Reading through the contest entries for the Biggest CDI Challenge, it was easy to see a trend, a common theme for most of the submissions. Most entrants talked about the problems they had getting physicians to attend CDI training sessions or responding to queries. Many talked about the lengths they went through to get physicians' attention on the topic of clinical documentation. One of the winning entries used the phrase "permanently modifying physician behavior" as a goal. At the core of all of these challenges is the same question, "How do we get physicians to care about clinical documentation practices?"
So, the similarity is the common challenge of rallying physicians around the CDI cause. The differences are in the characterisitcs of each hospital or healthcare system. Every system has a unique culture, unique challenges and an entirely different group of physicians. So while we can frame the issue - getting physicians to practice high quality clinical documentation - as a common one - we still need to tailor any solution to the specific organizational culuture of each hospital or healthcare system - and, more specifically to the organizational culuture of each medical staff within each hospital or healthcare system.
I saw these differences up close and personal as I helped hospitals implement CDI programs. As a consultant, I would come to the hospital with some "proven" methodologies. But, I quickly saw that it took much more than the methodologies to make a dent in documentation practices. It started from the beginning of the process - when the hospital just began thinking about CDI. For example, if the right people were not invited to the initial meetings to discuss the possibility of creating a CDI program, the likelihood of success was quite low. If the wrong physicians were invited, or no physicians were invited, that generally spelled trouble for the organization. If certain department heads were omitted from the initial guest list, there would be impending doom. In one case, the HIM director was left off the list for the meeting where CDI was first introduced. This omission said something much deeper about the organization's politics. Because a CDI program can not succeed without at least the cooperative effort of HIM, this organization's CDI program was doomed before it even got off the ground. In some cases, the CMO would be on the CDI team, but the real, or "unofficial" leaders of the medical staff (the physicians who other physicians respect and listen to, even though they are not dubbed as official "leaders" by the hospital) were ommitted - also a clear sign of impending failure.
Over the next few months, I will be using pieces of the stories that were submitted to help illustrate certain issues surrounding CDI. I will also be using your submissions and responses to them to help build some additional resources for CDI success. In the meantime, think about both your CDI process and the culture of the medical staff in your organization. And, ask yourself if your processes are congruent with your culture. Are you appealing to the right people to help obtain medical staff support? Are you using the right type of reports, information, or incentives for your medical staff? For example, some staffs are extremely competitive and would therefore be motivated by reports that compare query rates or response rates. While others are more focused on camaraderie......these physicians may work better in an informal atmosphere where samples of documentation deficiencies are reviewed and they provide face to face feedback to each other (I've facilitated these types of groups and they can work well in certain organizations.) Do your CDI strategies match your medical staff culture?
