Published on February 23, 2014
2014 Clinical Documentation, Coding and Analysis Conference Enhancing the NSW Health Clinical Coding and Health Information Management Workforce Anita Jacobsen NSW Health Education and Training Institute HEALTH EDUCATION & TRAINING INSTITUTE
Health Education and Training Institute (HETI) Established in April 2012 as part of the new government’s changes to NSW Health governance Leads, coordinates and advocates for quality education and training for the NSW public health system One of 4 Pillars for Health Reform working with the Clinical Excellence Commission, Agency for Clinical Innovation and the Bureau of Health Information, as well as the Ministry of Health and all Local Health Districts and Specialty Hospital Networks Works closely with all other entities to ensure alignment of activities. HEALTH EDUCATION & TRAINING INSTITUTE
HETI’s Vision… “A world class NSW Health workforce supporting excellent patient centred care.” HEALTH EDUCATION & TRAINING INSTITUTE
Clinical Coding Workforce Enhancement (CCWE) Project - Background NSW Health – research and consultation dates back to 2009, project proposal endorsed in 2011 Responding to New Government priorities Health and Hospital Workforce Reforms Introduction of Activity Based Funding (July 2012) Clinical coding workforce needs Current and projected shortfall (AIHW, 2010) Hospital separations increasing Challenge of achieving a balance between quality & timeliness in clinical coding Technological developments (e-health reforms & e-MR) New skill sets required & new opportunities (remote coding) HEALTH EDUCATION & TRAINING INSTITUTE
Clinical Coding Workforce Census Data collection to guide the implementation of the Clinical Coding Workforce Enhancement strategies 1 July – 30 September 2011 NSW Local Health Districts (LHDs) and 3 specialty Networks provided information on: Clinical coding workforce profiles Vacancies Positions that could be created above establishment HEALTH EDUCATION & TRAINING INSTITUTE
Health Information Services Workforce Profile NSW Health Employee Headcount Position F/T P/T Temp Casual Total Health Information Manager Coding Manager Admin/ Coders 16 10 1 Filled Vacant FTE FTE Total FTE 19 Clinical Coders 132 129 Grand Total 180 141 3 19 3 20 7.8 9.5 2.0 11.5 3.8 11.8 4.0 15.8 21 2 27 13 13 HEALTH EDUCATION & TRAINING INSTITUTE % FTE 6.1 5.3 283 82.3 206.4 344 100 233.0 5.3 33.0 39.0 239.4 272.0
Coding education HEALTH EDUCATION & TRAINING INSTITUTE
Project objective: Enhance the NSW Health Clinical Coder & HIM workforce Strategy 1 • Recognise and develop the skills of existing clinical coding staff, to the national occupational standard Strategy 2 • Recruit and develop new entry-level clinical coders to the national occupational standard Strategy 3 • Increase the NSW Health HIM Workforce via professionally-recognised courses HEALTH EDUCATION & TRAINING INSTITUTE
Clinical Coding Workforce Enhancement Project development Scoping research and stakeholder consultation Evaluation HEALTH EDUCATION & TRAINING INSTITUTE Development and approval of project proposal Formation of representative project governance structures Implementation Development of appropriate implementation approaches
Clinical Coding Workforce Enhancement Project Governance Structures Project Steering Committee Strategy 1 - Strategy 2 – Working Party Working Party HEALTH EDUCATION & TRAINING INSTITUTE Strategy 3 – Scholarships Working Group
Strategy 3: Increasing the Health Information Management Workforce No degree course is currently offered in NSW No longer any natural flow of HIM graduates into NSW Health workplaces Identified industry needs: Solution to chronic shortages of HIMs, particularly in regional/rural areas Increased visibility of HIM career opportunities Education models – supported delivery via distance education Multiple pathways into HIM careers to capitalise on existing skills HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 3 – Supporting NSW Health employees to develop towards HIM roles Existing NSW Health nonclinical employee Existing NSW clinical employee Existing NSW Health Clinical Coder New Qualified HIM HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 3 – Qualifications to support multiple entry points Employee without relevant Degree/experience Employee with a relevant Degree/experience HEALTH EDUCATION & TRAINING INSTITUTE Bachelor of Science (Health Information Management) Qualified HIM - 3 years full-time Masters of Health Information Management - 2 years full-time Qualified HIM
Strategy 3 - Application process Application process opened in July 2013 for one month, requiring: Applicants to enrol in course Employer support for application Support from a relevant executive Merit-based selection process Impartial panel, with expertise in HIM, health reform and adult education Short essay questions HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 3 - Progress 23 applications received and considered by a panel with expertise in health information management, health reform and education 6 7 3 4 3 high scoring applicants – awarded scholarships met selection requirements, unsuccessful – did not meet selection requirements did not meet employment requirements could not show proof of enrolment Strong applications showed: Commitment to a career as an HIM Ability to balance education and employment understanding of the current and future needs of the system, strongly linking the role of HIMs HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 3 – Future Improving the process for future intakes Timeframes Target group Funding amount / number of scholarships Education providers Application process Obtaining funding for future scholarship processes Potential co-funding with LHDNs HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 1: Recognise and develop the skills of existing clinical coding staff In June 2012, 120+ health information service staff enrolled in the HLT43212 Certificate IV in Health Administration Generic qualification – aligned to the mid/senior clinical coder role through selection of electives Cohorts commenced in groups of 20-25, according to the capacity of the RTO Program structure: Recognition of current level of competence Development to next level of clinical coding skills Gap training for any areas remaining in qualification HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 1 - Progress Approximately 120 learners across NSW Completions to start in June Unique opportunity for professional recognition and development – ‘free’ training High level of enthusiasm among participants – particularly in relation to the recognition process Low withdrawal rate increasing interest Growing ‘learning culture’ Observed increase in staff’s knowledge and motivation, broadened outlook on functions surrounding coding HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 2: Recruitment and development of new entry-level trainee clinical coders Agreement to act 11 of 17 District and Network Chief Executives agreed to create 33 new 24-month trainee positions across NSW Many districts created positions above establishment Some recruited to existing vacancies Some unable to participate due to various pressures, hoping to be in a position to do so in future. Consistent state-wide recruitment process followed Common position description, interview questions & Aptitude test Common recruitment timelines HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 2 – the model 2 years temporary employment Supported traineeship – 80:20 rule Blended Education program Online learning Face-to-face or teleconference sessions Supervised workplace experience First 12 months in medical records department Second 12 months coding in the workplace Dedicated supervisor when commencing coding in the workplace Ongoing assessment Enhanced and staggered focus on medical terminology and medical science HEALTH EDUCATION & TRAINING INSTITUTE
Strategy 2: Funding support HETI and the NSW Ministry of Health Funded the education component through the RTO Small contribution towards new trainee salary for all newly created positions Locally-based Clinical Coding workplace supervision positions To support trainees in the workplace Commonwealth traineeship financial assistance Employer incentives for LHDs/Networks In some cases, funding to the NSW Health RTO Allowances to trainees HEALTH EDUCATION & TRAINING INSTITUTE
Strategies 1 & 2 – Impacts to date? Participation remains consistent Growing a learning culture in coding departments Re-energising departments or supporting change Improvement in quality of new entry-level staff Improvements to recruitment approaches for clinical coding generally Collaboration Higher expectations for education HEALTH EDUCATION & TRAINING INSTITUTE
Strategies 1 & 2 - Challenges Using Vocational Education & Training (VET) sector Adult learners – flexibility ‘State-wide’ program and variation between districts Change, change and more change Keeping our trainees/learners – and our trainers! HEALTH EDUCATION & TRAINING INSTITUTE
What next for the project? Sustainability – long term approach to coding workforce development is needed – there is no ‘quick fix’ Project --> Program: planning for sustainability Evaluation of training & workforce outcomes Overall impact Outcomes (once training is complete) Training to full qualifications to remain on the NSW Health RTO’s scope of delivery Aim: To source ongoing funding to continue to deliver outcomes for the workforce. HEALTH EDUCATION & TRAINING INSTITUTE
What next for clinical coding education? Employers must become informed purchasers education of Demand quality outcomes – job-ready workers Support for adult learners Appropriate, effective learning and assessment modalities Encourage more competition Contribute to review of the national qualifications second Draft is due for release in coming days. the Imperfect qualifications Only informed feedback will improve them Question – how closely do these qualifications reflect the work roles/functions of my clinical coding staff? www.cshisc.com.au – from 1 March until mid-April New directions? HEALTH EDUCATION & TRAINING INSTITUTE
Recommendations for addressing clinical coding workforce needs Improve recruitment practices – test, test, test! Restructure and redesign – think broadly about potential scope of destination roles for clinical coders – or risk losing them all New directions? Advocate: Investment is critical Sustainability – advocate for a long term approach to coding workforce development – there is no ‘quick fix’ Speak up - Keep articulating the need and advocating for this ‘critical link’ in Activity Based Management. HEALTH EDUCATION & TRAINING INSTITUTE
Thank you Anita Jacobsen, Senior Program Officer Education Strategy & Implementation email@example.com HEALTH EDUCATION & TRAINING INSTITUTE
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