Organisational – Case study

The assignment involves the critical analysis of a case-study. Your answer should be in essay format and of approximately 3,000 words in length. The assessment will test your ability to:

• Analyse a case-study
• Comprehend and assimilate of different models and theories
• Show evidence of an ability to critically analyse and compare
• Develop a logical argument and line of reasoning and present that in a cogent and effective manner
• Construct and develop a logical and supported argument
• Offer realistic and practical solutions to organisational problems

CASE STUDY: THE ANERSLEY HOSPITAL

Background
Anersley Hospital is a long-stay psychiatric and geriatric hospital of some 600 beds which is located on an extensive site in a suburb of a large town. Many of the buildings are quite dated and there are several buildings constructed from metal and wood that date back to the Second World War. During the last three years the hospital has become the central point for all psychiatric services for the town and the surrounding area. This has happened as smaller units have been closed down as part of a plan to rationale and centralise the service. The total number of beds available however has declined as more patients are treated on an out-patient basis. These out-patient clinics have become a more important part of what the hospital does and new facilities have been built to cater for the significant increase in out-patients.

The Medical Records Department
Due to the rapid and somewhat erratic expansion of the hospital, the departments and facilities are sited in a rather unplanned manner. This lack of a clear structure is perhaps best illustrated by the Medical Records Department . The Medical Records’ Filing Section was situated in one of several wooden huts at the end of a long corridor in one of the outer wings of the building. Most of the other huts were now used for storage. Although the hut was quite run down, staff had tried to personalise the building by putting up colourful posters as an attempt to personalise the Department. There was even a hand written sign saying “The Shack” above the door of the hut. Most of the office furniture was rather dated and didn’t match.

The function of the Records Department has changed significantly in the last few years. Previously it had been little more than a storage facility. Medical staff would make notes on each patient and these would then be placed in folders, and the folders stored in boxes on long shelves. Notes could then be found by consulting a well-worn card index. While in theory the notes were the responsibility of the consultant, there were also notes from other clinical staff such as psychiatrists, social workers and laboratory staff. Medical secretaries were also now located in the Records Department as well as other staff providing clerical support to the consultants during clinics. The Department received many requests for information from various sources both within and outside the Department.
Working methods within the Department had evolved over time and there were few policies and procedures in place. Patients’ records were collected informally by a range of staff including nurses, clerks, and porters. There was very little security as most of those who came for records were known to those who worked in the Records Department. It was even accepted practice that if the records clerks were very busy they would allow some of those wanting notes to search for them themselves. Appointment clerks would often come down to Medical Records two or three days in advance of a clinic to collect several batches of patients’ notes in one go. Despite the lack of procedures, and the relaxed approach to security, the system appeared to work well and the Department had a strong record of finding notes quickly.

Mrs Price has been in charge of the Filing Section for more than ten years, and overall she has spent more than thirty years in the Department . She is well known around the hospital and well liked for her pleasant manner and her way with people. Four filing clerks report directly to her and they are responsible for the filing work in the Department. Although Mrs Price is in charge, she tends to do the same work as the clerks and they split the work informally amongst themselves. The performance of the Filing Section has remained high even with the considerable expansion of the number of patients’ records that they now have to deal with. During busy periods they would often work through breaks, while during quieter times they would chat with colleagues. At break times they would take turns to go to the local bakery shop to buy cakes for the Section, and other visitors who happened to be around at the time. The cakes were paid for through a game the clerks played. Any rubbish was thrown into the waste basket from where you sat. Anyone missing the basket had to pay a penalty .

The Move
Twelve months ago it was decided to centralise many of the psychiatric and geriatric out-patient clinics and also reduce the number of in-patient beds. The effect of this was to greatly increase the number of out-patients passing through Anersley. To cope with this increase in patients new facilities were built, old facilities were up-graded, and several new staff were appointed . A lot of the new staff had been transferred from large hospitals in the region. There was some tension between the old and new staff, and in particular the new staff were seen as being less friendly and more concerned with meeting targets. The Medical Records section was still physically separated from this change being at the end of corridor. They still worked very closely together.

A report by consultants however resulted in the centralisation of even the Medical Records Department. Now, rather than medical secretaries being located around different departments of the hospital, they were all brought together along with record filing, appointments and secretarial support. A fourth new section was also created to provide statistical data for various sources . The new centralised Medical Records Department was to be located in a purpose built section created from re-modelling 2 wards previously used for in-patients. The new office was re-decorated to be light and airy, and brand new co-ordinated office furniture was bought. Patients’ files were now stored on purpose-built shelving installed by a specialist document storage company. The capital cost of creating the new Department was high, but justified by management as they would be able to offer a much more organised and efficient service.

The New Manager
With the re-organisation of the different sections almost completed, the post of Medical Records Officer (MRO) was created. The MRO was to be in charge of the new Medical Records Department, with the four Sections Head reporting directly to them. A major role that needed to be tackled first was to manage the change over to the new structure. Mr Fraser was the successful applicant. He had worked previously in various medical records administrative roles, and was currently a deputy MRO in a large hospital, where he had gained a good reputation . He had impressed the interviewing panel with his knowledge and expertise, and also his plans for running the new centralised department. In his new role he would report to the Unit Administrator.

The appointment of Fraser had been made after decisions had been taken about the equipment and layout of the new Department. After reviewing the data, he felt that some significant changes needed to be made, if the Section was going to meet the level of service now required by the increase in patient numbers . Fraser spent a long time going over the plans and familiarising himself as much as he could with what was required. He developed a master plan to ensure a smooth transition to the new building and systems. This overall plan was broken down into detailed instructions for each individual member of staff. The instructions were distributed to all staff ten days before the proposed move to the new building . On a slightly negative point he was disappointed about the apparent lack of enthusiasm he felt from the existing staff about the proposed changes.

Mrs Price, like all other staff members, received a document written by Fraser containing information and instructions for the new working practises. After being given a short briefing by Fraser, she was left to supervise her own small team of staff. The team spent some time working through the complicated instructions and trying to understand exactly what was required of them under the new system. A few days before the actual move, Fraser met with all staff to ensure that things were ready for the changeover. None of the staff raised any questions and Fraser was disappointed with the lack of enthusiasm shown by the members of the team. He had put a lot of time and effort in to preparing all the paperwork and expected more of a positive reaction. He believed that the lack of engagement by staff was a result of the limitations of Mrs Price’s supervisory skills. He also felt that they failed to grasp the importance of standards and good working practices.

The actual changeover was masterminded by Fraser down to the smallest detail to achieve the move over a single week-end to minimise disruption . Out-patient clinics were cancelled on the Friday to allow everything to be filed and then packed away for the move by staff in the morning. The team were then given the afternoon off. Over the week-end everything was moved to the new building by porters and security men, and supervised at all times by Fraser. On Monday morning the new Medical Records Department opened for business.

The New Department
The basic procedures for filing patients’ records in the new Department were largely unchanged, although major changes had been made in terms of layout and stream lining. To improve security a floor-to-ceiling screen had been erected at the end of the Records Library, where the patients’ records would be stored. There was only one entrance to the Records Library which was through a sliding door next to Mrs Price’s new desk. She had been given strict instructions to allow only those people on a list provided by Fraser access into the Library. Staff working in the Library behind the screen could only leave at specified times unless there were special circumstances.
As the new procedures started to work, Fraser was pleased with the immediate positive results that were apparent . Before the change it was quite common for piles of patient records that needed to be filed to be left in piles on clerks’ desks overnight. Now all staff had to clear their desks before leaving at the end of each working day. Tracer cards were also introduced, so that whenever a patient’s record was removed, a card was placed in the gap left. Staff were no longer allowed to put up posters, as Fraser felt this gave an unprofessional image to other hospital staff and visitors. He also had to stop staff from throwing balls of paper through the sliding door in the screen, which they often did during long afternoons. Tea breaks were also now scheduled at fixed times during the day. As he was keen to improve Mrs Price’s managerial skills, he also made sure that his instructions for staff were channelled through her.

Problems Emerge
In the first six months after the move to the new building problems began to emerge with the new systems. Overall the quality of the service provided by the Department declined and there were frequent delays in finding patients’ records. A small backlog of returned records that had not been filed began to develop . As a result Fraser introduced a new rule that any records not filed at the end of each day had to be returned to Mrs Price for safe keeping. The new rule didn’t work however and the pile of records left with Mrs Price continued to grow. Eventually Mrs Price asked if the clerks could work half an hour’s overtime each day for a week to clear the backlog. Fraser refused however, arguing that if the clerks spent less time chatting they had plenty of time to file all records.

Medical secretaries were also beginning to complain as records were often not sent in time for their out-patient clinics. To address the problem Fraser decided that records for clinics must now be sent even earlier so that any problems could be solved. This new rule resulted in a further breakdown of the relationship between Medical Records and the staff running the clinics. However, Fraser saw little of these problems as he was often away from the Department attending meetings regarding integrating all records systems within the district.

The speed of the service with the Department was starting to slow even more to due missing or incomplete records. The backlog of records needing to be filed continued to grow. To try and stop this problem getting worse, the clerks stopped using tracer cards when they removed a record . However, Fraser found out about this and so he started to do random spot checks to ensure that tracer cards were used. This only served to further distance himself from the clerks and reduce the level of trust in the Department.

There was a growing feeling around the hospital that there were significant problems within Medical Records. Management however did not think it right to interfere and so left Fraser to try and sort the problems out.

The Crisis
A week later the Head of the Unit was telephoned at home at 11.30pm by an angry consultant. The consultant informed him that he had been waiting for over 3 hours for the records of a patient who had had just been taken to the hospital as an emergency admission under the Mental Health Act. The Unit Head apologised and assured the consultant that he was on his way to sort the problem out. After a brief telephone call to Fraser, they both made their way to the hospital.
At the hospital Fraser hurriedly tried to track down the patient’s records, but found they were missing, and no tracer card had been placed in the vacated slot . He also found several piles of records yet to be filed hidden in desk drawers by the clerks. There was also a cardboard box next to Mrs Price’s desk containing another batch of records marked “need to be filed”. After a frantic search Fraser finally had to admit that he couldn’t find the patient’s records. The consultant stormed off in disgust.

Task Brief
Based on the information contained in the case study, and using relevant theories studied on this module to support your answer:

1) Explain the reasons behind the problems currently being experienced in the Medical Records Department .

2) Outline a possible recovery plan to restore confidence in the service offered by the Department .
Why has a backlog developed?

Possible reasons why a backlog may have developed:

1. The hospital is treating more out-patients and this will more than likely have led to an increase in the number of records requested. There has been no mention of additional staff for the department so one would assume that the level of staff has remained the same.

2. Additional security has restricted who can use the area meaning that other staff are no longer able to search for themselves when the clerks are busy. This will add to the additional workload.

3. Mr Fraser has put an end to the flexible working practices which were previously in place prior to his arrival. Staff no longer likely to work through their breaks to get the job done when work “bottlenecks”.

4. The tracer card system whilst being a useful addition clearly appears to be slowing down the filling process. This is the reason why staff appear to have abandoned it when the backlog developed.

5. Staff my not have understood the new procedures which have been put in place so may well be implementing them wrongly or not at all.

6. A “them and us” culture seems to have emerged which may be having a demotivating effect on the staff.

7. Attempts to solve the backlog by working overtime are not only refused but are also met with criticism of the staff work ethic. This is also demotivating and insulting.