It takes a special person to be a mentor, as being one requires time, energy, and commitment to the task.
"I became a mentor from a desire to see other people grow and develop and to assist them to do just that," says Barbara Brunt, MA, MN, RN-BC, NE-BC, director of nursing education and staff development at the Summa Health System in Akron, OH.
Brunt has been recognized nationally for her ability to mentor others. She is a recipient of the National Nursing Staff Development Organization's Outstanding Mentor Award, which was presented to her at the organization's annual conference in July 2009 in Philadelphia.
Her organization's mentor program is called Mentoring Aspiring Professionals (MAP). Before we discuss the components of MAP, it will be helpful to differentiate between a preceptor program and a mentor program. Some organizations use the terms interchangeably, which can become a real problem for the organization and employees.
Preceptor and mentor differences
There are some similarities between preceptors and mentors: Both must have a sincere desire to help their colleagues succeed, have a strong commitment to their organization and their colleagues, and have some training and education to be successful in these roles. However, the types of training and education required differ.
Preceptors need job expertise because their role is to accomplish specific, measurable tasks in a certain amount of time. The objective is usually to facilitate the successful orientation of people to their new job and role responsibilities. To do this, preceptors must comprehend and implement the principles of adult learning, evaluate orientees' job performance, and offer and receive constructive criticism.
The objective of a mentoring relationship is to facilitate professional growth and development. Mentors must also be leaders who are willing to help others advance in their chosen career path. Mentors must be knowledgeable about resources for such advancement and be able to act as objective sounding boards.
The preceptor relationship has a definite, fixed beginning and end, whereas the mentor relationship is more fluid. It is of indefinite length and has no clearly expected conclusion.
Authority is another important difference. Preceptors are authority figures who have input into the success or failure of orientees. Mentors function as facilitators who have no formal authority over those who are being mentored. Mentors work to help people realize their career potential. This type of relationship can be invaluable to an organization that wants to groom leaders who will contribute to organizational success. Such organizations establish a mentor program for the specific purpose of identifying employees who possess leadership potential and helping them to develop this potential.
Identifying future leaders
Summa Health System's MAP program is a "leadership development program for employees who possess leadership potential and want to prepare themselves to compete for management positions within the organization," says Brunt.
The program is open to employees from all departments, not just clinical areas. Those who want to be mentored (referred to as protégés) must make a formal application for acceptance into MAP. They must have been an employee for at least three consecutive years working full time or on a regular part-time basis. Applicants must possess a bachelor's degree or be enrolled in a bachelor's degree program. They must not have on file any disciplinary actions for the six months prior to application, and must not have received a rating of "needs improvement" or "does not meet some expectations" on their most recent performance evaluations.
Brunt explains that MAP was born as the result of senior management's belief that there was a need to identify persons within the organization who have leadership potential and offer such employees opportunities to enhance their leadership potential.
Setting goals
Selected protégés must commit to one year of mentorship. Applicants may request a specific mentor or be assigned to a mentor who best complements the protégé's goals as identified on the application. It is expected that the mentor and protégé have at least monthly meetings at times and places convenient to both. They jointly determine goals and experiences that will help the protégé achieve those goals.
Summa offers quarterly educational lunch meetings. Education topics are selected based on protégé and mentor input. Examples of classes include panel discussions with senior management staff and discussions pertaining to quality improvement. Protégés also have the opportunity to attend the organization's leadership institute classes.
At the conclusion of the 12-month mentorship process, there is a graduation ceremony with formal acknowledgment of the work accomplished by both mentors and protégés. Although the formal mentorship process concludes with the graduation ceremony, mentors and protégés may choose to continue with the mentorship process.
Professional growth
Brunt mentored a nurse who was in the process of exploring various career options and roles, and who was currently working as an obstetrics case manager. As part of their mentorship process, she and Brunt worked on writing an article about their organization's case management program.
Brunt is pleased to note that the article has been accepted for publication in a professional journal. "These kinds of successes, where you can actually see that mentoring made a difference, is one of the true rewards of participating in the mentoring process," she says.
Mentor and preceptor programs, while different, both have the potential to enhance individual professional growth and development as well as organizational success. It is important to differentiate between the two.
Some mentorships occur naturally and informally. Others, such as those initiated by Summa Health System's MAP program, are more formally planned and implemented, with a definite purpose and even a proposed (although not required) conclusion.
The important point is that mentorships can and should be rewarding for mentors and those who are being mentored. The outcomes can be professionally exciting for not only the mentor and protégé but for an entire organization as well. If your organization is looking for ways to facilitate professional growth and development with a desired outcome of improved organizational outcomes, consider developing and implementing your own mentor program.
This article was adapted from one that originally appeared in the January issue of The Staff Educator, an HCPro publication.
As we concentrate our attention on the pressing challenges of extending into qualified electronic health records, complying with the HITECH Act, and achieving "meaningful use," we dare not forget our old friend, the legal health record. No matter what we do on the EHR front, we must still maintain a LHR, we must assure its conformance to standards of content, accuracy and completeness; we must keep it for decades and guarantee its integrity; we must be able to produce copies of it on demand. Further, the LHR is an essential component of the revenue cycle serving as both the source of coding and the documentation that must be provided to support billing. The LHR is neither unrelated to the EHR nor is it completely included, it is separate but related, and has different objectives and users. As we will see, applying automation to the LHR gets us much closer to meaningful use.
The LHR is, in essence, the hospital's "flight recorder." The flight recorder is not used to fly the aircraft, its job is to provide an indisputable history of the flight. These are the same functions performed by the LHR.
The EHR, on the other hand, is like the aircraft pilot's tools, controls, warnings, navigation displays, communications, and so on. In healthcare, some of these tools take the form of CPOE, clinical decision support, vital signs, e-prescribing, and results reporting. These tools should evolve rapidly and be replaced as they become obsolete or feature constrained much like aircraft systems. This very need is antithetical to the long term retention requirements of the LHR. As EHRs are relatively new, few have yet found themselves in the uncomfortable position of being unable to respond to a subpoena because a portion of the historical record was within a transcription or lab system that was no longer available. Data in the "flight recorder" endures. The LHR, like the flight recorder, must be physically or virtually distinct to ensure it endures over time as clinical systems evolve.
Other major differences between the needs of EHRs and the needs of LHRs concerns their intended audiences, the presentation of information, the form of data exchange and the requirements of HIPAA for privacy and tracking of access. The intended audience of EHRs is clinicians, the data presentation is fluid and graphical, data is designed to be viewed on electronic media and record accesses and updates are tracked to the user level. In a LHR, the intended audiences are external to the patient care process, the data presentation is fixed and delimited by an occasion of service, data is presented on paper reports and the recipient of the information must be logged in addition to the user sending the information. An EHR designed around LHR needs makes a terrible EHR and vice versa.
The EHR automates and streamlines the clinician's workflow. The results to be achieved are better patient care and better utilization of resources. The users of the EHR are primarily clinicians and the improvement theory is that electronic workflows, rules and information access are more efficient and effective than paper based processes. This same theory can also be applied to the LHR, many of which today are partially or completely based upon paper.
The workflows to be streamlined and automated by eliminating the paper in the LHR are mainly administrative as opposed to clinical and the potential for improvement is profound—on the order of $10,000 per adjusted occupied bed per year if all revenue cycle gains are included. To appreciate the source of these gains one need only examine the typical LHR workflows.
If you look only at physical movement—movement of the chart to various areas and movement of people traveling to HIM to access the chart. The source of waste in paper or hybrid processes is that the chart can only be in one place at a time. If it is in the completion area waiting for a physician to sign a document, it is not available to a coder, and vice versa. Processes that affect the revenue cycle must wait for those which don't. Delayed time negatively impacts billing and collections, and trying to accelerate the process without the appropriate chart information negatively impacts case mix and denial rates. Further, virtually all of the movement is choreographed manually, automation of the tasks that must be completed in each of these areas is mostly impossible. These two traits of paper and hybrid LHRs—sequential access and manual workflows—waste time, space, effort and money.
When we eliminate the paper in LHR processes we see a completely different picture. There is virtually no physical movement of either people or charts. The chart is available, simultaneously, to any who may need it, whenever they need it and wherever they need it. Tasks that require collaboration are profoundly improved.
Coders and external experts must occasionally collaborate in order to arrive at the correct coding of difficult cases. With paper, this process can take from days to weeks, all the while cash-flow suffers. With an e LHR, this same process can take minutes and be controlled by workflow.
Electronic workflow causes chart content to be automatically delivered to LHR processes based upon what is required. Charts requiring analysis are automatically delivered to analysts, documents requiring signatures are automatically delivered to providers, charts requiring coding are automatically delivered to coders with each workflow being executed simultaneously and the content presented in the most efficient format for the business purpose at hand. Besides workflows, e-LHR applications can provide tools for acting upon the work. Analysts have analysis and deficiency management tools, coders have coding and collaboration tools, providers have signature and dictation tools. The entire life cycle of the LHR can be managed electronically with substantial improvement in productivity, cash-flow, case mix, space and physician satisfaction.
Further, an e-LHR helps in two important areas of "meaningful use." Currently, "meaningful use" is comprised of five main components: The first, to improve quality, safety and efficiency, is purely an EHR objective as it is pointed directly at clinicians and direct patient care. The other four components are outward, rather than inwardly focused. Two of them are well within the capabilities of an e-LHR: To engage patients and families by providing patients with electronic copies of their records is squarely an e-LHR function as is the requirement that we track and report disclosures of protected health information to all those involved in treatment, payment and operations under the expanded HIPAA security rules.
The LHR has been around for many years and must continue to endure. The EHR, with its focus on the present and near future, concentration on clinical decision making and goal of improving the patient care process is an essential technology but aimed at a different constituency and problem set than the LHR. There are significant gains to be realized by automating the LHR and providing an e-LHR but these gains will not be realized within the confines of an EHR focused upon patient care workflows rather than revenue cycle and HIM workflows. The synergy between an EHR and e LHR can immediately address two of the five "meaningful use" criteria as well as help offset the costs of implementing an EHR.
Carl Cottrel is a 20-year veteran in the field of automating health information management. He is currently the vice president of product management at eWebHealth.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
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