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Honestly, have you noticed how almost everyone around you seems “comfortable?”

Most of us live and work in environments where everything is systematized, laid out as rules or policies or (the worst) “best practices.” And then, on top of the things we do to ourselves, we have local, state, and federal governments applying their own rules and policies and (dare I say it) “best practices,” except they call them “ordinances,” “statutes,” “regulations,” “policy statements,” and “laws.” (We interrupt this essay with an appeal to whomever/whatever you hold in your belief set: “Deliver us from bureaucrats and professional politicians!”)

But let us discuss some of these infringements on our individuality.

First, I recognize that policies and procedures have their place. To this end, there are three kinds of decision-making, management, and planning:

  • Operational: The day-to-day, relatively mundane performance of our duties and responsibilities;
  • Tactical: Short-term planning, usually ranging from one to 12 months; and
  • Strategic: Long-term planning in excess of 12 months, typically going to 36 months (and yes, I know “long-term planning” in a hospital means 90 days out.)

Policies and procedures serve to facilitate operational work, since they obviate the need for staff actually to think about anything. The more that can be codified in writing and imposed on staff, the more consistent their work output. Thus, policies and procedures inherently are a good thing, but not if they are allowed to age. Consider this list:

Top 10 Ways to Know Your Policies are Outdated

(In No Particular Order)

  1. They are written in Chaucer’s English.
  2. They reference “serfs” and “subjects” rather than “staff” or “team.”
  3. They use “thee,” “thy,” and “thou” far too often.
  4. Each one ends with “Off with their heads!” as the price of noncompliance.
  5. There are three policies related to flint arrowheads and 11 on making and maintaining long swords and pikes.
  6. Citing 95 percent organizational illiteracy, the policies call for a full-time “reader” to keep the “serfs” and “subjects” up to date on new policies.
  7. Holidays include “St. Swithin’s Day” and “Whit Monday.” (Yeah…look them up.)
  8. They were last updated by Peter the Great.
  9. There are frequent references to Queen Victoria.
  10. There is a policy addressing what to do during a Viking invasion.

If management does not take the time to review policies and procedures on a regular basis, they get stale and their value diminishes at an alarming rate. 

Ironically, that is exactly what happens with most ordinances, statutes, regulations, policy statements, and laws: they seem never to go away or be revised in any meaningful way. The Internet is full of websites outlining absurdly specific and woefully outdated such laws ranging from the governance of such matters as riding a bicycle in a pool to shooting wild game from vehicles.

While these state laws and local ordinances often do inspire a chuckle (or at least a smile), be assured that the same sorts of nonsense are allowed to go on at the federal level as well. I mean, consider ICD-10, which we are implementing – finally – the same year that the World Health Organization plans to release ICD-11! And did you know that the Mendenhall Order (1893) adopted metric measures as the fundamental standards for length and mass in the United States? Yet we are the only country in the world that has not replaced the English system with the metric system. So, what good is the Mendenhall Order?

Someone should look into that.

About the Author

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Editor for icd10monitor.com


Billy Richburg, M.S., FHFMA

Billy Richburg has had a long career in healthcare holding high positions such as the Sr. Director for FinThrive, MedAssets, and IMaCS. Billy is now enjoying the finer things in life in his sweet retirement!

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