Leadership and Management
Leadership and Management tests the supervisory side of coding and HIM operations: budgeting, staffing, productivity, project work, and quality improvement. Many items are calculations such as FTE requirements or productivity variances, wrapped in an operational scenario.
Management functions
Planning, organizing, staffing, directing, and controlling frame the work. Managers set goals, design workflow, delegate with clear authority, appraise performance against standards, and document expectations in job descriptions and policies.
Budgeting and staffing math
- Operating budgets cover recurring costs; capital budgets cover assets above a capitalization threshold.
- One FTE equals budgeted paid hours ÷ 2,080. Workload calculations should use productive hours (excluding PTO, holidays, education), commonly 1,700–1,850 per year.
- Productivity standards are expressed as units per hour or minutes per record and must be applied to comparable record types and case mix.
- Variance analysis compares budgeted to actual volume and rate; separate volume-driven variance from rate-driven variance.
Projects and quality improvement
A project charter states the problem, scope, sponsor, stakeholders, deliverables, timeline, budget, and risks. Work breakdown structures and Gantt charts sequence the work; post-implementation reviews capture lessons. Improvement methods include PDSA cycles, DMAIC, Lean waste reduction, root cause analysis, fishbone diagrams, and Pareto charts. Change management pairs a communication plan with training and visible sponsor support; teams typically move through forming, storming, norming, performing, and adjourning.
Worked example
An inpatient coding unit faces 12,000 discharges per year at a validated standard of 2.5 records per productive hour: 12,000 ÷ 2.5 = 4,800 hours. At 1,800 productive hours per FTE, that is 4,800 ÷ 1,800 = 2.67, so budget 3.0 FTE. If the standard improves to 3.0 records per hour, hours fall to 4,000 and the requirement to 2.2 FTE - a real reduction, but only if the standard was validated on this record mix rather than borrowed from another facility.
Traps that cost marks
Using 2,080 paid hours for workload; rounding FTE down and quietly assuming overtime; applying one productivity standard across short-stay surgical and complex medical records; budgeting salaries without benefits; and treating volume variance as a performance problem when the driver was case mix.