Combining HIM Staff

Rumors had been swirling for years. Would this ‘two hospital town’ combine hospitals and if so, what would that look like? What would happen in HIM? The rumors became a reality. As the HIM Director, what was to be my role and how could I help my staff through this process? I searched through journals and professional magazines trying to glean as much information from colleagues who had successfully merged HIM departments. Thankfully, there were some out there, but nothing prepared me for the two years it took to fully combine the two departments. It has now been over 10 years and reflecting back, I see what worked and what didn’t.

First Steps
The first thing I learned was to not promise anything that was out of my direct control. At this stage of the game, this is just about everything, including: salaries, department location, benefits and even dates by when decisions and answers will be known. I could promise staff that I would be there to listen to their concerns, keep their best interests in mind when I had input, be honest with them, and keep them informed as soon as I had information I could share with them.

One of the first conversations we had was that volumes drive the amount of staff needed to complete various tasks, and so staffing would ‘likely’ stay very ‘similar’ for quite a while. I explained that now there would be almost double the volume so it made sense that staff from both campuses would be needed. This thankfully, ended up being a true statement. HIM on both campus’ was quite lean so we were not asked to reduce any staff. It is important to encourage staff to not start looking for other positions as some will be tempted to leave the turmoil!

I was surprised by the next items that were causing stress for staff. They wondered who they would end up working with (the other campus had been rivals for a very long time!) and if they would have a window and a door to their office or if they would be in a cubicle. This was a very big issue to some and it is good to expect these kinds of issues to consume a lot of hours of discussion. Keep in mind, the decision on department location and layout likely will not be solely the HIM director’s decision as a larger master plan has likely been thought of. It is important to let staff air these concerns but do watch for underlying issues that may have nothing to do with the window and more to do with their fears and concerns about change.

Acquainting Staff With The Other Campus
As soon as possible, try to arrange for a ‘meet and greet’ with both campus’ HIM management teams. If your department is small, expand the meet and greet team to other informal leaders within each HIM department. The goal is to start talking positively about the other campus and see the ‘other side’ as co-workers who will bring expertise and strength to the department. I would suggest this meeting take place in a neutral place like a coffee shop or restaurant so everyone is as comfortable as possible. The agenda should be very low key. Hopefully, each side would then go back and talk about how the new staff is nervous and anxious too.

The next gathering would be for everyone in HIM and could be something during work such as a lunch potluck. Staff will likely sit with their own co-workers but at least everyone (in shifts) will be in one room at the same time and they may find that they know each other through outside interests.

The next event we had was an after work bingo/game event. One campus planned a few games and the other worked on getting door prizes. This worked out quite well and each campus appreciated the work the other campus had put in. The last mixing event, about 6-10 months into the merger, required staff, by position, to work together to plan and carry out their part of the event. For example, all coders worked together from both campuses to work on one aspect of the get together while all of the transcriptionists worked on another aspect. This helped the groups start working together, building pride within the groups and forming cohesion. Working together on the fun pieces then allowed them an easier time working together on policies and schedules for their areas.

As mentioned above, do not promise things that are outside of your control. One mistake I made was to jot down all of their questions and tell them I would report answers at our next meeting. I didn’t realize that many of their questions had not been decided on by Administration. I kept their list front and center on the agenda of each meeting and unfortunately, it shined a spotlight on the fact that we were not getting many answers very quickly. Keeping a list of their concerns is good but keep in mind, realistically, it may be several months before many of the logistical, benefits, job titles and salary items will be addressed. The growing list could be referred to periodically and celebrated when some items are answered.

Watch out for rumors and half truths passing between staff behind closed doors and during coffee breaks. No matter how many times you stress the need to report to you with questions or rumors they hear, some will still persist on forwarding rumors. Give examples of rumors you have heard yourself and then tell them either the actual fact or add it to your list to find out from someone.

Be carefully in your quest for a happy, productive and cohesive department that you don’t set unreal expectations on how quickly staff will accept their new co-workers. They may have had history with some of the staff that you are not aware of or there may be other issues. Don’t try so hard to make the new staff feel welcomed that you slight your existing staff.

Unexpected Benefits
There truly is a silver lining in this daunting task. You will really learn what you are made of and see the remarkable perseverance and kind hearts of your staff. Some staff will shine with positivity and leadership that you didn’t know existed. Also, the new staff will bring new skills and preferences that benefit the whole group. A few may really like to work with physicians – so they may become the go-to people when there are physician issues. A few may love to draft policies and work on process improvement, so those that don’t like these tasks now will have help. I saw employees happy to accept the help of the new co-workers in these areas. Also, there were a few more bodies to pick up evening shifts and weekends so those hours were now shared among a larger pool of people resulting in more daytime hours for many, which they liked.

After two years, we really were a cohesive group watching out for each other. My staff realized that people did not lose their jobs like they thought and that the new co-workers were a lot like them – wanting to do a good job and enjoy being at work. After 10 years, staff and leaders had a hard time remembering who came from which campus – and that was the best indicator it had worked!

Debi Nelson has been in the HIM profession for over 30 years and was an HIM director for most of those years in Wisconsin and North Dakota. Successfully merging two HIM departments with long term success is one of her career highlights along with public speaking for AHIMA events. Debi is married with two grown children and four precious grandchildren.

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