Agile CDI teams: A case study of one health system’s success

Nov. 16, 2020 / By Steve Austin

In previous posts, I’ve hinted that agile thinking and behaviors are not just for software developers. In this post, I will provide an example of how agile can apply to health care revenue cycle workflows too—in this case clinical documentation improvement workflows. The promise of the agile mindset is that organizations can adapt more quickly to changing circumstances, which is especially relevant as we grapple with COVID-19. The following information is from a conversation I had with a long-time customer, a CDI director at one of the nation’s top health care systems, to discuss the impact of COVID-19 and other changes.

This customer has a large CDI team of more than 100 members across the enterprise providing services for facilities in multiple states. Prior to 2020, most CDI staff worked on-premises, but at the start of the year, the organization implemented a 100 percent work-from-home policy for CDI specialists – a move that was originally made for flexibility, recruiting and retention purposes, but that also proved prescient. By creating a fully remote CDI workforce, the organization removed geographical barriers to allow staff to work on cases, wherever the cases happened to be. Staff are organized into teams with core responsibilities based on specific areas of the enterprise, but they are flexible enough to work on other areas as needed.

At this health system, inpatient admissions have been increasing. Yet, adding staff to the CDI team has not been an option, leading to the classic “doing more with less” problem. To keep up, this group places a premium on “meaningful touches.” Instead of attempting to review every record, priority is placed on identifying and reviewing just the records that most likely can be improved. Technology plays a big role in this. To create consistent and rapid prioritization, this customer uses automated CDI prioritization so that cases are always being evaluated for query opportunities as new data and documents accumulate in the patient’s chart. “In reality, about fifty percent of cases ever need intervention by CDI,” according to the director, “so we are looking to technology to bring those cases forward, to increase the percentage of meaningful touches instead of trying to review every record, which is no longer possible.”

To tie this together, another shift for this organization was creation of “weekly team goals.” This behavior is very similar to working in sprints, a topic I covered in my previous post. To make this possible—and to allow teams to respond with agility—a daily report is created out of their 3M system and distributed automatically to every CDI member each morning. This report shows the case load and progress towards weekly goals, making it very clear where bottlenecks are occurring and where opportunities exist for teams to swarm in the areas that need help. As you would expect, individual productivity is also measured, although from a management perspective, CDI reviewers are organized and managed as teams. 

It’s also interesting to note that this health system adopted daily peer huddles to improve communication—same group, same time of day, every day—during which individuals report out their progress, current work, and, importantly, any impediments that need to be escalated for resolution. These stand-up meetings occur not just in the CDI department but in peer groups throughout the organization all the way up to the C-suite. 

To summarize, the agile behaviors adopted by this organization to meet today’s challenges are:

• Organizing a large workforce into cross-functional teams
• Establishment of weekly team goals 
• Transparency via daily enterprise-level progress reporting to every member
• Routine, daily peer-to-peer stand-up meetings

This example also shows that agile can be practiced effectively in many settings outside of software development. In this case, the shift to a more agile mindset and behaviors has allowed our customer to perform optimally under the current health crisis, and they are also in a position to serve their organization well into the future. 

Steve Austin is innovation manager for the 3M 360 Encompass System.

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