Case Study Challenge

Guy’s & St Thomas’ NHS Foundation Trust (GSTT) identified an opportunity to improve their Clinical Coding function and commissioned maxwell stanley to review, re-design and manage the transformation of both the department and all external processes affecting it.

Case Study Approach

Following a detailed review by PwC, maxwell stanley undertook a comprehensive and detailed analysis of the current processes, structures and clinical engagement and proposed  the re-design should consist of four work streams:

  1. Organisational Structure & Effective Team Management
  2. Improving Productivity & Quality
  3. Quality Assurance & Auditing Of Processes & Outputs
  4. Clinician Engagement & Improving Source Documentation

Our Transformation Director was assigned the role of Interim Head of Clinical Coding, implementing a new management structure; formalising management roles; assigning Team Leader posts and recruiting a new a Head of Clinical Coding. New clinical coding policies and procedures were introduced; with robust governance structure put in place between clinical coding management and identified clinical leads within each specialty.

maxwell stanley introduced a personalised training and mentoring programme to improve the quality and productivity of Clinical Coders and our team of qualified Clinical Coding Trainers and Mentors were embedded internally so that GSTT could benefit from continuous training delivery to enable selected members of the Clinical Coding team to achieve ACC status. ‘Specialty rotation’ was introduced to prevent de-skilling and a new monitoring system was designed and implemented by maxwell stanley to maintain improved productivity and quality.

Our team of qualified Clinical Coding Auditors implemented and delivered an internal audit programme linked to the personalised clinical coder training programmes. Our PbR Analysts introduced data analysis and reporting of key coding items, such as EDL completion rate, episode rejection rates, and also undertook benchmarking exercises with peer Trusts.

Our Transformation Director embarked on extensive clinician engagement, introducing a ’joint responsibility’ improvement plan between Clinicians and the Coding department, including joint training and a programme of benchmarking exercises at individual clinician level to identify errors leading to coding and reimbursement inaccuracies. Source information was also improved through the implementation of formal feedback loops to the ICT strategy board to help develop coding functions on the EPR systems, and data quality feedback/query cycles to identify when insufficient source information is submitted.

Case Study Outcomes

  • Redesign and improved effectiveness of management structure
  • Recruitment of Head of Department to continue the management of the transformation
  • Improved efficiency and accuracy of clinical coders through on-site training, mentoring and monitoring
  • Full clinician engagement on an individual specialty basis, ensuring correct recording of activity and improved source documentation
  • Transformation leading to substantial improvement in accuracy of financial reimbursement