As she anticipated, her facility's coding quality and productivity are below that of other healthcare

facilities in her organization. Gina conducts a root$-$cause analysis to help identify the cause of the

decline in both the productivity and quality of the coding being performed by her team.

Real$-$World Case Question

Conduct your own root$-$cause analysis $($just as Gina has done in this case by constructing a fish$-$

bone diagram$)$ to determine the reason for the decline in performance metrics for both quality and

productivity.

Real$-$World Case $18\mathrm{.}2$

Karen is the regional coding manager for a large healthcare organization. She is responsible for coding

compliance and training for three hospitals. Karen creates a dashboard each week with the metrics from

each hospital. The metrics are specific to each facility and grouped by patient type. This dashboard is

shared weekly via email with all coding staff and relevant leadership. Although there is some fluctuation

from week to week, the metrics have remained relatively consistent for the past two years. Karen notices

that the metrics for the past two weeks for Uptown Hospital, the large urban hospital in her region, have

shown a significant change. There are a large number of inpatient charts that have not been coded.

Karen also receives the results of a recent coding audit for that facility. The audit reveals a coding quality

issue with the inpatient coding. Karen contacts Sue, the coding manager at Uptown Hospital, to

determine the cause of the recent changes. Sue informs Karen that one of the inpatient coders went on

maternity leave three weeks ago, another had surgery two weeks ago, and both have not returned to

work. In order to manage the inpatient coding backlog, Sue was having two outpatient coders fill in$.$

These coders have much lower productivity when coding these inpatient charts and are not properly

trained to code this patient type. These coders' charts were the primary problem in the recent coding

audit for inpatient coding. Karen knows from her weekly metrics that the other two facilities are current

$($up$-$to$-$date$)$ on inpatient coding. Karen and Sue brainstormed possible solutions. In an attempt to

resolve the problem and formulate a better solution. Karen makes arrancements for innatient coders at$1.$ Conduct your own root$-$cause analysis $($just as Gina has done in this case by constructing a fish$-$bone diagram$)$ to determine the reason for the decline in performance metrics for both quality and productivity.