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institution with other institutions of the same type regionally and nation-
ally. Because such a comparison exposes the usual and unusual aspects of
an institution, it is invaluable in formulating the institution's documenta-
tion plan. The comparison should be made in terms of the institution's
mission, functions, range of activity, size, and significant "first" or "only"
accomplishments. Reading institutional histories, if available, and statisti-
cal compilations (for example, the American Hospital Association's an-
nual report of hospital statistics) is useful for making interinstitutional
comparisons. The lists of institutional types presented in Chapters 2
through 7 may be used to compare health care institutions of various
types with their peers. Archivists may also wish to consult their institu-
tion's public affairs department, which will be attuned to the special
qualities of the institution; however, archivists should keep in mind that
this department's mission is to portray the institution in the best light
possible.



STAGE TWO: SELECTION 211



RELATION TO THE U.S. HEALTH CARE SYSTEM

Broadening the analysis even further, archivists should acquire a general
understanding of the U.S. health care system and how their type of
institution or organization fits into it. This final layer of analysis, called
field analysis, provides the perspective necessary for archivists to place
their institutions in a societal context.

An understanding of these three layers of context — institutional,
peer, and systemwide (in other words, understanding the institution, its
place among similar institutions, and its relationship to the health care
system as a whole) — provides a solid foundation on which to build a
documentation plan.



STAGE TWO: SELECTION

Once the three layers of analysis have been completed, the documenta-
tion plan may be drafted. This is accomplished in four steps:

1 . defining the core record series,

2. conducting a retrospective analysis of existing historical materials,

3. conducting departmental studies, and

4. identifying significant record series for archival preservation.

Core record series are the basic series around which archivists should
shape their collections.^ As the foundation of archival collections, core
record series are the minimum documentation that should be preserved to
document broadly the functions and activities of an institution. Defining
the core record series entails first subdividing the institutional administra-
tion function into categories of activities. For example, a hospital's admin-
istration function, and probably the administrative function of other types
of institution as well, might be subdivided into the following categories of
activities: governance, external relations, fiscal management, operations
management (line activities), facilities management, and human resource
management. The administration function is emphasized at this point
because by documenting it, an archivist can gain a general overview of the
institution and all its functions.

Next, the administrative departments and offices that have significant
responsibilities for these activities are listed, along with the important
record series that they generate.^ Archivists should consult the most
recent organizational chart, institutional telephone directory, and depart-
mental and institutional annual reports, for example, to be sure they have
not overlooked any significant organizational units. It is likely that some



212 DOCUMENTATION PLANNING AND CASE STUDY



organizational units, such as purchasing, will not produce any core re-
cords series; if this is the case, they will not appear on the core list. It is
important for archivists to begin formulating the list theoretically, but also
to work from the reality of what record series are actually created.
Although virtually every institution creates annual reports, which are
important sources of information and should be part of the core record
series, other significant record series may be less obvious.

Some core record series may document more than one function, but
they should be listed only under their primary function and the office
where the (or an) original is found to avoid confusion and repetition.
When the listing of core record series is complete, it should contain only
those record series that are necessary to document a function or activity at
a general level. (See Table 8-1 for the core record series of Children's
Hospital, Boston.)

If the institution already has an archival program in existence or has a
cache of historical materials, the archivist needs to conduct a retrospective
analysis of existing historical collections to determine generally how well
the collections document the institution's functions. Depending on the
extent of the records and the complexity of the institution, the archivist
may decide to conduct a more specific collection analysis based on the
activities and projects that support the institution's functions. Such an
analysis is performed by examining all collections and deciding which
functions (and then possibly which activities or projects) the collections
document, and how well they document the functions over what period
of time.^ The results of this analysis will be more impressionistic than
scientific, but they will enable the archivist to assess the collection's
strengths and weaknesses, which will be useful information when the
documentation plan is written. This information may also lead the archi-
vist to try to locate care record series that are incomplete or missing.

If the institution has no existing archival program, then the archivist
should determine whether noncurrent records are stored in a central
location. At this point the institution's records manager should be con-
sulted. The purpose of reviewing these noncurrent record series is to
determine how well they document the institution's functions, activities,
or projects and which of them should be preserved in the archives. This
analysis should also include an assessment of significant record series that
have been lost or destroyed (if they can be identified) and the functions
they would have documented. Again, this analysis will inform the docu-
mentation plan.

The next step in the selection process involves studying the institu-
tion's medical departments and other nonadministrative units. The func-
tions other than institutional administration (i.e., patient care, health



STAGE TWO: SELECTION 213



TABLE 8-1 Children's Hospital's core records series

All Functions (function level)

All departments, and other organization units (organizational unit level)

Annual reports of the department/unit (record series level)

Departmental committee minutes

Departmental organization charts

Departmental policy and procedure manuals

Departmental publications (e.g., newsletters, brochures, updates)

Photographs, films, slides, etc., of department staff, interiors, and events

Institutional Administration (function level)
External Relations (activity level)

CEO's office (organizational unit level)

Correspondence file (record series level)
Department of Development and Public Affairs

Official institution publications {The News, Children's Today, Children's World,

Inside Children 's, Pediatric Views)
Photograph/slide files
Press releases

Promotional videotapes of Children's Hospital
Governmental and Community Relations Office
Correspondence file

Fiscal Management

Vice President for Finance's office
Annual profit/loss statements
Audited financial reports (institutional)

Operations Management
Research Administration

Investigator profiles (annual compilation of institutional research activity)
Committee minutes (Enders Faculty Council Steering, Awards, Education,
Facilities, Research Computing, and Technology Transfer)
Vice President of Medical Affairs' Office
Medical staff bylaws
Medical staff correspondence file
Medical staff directories

Minutes of medical staff standing committees (Cardiopulmonary Resuscita-
tion Committee, Clinical Investigation, Credentials, Disaster Control, Ethics
Advisory, Infection Control, Medical Records, Medical Staff Executive,
Nutrition Advisory, Oncology, Pharmacy, Quality Improvement, Radiation
Safety, Senior Appointments, Special Care Units [Multidisciplinary Inten-
sive Care Unit, Cardiac ICU and Newborn ICU], Tissue, and Transfusion)
Rules and regulations of the medical staff
Vice President for Operations' Office
Resident Handbooks

Facilities Management
CEO's Office
Property deeds

(continued)



214 DOCUMENTATION PLANNING AND CASE STUDY



TABLE 8-1 Children's Hospital's core records series (continued)

Facilities Management (continued)
Engineering office

Blueprints for building(s)
Facility Planning office

Planning reports

Photographs/slides of buildings

Correspondence file
Vice President for Operations

Correspondence file

Human Resource Management
CEO's office

Professional staff correspondence
Communications

Children's Hospital telephone directories
Human Resources

Employee handbook

Hospital policy and procedure manuals

Governance
CEO's office

Annual or periodic reports of CEO

Articles of incorporation

Charter

Constitution and bylaws

Minutes of medical center/hospital standing committees (Audit, Develop-
ment, Executive, Facility Planning, Finance, Investment, and Patient Care
Assessment)

Organizational charts

Patient Care

Admitting, Emergency Services, and Operating Room
patient logs (currently online)

Development and Public Affairs office

Directory of Medical Staff and Ambulatory Programs

Medical Records Department
Disease index (online after 1979)
Patient records index (online after 1979)

Department of Laboratory Medicine
Laboratory handbooks

Health Promotion
Health Information Department
Occasional publications

Education
Human Resources
Training Handbook



STAGE TWO: SELECTION



215




FIGURE 8-1 Operating room in Children's Hospital, Boston, 1932.
dren's Hospital Archives



Source: Chil-



promotion, education, and biomedical research) are emphasized from this
point forward. The selection process now changes from that used to
identify the core record series: the organizational units become the first
level of selection, after which come the function/activity level and then
the record series level. This process is appropriate because in most of the
U.S. health care system's institutions the patient care, health promotion,
education, and biomedical research activities are inextricably linked at the
departmental level. The first step is to list the medical and other nonad-
ministrative departments. These units may be subdivided as necessary.
For example, at Children's Hospital some of the medical departments are
subdivided into divisions and subdivisions. (See Table 8-2.) Then the
archivist conducts a study of each organizational unit, talking with the
unit's head or another designated representative and the individuals
responsible for managing the unit's records to better understand how it is
organized and what it does. Through this process the archivist gathers
background information and determines what core record series the
department generates (e.g., departmental annual reports, minutes of
departmental committees, photographs and other audiovisual materials,
departmental newsletters or other publications, departmental policy and



216 DOCUMENTATION PLANNING AND CASE STUDY



TABLE 8-2 Departments or services engaging in patient care, health
promotion, biomedical research, and educational activities



Medical Departments

Anesthesia

Cardiology and Cardiovascular Surgery

Dentistry

Medicine

Adolescent and Young Adult Medicine

Emergency Medicine

Endocrinology

Gastroenterology and Nutrition (one program)

Clinical Gastroenterology and Nutrition
General Pediatrics (eleven programs)

Child Development Unit

Clinical Pediatrics Program

Community and Support Services

Comprehensive Child Health

Developmental Evaluation Center

Family Development Program

Martha Eliot Health Center

Medical Diagnostic Programs

Pediatric Group Associates

Pharmacology-Toxicology Program

Services to Handicapped Children
Genetics (one program)

Clinical Genetics
Hematology and Oncology
Immunology (four programs)

Allergy

Dermatology

Clinical Immunology

Rheumatology
Infectious Diseases
Nephrology
Newborn Medicine
Pulmonary Medicine (one program)

Cystic Fibrosis Research Laboratories
Inpatient Services (eight programs)

Blackfan Service (school-aged children)

Bone Marrow Transplantation Service

Clinical Research Center Service

Janeway Service (adolescents)

Medical Intensive Care Service

Neonatal Intensive Care Service



(continued)



STAGE TWO: SELECTION 217



TABLE 8-2 Departments or services engaging in patient care, health
promotion, biomedical research, and educational activities

(continued)

Inpatient Services (eight programs) (continued)
Oncology Service
Rotch Service (infants and toddlers)

Neurology

Neurosurgery

Ophthalmology

Orthopaedic Surgery
Sports Medicine

Otolaryngology and Communication Disorders
Communication Enhancement Center

Pathology

Psychiatry
Psychology

Radiation Therapy

Radiology
Nuclear Medicine

Surgery
Gynecology
Plastic Surgery
Urology

Other Nonadministrative Departments /Units

Department of Laboratory Medicine

Information Service

Nursing

Nutrition and Food Service

Pastoral Care

Patient Activities

Pharmacy

Physical Therapy

Quality Improvement

Respiratory Therapy

Social Work

Utilization Review

Volunteers



218 DOCUMENTATION PLANNING AND CASE STUDY



procedure manuals). The archivist then identifies for preservation any
additional record series that best document the department.^

It is possible to decide not to document a particular division or
subdivision beyond the information contained in department-level rec-
ords. If, however, a division or subdivision is identified for further docu-
mentation, it is necessary for the archivist to meet with the division head
to identify record series for preservation. I found medical department
chiefs helpful in identifying those divisions and subdivisions significant
enough to be documented beyond the general level of information pro-
vided by records at the department level.

The selection process will assuredly not progress as smoothly as
suggested here. There may be times when records must be appraised
before the documentation plan has been completed because a department
is moving or an individual is retiring or has died, and there may be times
when a deparment head refuses to cooperate in the documentation
planning process. Although documentation plans are formulated from the
top down, the planning process also involves simultaneously working at
the unit level from the record series up. There is no specific formula that
can be used, but the archivist's ability to move from conceptualization to
archival reality and back again is essential to crafting a good plan.

At this point, if the institution is limiting its collecting scope to archival
records, the documentation plan is complete. If, however, the institution
wishes to acquire manuscript materials (papers of individuals and records
of outside organizations) or artifacts to complement its archival records,
then the documentation plan should conclude with detailed selection
criteria for manuscripts and artifacts. These criteria are part of a traditional
collecting policy.



DOCUMENTATION PLANNING: PRACTICAL ASPECTS

The first part of this chapter defined a documentation plan and described
the components of the planning process: background analysis and selec-
tion. The remainder of this chapter describes the practical aspects of
documentation planning and provides an example of a portion of a
documentation plan, that formulated for Children's Hospital, Boston.



ADMINISTRATIVE FOUNDATION

Building institutional support at various levels is critical to successful
documentation planning. After the archivist enlists the support of her or
his immediate supervisor, the next step is to gain the active support of the



DOCUMENTATION PLANNING: PRACTICAL ASPECTS 219



institution's chief executive officer (CEO) for the program. In fact, it is
helpful if the archivist sends out a letter, over the CEO's signature, to all
departments explaining the documentation planning project and request-
ing their cooperation. To gain CEO support, however, it may first be
necessary to have the support of other administrators, such as vice presi-
dents, legal counsel, department heads, and laboratory directors. Realisti-
cally, in some institutions it may not be possible to obtain the support of
key administrators. In that case, gather whatever support you can while
you keep trying to win the support of the other institutional leaders. The
worst case is that you may have to wait for top-level support until the
administration changes.

ARCHIVES COMMITTEE

While the archivist is securing the authority to carry out the documenta-
tion planning project, the archives committee is assembled. The commit-
tee should consist of records creators, users, and preservers: the archivist,
the records manager (who may be the same individual as the archivist),
the librarian, key administrators from each functional area, historians of
medicine or other historical researchers interested in topics documented
by the institution's records, a representative from the institution's legal
department, and a trustee or overseer. If the CEO or executive vice
president can be enlisted to serve on the committee, so much the better.
Others may be added to the team as appropriate. In the case of a hospital
that engages in biomedical research, for example, a physician, the medical
records specialist, and a biomedical researcher should be recruited to serve
on the committee. Although the archivist will effectively chair the com-
mittee, it is important that another committee member be the nominal
chair. Someone with greater institutional influence will usually be more
effective in accomplishing the committee's goals. In the hospital setting, a
senior staff physician or vice president is an appropriate archives commit-
tee chair.



DOCUMENTATION PLAN ARTICULATION

The heart of the documentation planning process is writing the documen-
tation plan. As mentioned earlier, the plan specifies what will be docu-
mented within each department and identifies specific record series that
will be preserved in the archives. Once information on existing historical
collections and/or noncurrent record series has been accumulated, the
archivist engages in additional analytical work, classifying the medical and
other nonadministrative departments and their subunits. The next steps



220 DOCUMENTATION PLANNING AND CASE STUDY



are to understand departmental functions and activities, and finally to
identify the record series that document their functions.

After selected record series have been designated to come to the
archives, the documentation plan is complete. For institutions or organi-
zations founded before the post-World War II "information explosion"
the archives committee may wish to select a date before which all or
virtually all records will be kept. It should be emphasized that the archivist
begins formulating the documentation plan theoretically, but as the re-
cords are reviewed, the plan will be revised as necessary to reflect the
reality of what records are actually generated. Annual notices should be
sent to organizational units to remind them of their agreement to send
specified material to the archives, and completed plans should be re-
viewed and updated every few years or when departments are merged or
disbanded.

The archives committee should also decide whether the papers of
individuals, the records of other organizations, and artifacts should be
sought to complement the archival collection. If manuscript material and
artifacts are to be collected, the documentation plan should specify which
individuals and/or types of organization should be solicited, taking into
consideration strengths and weaknesses of the archival collections. Mem-
bers of the archives committee will undoubtedly be helpful in identifying
individuals whose papers should be preserved.

In the hospital settings in which there is no records management
program, I have found it useful to have the archives program part of the
development and public affairs department rather than a function of the
hospital library. This is because development and public affairs staff
members have a broad understanding of the institution and how it
operates. They have their fingers on the pulse of the institution, under-
stand individual personalities, and can provide valuable advice on how to
accomplish documentation planning goals. There is, however, the danger
that the development and public affairs staff will view the archives solely
in terms of fund-raising and public relations activities.



CASE STUDY: CHILDREN'S HOSPITAL, BOSTON

INSTITUTIONAL ANALYSIS

Element 1: Mission and Functions The original mission of Children's
Hospital, as stated by the Board of Managers in 1869, was threefold: "The
medical and surgical treatment of the diseases of children. The attainment
and diffusion of knowledge regarding the diseases incident to childhood.



CASE STUDY: CHILDREN'S HOSPITAL, BOSTON 221



The training of young women in the duties of nursing. "^° The hospital's
current bylaws expand and clarify this mission:

The mission of Children's Hospital is to provide excellent health care to
children and, in support of this mission, to be the leading source of
research and discovery, seeking new approaches to the prevention,
diagnosis and treatment of childhood diseases as well as to educate the
next generation of leaders in child health.

In the nearly 125 years since the mission was first articulated, the institu-
tion's basic functions of patient care, biomedical research, and education
have remained the same. Patient care is now clearly stated as the primary
function, health promotion and community outreach activities play a
prominent role in the institution, and although the school of nursing
closed in 1978, the hospital still considers the education of nurses, physi-
cians, technicians, and others as one of its primary functions. Children's
Hospital is therefore involved in four of the six functions of the U.S. health
care system. Additionally, like all institutions. Children's Hospital engages
in institutional administration, a function that includes a range of activi-
ties necessary to keep the institution running: governance, external rela-
tions, fiscal management, operations management, facilities manage-
ment, and human resource management. These activities tend to be
similar in institutions of all types.

As the current mission statement makes clear, the primary function of
Children's Hospital is patient care. The hospital is a tertiary care facility
and provides the full range of services from standard, noncritical care
through specialized care and experimental treatment of infants, children,
and adolescents with extremely complex and virtually unique medical
conditions. The hospital is organized into fourteen clinical departments
with nineteen divisions that are further subdivided into twenty-seven
programs. Children's Hospital also offers more than 100 outpatient pro-
grams. Health promotion is closely allied to its patient care activities.
Although not explicitly stated in its mission statement, the Children's
Hospital bylaws (1989) emphasize health promotion through prevention.
The bylaws state that among its purposes are "to instruct, supervise, and
train [health care professionals] in the care, treatment, and prevention of
diseases . . . and to determine new and improved methods for the
treatment and prevention of diseases, and to disseminate information
about such matters."

Children's Hospital is the largest pediatric research facility in the
world and stands fourth among all independent hospitals in research
funding from the National Institutes of Health. ^^ The John F. Enders
Pediatric Research Laboratories at Children's Hospital house more than



222 DOCUMENTATION PLANNING AND CASE STUDY



500 researchers, and in 1992 the hospital was awarded $34 million for
research ($23 million from federal sources, $4 million from the Howard
Hughes Medical Institute, $3 million from industry, $3 million from
foundations, and the remainder from other sources, including the Com-


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Online LibraryJoan D KrizackDocumentation planning for the U.S. health care system → online text (page 23 of 26)