Spring clean your CDI workflow

May 10, 2017 / By Cheryl Manchenton, RN

Is your CDI program in a rut? Has your performance plateaued or even diminished? Maybe your program has a case of the “same-ole-itis,” otherwise known as “the way we have always done it” disease. In the words of the song from the musical Auntie Mame*, “Open a new window, open a new door!”

Over many years of consulting with clients, I’ve learned that there are three basic types of programs: CDI professionals with the first type of program know they have a problem and/or are looking for opportunities to improve. They are open to listening and trying new approaches. Those who have the second type of program recognize they have a problem and are receptive to trying new processes, but their ability to grow the program is severely limited by their refusal to step outside the box of conventional thinking. The third type of program (“we’re just fine”) is the most challenging. In this case, the CDI staff is quite proud of their program and its success and do not see any need to change despite indicators that improvement is needed. 

So let’s focus on the “same-ole-itis” and “our program is just fine, thank you very much” programs. I have seen a number of successful programs over the years, many of which appear, at least on the surface, to not need any help. Note: I said on the surface. Imagine how much more successful these programs would be if the CDI team or leadership would be open to a few modifications or enhancements. This is the very essence of moving “good enough” to “great.” Successful organizations do not remain successful without constant assessment and evolution. A CDI (or quality) process is not a static process, but a living, dynamic, flexing process. It must evolve with changes in the philosophy, knowledge and culture of our quality improvement and clinical documentation improvement communities. 

A commitment to grow and evolve only “on paper” will result in failure and frustration. Three things are essential during a change management process. First is the support of leadership. A process journey (especially a major philosophical change) can take up to two years to see results or work out the kinks. The organization’s administration has to provide support for this process and understand when program metrics dip at times. Second is accountability. If staff members are not held accountable for the new or enhanced processes, change won’t occur (or will occur much more slowly). The final essential piece is the right team members. Unfortunately, not all can adapt and sometimes this requires difficult staff decisions in order to build an engaged and motivated team.

When initiating a major process change, remember that it can be difficult to see clearly through our own microscopes. I was reminded of this truth while working on a recent project. A fresh set of eyes was needed, but, boy, was the message hard for me to hear. So, I took a deep breath and asked some questions and listened again. I encourage you to have an outsider look at your workflow and processes for a fresh perspective. 

Finally, encourage your staff to listen—and listen again—to the process change and commit to trying it for at least a month before the process is abandoned or modified. And they need to fully commit, not just give lip service to the process. I recently worked with a client on instituting some major process efficiencies. The staff that listened and responded to the advice for streamlining and improving their workflow are successful and excelling. The staff stuck in “same-ole-itis” are digging their heels in deeper, and while they are “meeting expectations,” the program is not growing as it could.

Time for a little spring cleaning!

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.

Revamping your CDI workflow could mean an impact on your CMI. Watch this short video and see how.

*Lyrics from the musical Mame by Jerry Herman