idea is to highlight potential opportunities for personal development and growth as the merger is established. Also, ensure that staff is clear as to what their roles and responsibilities will be both during and after the merger.

    Culture Blending

    As mentioned above, blending the cultures of both organizations is the key to ensuring long term success. According to SHRM, 70-90% of mergers and acquisitions fail based on Human Resources related areas, such as culture issues, loss of key talent, and lack of communication. Human Resources should play a vital role in ensuring this does not happen. Don’t be afraid to implement new ideas or processes during this time. Maybe the merging organization allows their staff to wear fun scrub tops on Fridays, and the staff looks forward to that; why ruin morale over something that staff in the acquiring organization might enjoy as well?

    One interesting method of blending cultures between organizations is to implement a buddy system. Pair staff with members of the other organization to not only assist in building relationships but also to create a sense of appreciation between the organizations. As the teams can see what the other side is working through and that they have similar end goals, the cultures are slowly blending as well. This type of buddy system can be implemented from the leadership team down to the line level employees to ensure successful relationships are being formed.

    Why are Mergers and Acquisitions so popular in Health Care?

    Health Care is an industry that has seen significant growth in the number of mergers and acquisitions taking place. In fact, it is the preferred growth plan for 44% of Health Care Executives. Why has this trend increased so much over the last few years? According to the article ‘Mergers and Acquisitions in Health Care – Who Benefits?’, high regulations in the industry, specifically in hospitals, can make it difficult for smaller organizations to be successful. When these small organizations merge into a larger one, they create a buffer to the volatility of regulations and increase their chances for continued success.

    Merger and acquisitions, in Health Care especially, are not going anywhere anytime soon. As laws and regulations continually change and strengthen within the industry, more and more companies will use this tactic to remain successful. However, a merger or acquisition cannot be successful without due diligence, open and honest communication, and the appropriate blending of the two organizations’ cultures. Human Resources is vital to ensuring these steps are addressed and handled appropriately, providing the best chance for success.


    How Nurses Can Prevent Injuries and Keep Their Backs Healthy

    Although caring for your patients is usually your first thought, don’t neglect your own well-being. Injuries will not only interfere with your career, but an injury can also adversely affect your entire life. Take precautions and be diligent about protecting yourself from injuries. Remember, taking care of yourself helps you to be there for your...

    How Nurses Can Prevent on the Job Injuries
    Tyler Olson/123RF.com

    Few things can sideline your nursing career faster than an injury. Nurses that work on the frontlines of patient care in hospitals are especially at risk for injuries. According to the Occupational Health and Safety Administration (OSHA), injuries on the job occur more often at hospitals than construction sites.

    Nursing injuries on the job can result from falls, needle sticks, and even assaults. But by far, the most common injury is due to overexertion. According to the United States Department of Labor, Bureau of Labor Statistics, in 2016, 45% of injuries to nurses was due to overexertion.

    Common Injuries on the Job  

    The back is the most frequently injured area of the body for nurses. According to OSHA, strains and sprains are the most common type of injury, especially to the low back.

    Overstretching the muscle fibers can lead to a pulled muscle. Repetitive injuries can also occur. Repositioning patients, moving equipment, and being on your feet all day, can take its toll. Repeating these actions multiple times a day, day after day, can lead to chronic problems, such as sciatica pain, bulging discs, and osteoarthritis.

    Back injuries at work can have significant consequences. Injuries can lead to spasms, pain, and decreased range of motion. Discomfort can be severe enough that it makes regular movements difficult. In some cases, an injury can lead to extended time off from work. If you can work, chronic pain can have a negative effect on your job performance and morale.

    Why Work Injuries Occur in Nursing

    Work injuries can happen for several reasons. Some factors that contribute to workplace injuries are patient-related. For example, the obesity rate has increased in the United States, which means nurses may be caring for more patients that are larger.

    Patient workloads have also increased in some hospitals. Increased workloads might cause nurses to neglect practices that are time-consuming. For example, instead of getting the proper lift equipment to move a patient, a nurse might manually move the patient because it is quicker.

    Trying to lift or reposition a patient on your own can also lead to injuries, but even if you get help lifting, it sometimes is not enough. Lifting with helpers does take some of the weight off of you, but the weight is not distributed equally, which is still not ideal.

    Preventing Work Injuries 

    As a nurse, you are used to taking care of others, but it’s essential to also take care of yourself to avoid injuries at work. Fortunately, there are several things you can do decrease your risk of work injuries, including:

    Using proper body mechanics: While it’s ideal to use the right equipment when transferring or lifting a patient, it’s sometimes unavoidable to move a patient without a lift. Make sure you raise the bed to a comfortable position, lift close to your midsection, and avoid bending at your back. Maintaining the spine in a neutral position when bending involves hinging forward to keep the back straight.

    Getting help: If you need to move a patient, get the help of a second staff person. It might take an extra minute to locate someone, but if it is not a life-threatening situation, it’s worth taking a little extra time to keep yourself safe from injury.

    Utilizing the lift team: Many hospitals have a lift team in place to assist with patient care. The lift team is trained to move and transfer patients. When possible, use the lift team at your facility.

    Maintaining an ergonomically correct workstation: Whether you’re charting, putting in orders, or reviewing medical histories, nurses spend a reasonable amount of time in front of the computer. Make sure your workstation is set up correctly. Sit up to keep your spine straight. Your knees should be at hip level when sitting. Your computer monitor should be at eye levels to prevent neck strain.

    Using the correct equipment: Your best bet to avoid injuries is to use lift equipment provided by your facility. Even small hospitals usually have patient lifts, such as motorized ceiling lifts, portable lifts, and sit-to-stand lifts. Although designs may vary by manufacturer, lifts are designed for transferring patients from one place to another, such as from the bed to the chair.

    Keeping your back healthy: A strong, healthy back is less likely to become injured. Exercising regularly not only strengthens your back, but it also helps you maintain a healthy weight.  Being overweight places more strain on your back. Also, see your doctor for routine checkups to detect problems before they become more serious.

    Although caring for your patients is usually your first thought, don’t neglect your own well-being. Injuries will not only interfere with your career, but an injury can also adversely affect your entire life. Take precautions and be diligent about protecting yourself from injuries. Remember, taking care of yourself helps you to be there for your patients.


    Nursing Jobs available at HospitalRecruiting.com


    Six Ways Healthcare Employers Can Support Working Mothers

    Healthcare employers may be in a unique position to offer some of the support and services working mothers need. Here are 6 ways healthcare providers can help.

    Six Ways Healthcare Providers Can Support Working Mothers
    faithie/123RF.com

    As the market for top talent continues to shrink, healthcare workers are in a stronger position than ever to find a facility that meets their personal and professional needs. Healthcare is already one of the most flexible workplaces, with hours and shifts that can accommodate most. But for working mothers, employers can to go beyond scheduling to help women find better support and longevity in the workplace.

    The working mother labor force

    At almost half the US labor force, women at work are driving employment in healthcare and almost all other fields. But as their numbers rise in the workforce, so does the amount of time they devote to caring for their children. Recent statistics show the average mother, beyond her responsibilities on the job, devotes an additional 14 hours per week to family responsibilities.

    It’s estimated 70% of mothers with children under 18 are part of the workforce. Of that group, 75% work full-time. In addition, mothers are the primary or sole earners in 40% of households with children under 18. Working mothers whose employers help them balance their personal and professional roles and responsibilities are likely to see happier, engaged employees and higher levels of retention.

    Supporting working moms

    Healthcare employers may be in a unique position to offer some of the support and services working mothers need. Here are 6 ways healthcare providers can help.

    Welcome nursing mothers

    For mothers of newborns, lactation areas offer the privacy and time needed to express for their child. Beyond the legal requirement to allow for breastfeeding, mothers, children, and healthcare facilities benefit. Recent data shows mothers with access to lactation on the job miss work less often. Their babies are healthier overall, which can lower healthcare costs. A two-year study revealed significant savings in healthcare costs and a reduction in absenteeism.  Access to lactation consultants, who may be on staff, put healthcare providers ahead of the curve when providing support for nursing mothers.

    Offer stress management

    Healthcare employees work in a stress-heavy environment. For new and established mothers, the pressure of work/life balance can sometimes become overwhelming. Access to stress management training and techniques can help mothers in times of need and can benefit the institution. Reduced sick days, higher engagement, and commitment to the facility could be the result of offering avenues to learn how to manage and minimize stress, whether personal or professional. Again, many institutions have staff on hand who can be of assistance to offer advice if access is provided. For those who don’t, external resources are available to help workers find balance.

    Provide financial wellness assistance

    Mothers juggle a host of responsibilities, but financial issues can be a stress-inducing challenge. Access to financial wellness training and advice can help support new moms in transition through mothers planning for college, and almost everyone in between. For mothers who have student loan debt, are looking to buy a home, or even planning their long-term retirement strategy, financial wellness programs are becoming a much asked-for benefit for employees.  Outside resources are readily available, some through an institution’s 401(k) planner.

    Offer support groups

    Your facility may be rife with working moms looking for help, advice, or a place to vent. Support groups within the facility, organically created by mothers, or developed by the institution itself, can be a valuable resource. These groups can meet regularly to share tips, talk about solutions, and create a sense of camaraderie. Facilitators who may be on staff can help the group work toward positive outcomes and solution-driven discussions.

    Make sure moms have time for self-care

    New mothers particularly are keeping dozens of balls in the air simultaneously. As they transition back to the workplace after leave, or when family pressure shifts priorities for any mother, institutions can provide a bit of respite. Make sure managers require staff to take their lunch and break times – a breather not only revitalizes, it demonstrates you value every worker and her contribution. Remind staff that there are resources available to help them over a rough patch, or for long-term goals and planning. As many offerings as your institution may offer, they’re only worthwhile if employees utilize them. Managers who model positive behaviors (like not eating lunch at their desks) help staffers see self-care is a priority.

    Leverage flexible scheduling to mom’s advantage

    Again, hospitals are in a unique position to allow mothers flexibility when it comes to scheduling. Some moms may need a reduced schedule to balance work and family; others may be looking at shift or day changes. For hospitals and larger healthcare providers, this can be an easy fix. For smaller institutions, part-time hours or job-share opportunities can be the difference between losing talent or retaining them until priorities readjust.

    Healthcare providers can provide support and resources for working mothers in a variety of ways. All it takes is some planning and a commitment to assuring these valued contributors have what they need to balance work and family.


    Why You Should Take a Second Look at Healthcare Job Boards

    ...On the other hand, when you apply to a job via a job board, you show that you’ve put some thought and commitment into choosing it. Additionally, you will be able to tailor your CV and cover letter to that position, showcasing your sincere desire to pursue and accept the job. As some recruited applicants who only review the opportunity after being presented may not follow through, this gives the employer more security that you genuinely want the...

    Why You Should Begin Your Healthcare Job Search with HospitalRecruiting.com
    ferli/123RF.com

    For the average Dr. Jones, starting a job search can seem like a monumental undertaking. Regardless of whether you are fresh out of medical training, looking to expand your clinical responsibilities, or hoping to cut back on practice hours, making the most of your job search can seem like a hit or miss. To become more effective, you’ll need to hash out the details of your dream job, manage your personal and professional commitments, and highlight your unique skills and knowledge base in your chosen field.

    Using job boards might be an easy way to reach your job search goals. Read on to figure out if you should give them a second look.

    Job boards have a wider variety of job opportunities

    Job boards are known for their diversity. It’s the cheap(est) option for hospitals, large multispecialty groups, and other employers to advertise the jobs they most need to be filled. With the physician shortage expected to top 120,000 in a decade, these employers are eager to get their positions filled, and they will aggressively advertise on job boards. If you don’t have access to these and you are actively looking for a new opportunity, then you are shortchanging your search and denying yourself access to a stream of ideal opportunities.

    Some smaller practices may not have the overhead to afford recruiters, meaning that you will never see the opportunities if you don’t peruse the job boards. Alternatively, some employers may feel that they don’t need to spend money on recruiters because they are casting a wide net or have highly desirable characteristics such as a prime locale or a handsome recruitment package. As such, they may choose not to use recruiters, leaving you out of luck if you don’t get familiar with job boards. Finally, some recruiters only work with specific hospitals or hospital systems, and so they won’t have access to the breadth of opportunities in your field. 

    Job boards have no hidden agendas

    Job boards are the great equalizer, ensuring that all candidates start on an even playing field; candidates stand out only based on their professional merits. When you outsource your job search, you may be unaware of hidden fees or agendas associated with a “middle-man.” Recruiters may not offer you specific jobs because they feel that they are not the right fit for you, which may or may not be correct in your circumstance.

    Additionally, when you work with a recruiter, you may be at a slight disadvantage. Although recruiting firms work hard to place you, they come with a hefty price tag for employers. Often when a recruiter fills a job, the employer has to pay recruitment placement fees that can total more than $30,000 K per physician.

    Of course, this does mean that recruiters are very motivated to get the job filled. Still, employers will compare the recruited physician to a potential employee who comes without any additional fees via the job board. As such, when it comes down to equally strong candidates, a physician applying through a job board often will have the upper hand.

    Alternatively, the physician who gets hired via the recruiter may see some of his/her earning potential decrease to cover the recruitment fees. This may mean a diminished (or even absent) signing bonus or other perks of the job.

    You’ll stay in the driver’s seat

    When you choose job boards, you maintain control of your job search. You know which opportunities you present to and which employers have your resume and contact information. If you are keen on managing each part of the application process and have the time and organization to do so, this is crucial for an optimal experience.  When you rely on a recruiter or otherwise outsource your job search, you are dependent on someone else (for better or worse) on driving your progress forward. With job boards, there is no middle-man— you can contact the hiring manager, set up interview and progress at your pace. If this is appealing to your application style, then job boards may be the better choice for you.

    Guiding the process can be especially important if you have certain restrictions, such as location, that would make it more challenging for a recruiter to deliver the breadth of options that are specific to your need. For example, if you know you can only work in a particular town or region, job boards are for you, as you will find the lion’s share of local opportunities, while a recruiter may have access to only a small sampling.

    You’ll show future employers your drive and commitment

    Employers know that potential employees presented via recruiters are encouraged to apply to opportunities hand-picked by the recruitment firm that may be a good— but not perfect fit— for the candidate. “Enthusiastic” applicants who sign up with multiple recruiters may even be presented numerous times, indicating that they are not sufficiently involved or aware of the range of positions to which they are applying.

    On the other hand, when you apply to a job via a job board, you show that you’ve put some thought and commitment into choosing it. Additionally, you will be able to tailor your CV and cover letter to that position, showcasing your sincere desire to pursue and accept the job. As some recruited applicants who only review the opportunity after being presented may not follow through, this gives the employer more security that you genuinely want the job.

    Physician recruiters can be invaluable allies in your job search, as I’ve discussed here. Moreover, they provide an ideal pathway for many physicians, especially those who have unique circumstances like gaps in clinical practice or who require specific practice settings. On the other hand, job boards are ideal for active job seekers who want to keep in control of their search and are focused on a specific region or city.

    Job boards are a great resource that you can’t afford to miss. Have you given them a fair chance?


    What Emergency Medicine Physicians Want from Recruiters

    It’s time to get over the antagonistic relationship a lot of doctors have with recruiters and get to a point where we can help each other. Ultimately, it can only benefit us both to have higher quality interactions...

    What ER Doctors Want from Recruiters
    Mark Bowden/123RF.com

    As an ER doctor, I’ve worked with plenty of recruiters.

    Emails, phone calls, LinkedIn messages and *cringe* texts, offering me “exciting opportunities” and “a chance for work-life balance”.

    I empathize with recruiters because there’s a significant overlap between our jobs: We both have to call people we’re not well acquainted with and try to get them to work more. 

    You’re trying to get people to pick up a few more shifts (or switch jobs completely). I’m trying to get an internist to admit a patient for social reasons at 3:00 a.m.

    These are equally challenging spots to be in!

    Spots that could learn a lot from each other. It’s time to get over the antagonistic relationship a lot of doctors have with recruiters and get to a point where we can help each other.

    Ultimately, it can only benefit us both to have higher quality interactions.

    Honesty

    It’s not an “exciting opportunity”, “a great career change” or a “chance for work-life balance.”

    It’s work.

    And there’s nothing wrong with work. Emergency physicians are a group that like to work hard; we picked a physically, emotionally, and intellectually demanding specialty. Job opportunities aren’t a foreign notion that needs to be eased into.

    By the time we’re being recruited, we have insight that the grass isn’t greener on the other side, even if it’s presented that way. The real question is: What work are you offering and how much would I want to be paid to do it? 

    I’m going to determine if the work can be balanced with my life and whether this is a great opportunity. What I need to know are the details to help me figure those questions out.

    Call it what it is and lets move forward.

    Direct, clear speech

    Emergency physicians spend years of training learning how to gather and present immediately useful and relevant information. Information that’s actionable.

    We’re looking for the meat.

    So when you’re cold-calling an emergency physician, it makes sense to speak that language. The content of your language may be about a job but the gold is in the way it’s delivered. Focus on the meat, speak directly and say what you mean.

    Also, it isn’t advisable to make your initial contact by text. It can be seen as too informal. If an unknown number pops up and says “Hi, This is Chris from Doctor’s Recruiters, are you interested in a few more shifts?” one thing is for sure: Doctor’s Recruiters doesn’t understand its audience and I probably won’t like working with them.

    Texting is convenient for some things—so if we talk and I’m interested in moving forward with a job, ask what my preferred method of communication is. Like anyone else, you prefer some methods of communication for certain things because it lets you triage when you’ll respond.

    Same thing here, just ask first.

    Specifics about the hospital and its community

    What is the actual name of the hospital?

    It’s always suspicious when I hear about the great stuff happening in the same region as a hospital but no one will tell the name of the facility. It would be better to say “General Hospital, 20 miles south of Omaha” than “A community hospital near the bustling Omaha nightlife!”

    It makes it sound like you’re hiding something.

    We work in a range of facilities by the time we’re done with medical school and residency. The chances are that we have experience in a facility like the one you’re representing. When a recruiter describes a hospital, the first thing I’m thinking is “Oh, this place is like Hospital X. I liked it there/didn’t like it there. I could see myself working there again/never in a million years.”

    If you work in enough ED’s, you realize that they just have different proportions of the same patients. Geriatrics, trauma, pediatrics, drug seekers.

    They also have different proportions of the same problems. This one has a cath lab, that one doesn’t. This one has great culture with a few malignant people, that one has tons of malignant people and a few great ones.

    Same problems, different proportions.

    When I talk to a recruiter, I’m trying to figure out what proportion of patients and problems I’m going to be dealing with. It’s the ability to picture myself working in a facility that informs my initial yes/no decision when being presented with a job opportunity.

    This is supported by understanding the community it serves and solidified with information discovered when researching the actual facility.

    Specifics about how well the hospital functions

    The ED is the canary in the coal mine.

    When the hospital fails, it backs up into the ED. I want insight into how much time I will spend managing hospital issues versus being an ER doctor.

    Throughput metrics help tell this story. What is the Left Without Being Seen (LWBS) rate? What is the door to provider time? What is the average length of stay in the ED? How much boarding is there?

    There is a wealth of information about these metrics online, but the idea is the same; they’re vital signs for the hospital. If you tell me that an ED has 30K visits/year but an 8% LWBS rate and a 6 hour length of stay in the ED, there’s a major problem.

    What you’ve communicated to me is that the ED is congested, I’m going to be boarding a ton of people, will probably wind up seeing people in the hallways or in odd physician roles. Even though these issues aren’t inherently ED issues, they frequently become ours to solve.

    Many ED’s have these problems, it’s part of working in an ED. But knowing these numbers gives me a sense of how burdened I will be and helps paint a picture of what my days would be like.

    Also, a recruiter knowing this communicates that they understand the industry.

    Specifics about the ED and job itself

    The basic vital signs of the ED are what you typically see in the ads. Patient volumes, shift lengths and times, APP coverage, admit rates, and what services are available are expected information.

    When I hear this information, I’m doing calculations to get a sense of what my day would look like. For example, a recruiter tells me that there are 30K visits/year, 24 hours of doctor coverage in two twelve hour shifts, 12 hours of APP coverage and a 15% admit rate.

    There’s no cath lab, no GI services.

    I take this information and break it down to see what my day will look like.

    30K/365 days per year = 82 patients per day.

    82 patients per day divided by 24 hours of doctor and 12 hours of APP coverage (each APP hour is about 0.5–0.8 of a doctor’s hour), means I’ll be seeing about 2.5 patients/hr or about 30 total in a shift. I’ll admit 4 to 5 of them.

    You’ve also told me that I will be likely transferring out heart attacks and GI bleeding, these are probably not represented in the admission rate.

    That’s how I look at this information, it gives me a very clear sense of what my days would be like. I take these calculations, put them in the context of the locale described and think: OK, what would I have to be paid to work there? 

    This question is never answered satisfactorily with the phrase “Competitive pay.”

    If it were awesome pay, it would be your opening line, right? You wouldn’t hide $500/hr!

    So say it up front, it pays $X/hr with an RVU bonus, therefore averaging $Y to $Z/hr. Eventually, we’re going to gain this information either way, so be clear and direct with it.

    The dollar amount doesn’t take the deal off the table. I may be fine with lower pay because I want a slower ED than the one I’m in or I simply want a change. This information only answers the question of what it would be worth to put myself in that situation.

    Specifics about the staffing

    This also paints a picture, these are my future colleagues, people whom I have to assume care from and work with.

    Questions I’m going to have about the staffing will be:

    Why are there holes in the schedule? Is the ED expanding, or can they not keep providers? Did someone retire or quit? What’s turnover like there?

    When are the holes in the schedule? Nights? Weekends? Holidays? How can I be assured that I won’t get a disproportionate amount of undesirable shifts?

    Who makes the schedule?

    Who makes up the staff? Are there lots of locums? Are there many physicians who aren’t boarded in emergency medicine?

    What’s the administrative structure like? Tell me about the medical directors. Can I meet them or set up a time to talk with them?


    Overall, you’re painting a picture—the better you can make it, the more likely I am to see myself working in it.

    As a final point, physicians can be challenging to work with. Getting a phone call from a recruiter is a sign of job security. In our economy, anyone who has strangers throwing work at them should be grateful, not irritated!


    Medical Scribes – Benefits and Challenges

    Scribes may improve the overall quality of documentation. It can be more detailed, comprehensive, and available quickly. Improved documentation in turn can be used to achieve “meaningful use” EHR Incentive Program criteria and improve compliance with quality monitors, billing, and...

    Considerations for Using Medical Scribes in Physician Practices
    auremar/123RF.com

    The advent of electronic health records (EHRs) promised improvement in patient care: no more wading through thick charts, test results, or letters from consultants. No more wondering when dictations would be available. The real bonanza would be the almost instant exchange of vital information between care providers and institutions – possibly delaying disaster.

    Instead, EHRs have decreased face-time spent with patients, replaced by time-consuming data entry. It’s a distraction to both physicians and patients. No bonanzas.

    EHRs have, however, birthed an entirely new healthcare job category – medical scribes. Scribes, some claim, can provide many benefits to the practice of medicine, ultimately affecting the overall quality of healthcare delivery.

    The Joint Commission defines a medical scribe as an unlicensed individual hired to enter information into the electronic health record (EHR) or chart at the direction of a physician or licensed independent practitioner. Scribes work within physician practices, hospitals, emergency departments, long-term care facilities, public health clinics, and ambulatory care centers. They are employed by healthcare organizations, physicians or other licensed independent practitioners, or work as independent contractors. This blog addresses some of the benefits and challenges of scribes within the physician practice setting.

    Roles and Responsibilities of the Medical Scribe

    Scribes accompany providers into the exam room and enter information in real time. A scribe’s core responsibility is accurate, detailed, and timely documentation of patient encounters. Scribes don’t make independent decisions or translations when entering information into the HER, except as the provider directs. Scribes help the provider navigate the EHR, locate information, respond to messages as directed, and research information at the provider’s request.

    The scribe’s role should be clearly defined and communicated, with documented job descriptions, policies, and procedures. It’s important to have a signed agreement between the provider and the scribe with clear expectations and accountability.

    Legal Considerations

    A scribe’s responsibilities are ultimately controlled by the regulatory requirements and policies established by a healthcare setting, and the level of risk an employer is willing to accept. Practices must monitor federal, state, and regulatory changes to ensure their practices consistently meet compliance with standards.

    Scribe Documentation Guidelines

    The Joint Commission, in 2011, released guidelines to help regulate the use of scribes. These guidelines were updated in May 2019: https://www.jointcommission.org/issues/article.

    Third party payers may have specific guidelines for how a scribe documents and how the electronic signature is applied. Each facility or practice should contact third-party payers for their requirements.

    Common Documentation Duties for Medical Scribe

    Examples of information entered by a scribe may include, but are not limited to:

    • Name of the patient
    • Date and time of service
    • Name of the provider
    • History of the present illness
    • Review-of-systems
    • Medication lists
    • Physical examination, including vital signs
    • Lab values and results of imaging studies
    • Progress notes
    • Continued care plans
    • Indication of the involvement of a scribe

    The provider is ultimately responsible for the documentation. A provider’s note should indicate:

    • Affirmation of the provider’s presence during the encounter
    • Verification that the information was reviewed by the provider
    • Verification of information accuracy
    • Additional information, if indicated
    • Authentication of date and time

    Benefits Include Freeing Physicians from Data Entry

    Scribes capture medical information at the point of care which allows the provider to focus on bedside manner and provide attentive, face-to-face care that increases both patient and provider satisfaction. They can reduce the documentation time needed by the provider during a visit. The use of scribes can increase provider morale by reducing the number of clerical tasks and resulting stress while learning ever-changing systems.

    A patient may perceive visits negatively if the provider spends most of her/his time looking at a computer monitor instead of the patient. A scribe can enter information into the EHR without intrusion, allowing the provider to focus more on the patient. Efficient clinical workflow may enable providers to see more patients rather than spending valuable time documenting.

    Scribes may improve the overall quality of documentation. It can be more detailed, comprehensive, and available quickly. Improved documentation in turn can be used to achieve “meaningful use” EHR Incentive Program criteria and improve compliance with quality monitors, billing, and reimbursement.

    Cost, Workflow Challenges

    Adding medical scribes to a system creates challenges that must be considered and managed carefully. These challenges include:

    • Scribes in the exam room may cause patients to be less forthcoming with pertinent information for accurate diagnosis and treatment, affecting the overall quality of care.
    • Documentation workflows and responsibilities need to be redefined and responsibilities identified to streamline the process.
    • Provider verification of scribed documentation for accuracy may slow overall workflow.
    • If the scribe is inexperienced using medical terminology and in clinical workflow, documentation errors may lead to problems such as increased costs, increased turnaround time, and billing and medical errors.
    • Some providers may not review scribed entries for accuracy before authentication, increasing the possibility of errors. These errors can affect treatment plans, coordination of care, coding, billing, and other documentation requirements.
    • The provider may not be able to generate additional revenue to offset the expense of the scribe.
    • When a scribe is not available, providers may not be able to navigate the system effectively and efficiently.

    Patients should be introduced to the position of medical scribe, and be advised that scribes may allow more interactive time with their provider. Some patients may not want an additional individual in the room while they are examined or when discussing sensitive medical information. Patients have the right to refuse additional staff (e.g. scribes, residents) in the exam room.

    Regardless of the practice type or size, the decision to use a scribe is significant, and must be carefully defined, managed and monitored. There is one certainty:

    Providers must remain connected to all patient information.

    American Health Information Management (AHIMA), www.ahima.org, is an important resource that provides information, resources, and tools to advance health information professional practices and standards.


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