Select, Measure, Empower, and Retain: Four Critical Components for a Successful CDI Program
Cheryl Davidson, RN, MSN, CDIP
Network Director, Clinical Data Quality
St. Luke’s University Health Network
Bethlehem, PA1
Learning Objectives
• At the completion of this educational activity, the learner will be able to:
– Identify the four most important components for meeting documentation improvement goals
– Utilize pre‐hire screening assessment screening tools that will assist in the evaluation of critical thinking, conflict management, and emotional intelligence of potential CDI candidates
– Discuss the impact of using prescreening tools & professional development plans on program outcomes
– Describe and define the components of a CDS performance audit tool and impact on CDS and team attitude, engagement, and performance
– Describe the impact of measurement tools on staff retention
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St. Luke’s University Health Network
• 7 hospitals in 2 states
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Level I trauma center
Region’s only medical school
Over 200 sites
1,300 physicians
• Statistics
– 54,000 annual admissions
– 194,000 annual ER visits
– 10,000 employees
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
St. Luke’s University Network Delivers Outstanding Care!
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4 Critical Components for a Successful CDI Program
• Select
• Measure • Empower • Retain
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St. Luke’s Clinical Documentation Story
• Implemented in 2011
• Recruited 15 inexperienced CDI staff
• CDI program reported up to VP and CQO
• Received high degree of senior leadership support
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
St. Luke’s Early CDI Program Challenges
• High attrition rate d/t lack of clarity of CDS role
• No screening process for qualified staff
• Inability to effectively quantify CDS outcomes and identify poor performers or reward high performers
• Resistance to accountability for metrics & expectations (group mentality)
• Conflict avoidance by CDS staff • Disorganized approach to educate new CDS staff
• Little engagement and low morale
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Evolution of St. Luke’s CDI Program
• Developed tight screening process in conjunction with HR department
• Developed a screening tool to measure CDS performance
• Implemented a process to provide candid and consistent feedback to staff
• Initiated process for professional and personal development
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Results
• Up to 25% above baseline improvement in CMI
• Consistent outcomes of CDS accuracy at >90%
• Increased partnership between CDI and medical staff for outcomes in CDI metrics and participation on PI teams
• Improved quality metrics performance
• Improved employee engagement and self‐reported job satisfaction
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Select!
“If your company’s mission is to climb a tree, which would you rather do: hire a squirrel or train a horse?”
—From You Can’t Send a Duck to Eagle School
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Audience “Raise Your Hands” Questions
1. Do you use a pre‐hire screening tool/s?
– Yes
– No
– Would like to
2. How effective have they been?
– Effective
– Somewhat effective – Not effective
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St. Luke’s Selection of Quality CDI Staff
• HR pre‐hire Previsor screening assessment
– Customer service assessment to assess competency in 6 domains:
• Accuracy
• Assertiveness
• Composure
• Helpfulness
• Motivation
• Sense of duty
• Additional pre‐hire CDI screening assessments
– Emotional Intelligence 2.0
– Watson‐Glaser Critical Thinking Assessment
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Development of Quality CDI Staff • Additional tools for CDI development (post‐hire):
– Myers‐Briggs Type Indicator (MBTI)
– My Thinking Styles
– Firo B
– California Psychological Inventory (CPI) for supervisory level
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Recent Trends • A “new” workforce
– Healthcare trends & employee landscape
– Demand for high performers
• New rules in healthcare recruiting
– Selection process
– Employee engagement – Performance measurement
• Recruit for high performance
– Value of branding
“White Paper: The New Rules of Healthcare Recruiting”: HealthStream. 14 Jan. 2016 <http://www.healthstream.com/resources/white‐papers/white‐papers/2016/01/14/the‐new‐rules‐of‐healthcare‐
recruiting>
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Putting It All Together
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Putting It All Together
• Ascertain candidate’s strengths in 6 domains of customer service assessment • Identify behaviors that might hold a candidate back from being successful in their role in regard to EQ
• Assess candidate’s critical thinking in relation to their ability to:
– Recognize assumptions
– Evaluate arguments
– Draw conclusions
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Putting It All Together
• Greater understanding of individual’s perceptions and judgments
• Greater ability to examine how one approaches situations and makes decisions
• Recognition of individual’s core needs
• Gain a clearer picture of one’s personal and work‐related characteristics, motivations, and thinking styles, as well as how they manage themselves and deal with others (leadership)
• Always check with your human resources department prior to implementing assessment & development testing
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Impact of Assessment Screening Management observations
• Attrition rate below 10% in year 4
• New CDS staff functioning at higher levels within 6 months of hire
• Increased & more consistent accuracy in outcomes • Less time spent on remediation/coaching
• Improved relationships
CDI staff perceptions
• Increased job satisfaction
• Decreased level of anxiety d/t staff turnover
• Improved ability to manage conflict within team and with medical staff
• Greater ease in accomplishing program goals and meeting metrics
• Improved relationships
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Measure!
“A painstaking course in qualitative and quantitative analysis by John Wing gave me an appreciation of the need for, and beauty of, accurate measurement.”
—Paul D. Boyer
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Audience “Raise Your Hands” Questions
1. Do you currently measure accuracy of individual CDS?
– Yes
– No
2. If so, how?
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Audit tool
Peer audits External audits
Other
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St. Luke’s CDI Performance Measurement Tools
• Quarterly accuracy measurement of CDI staff performance with validation tool
• Real‐time feedback and education
• Development plans
• Professional development and coaching sessions • Peer audits
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Validation Tool
St Luke’s: ________________ Campus CDS accuracy objectives/behaviors:
CDS: _______
Reviewed on: # missed
by: Total cases reviewed: Possible points x weight Points earned
1.
Identifies correct concurrent initial and possible DRG in Guide software.
2.
Sequences correctly to reflect the highest severity when 2 or more diagnoses are POA and equally meet definition of PDX.
3.
Identifies concurrent documentation improvement opportunities.
4.
Reconciles correctly after coding to reflect highest severity, relative weight, and clarification rates.
5.
Clarifies for diagnoses using compliant format. 6. Ensures documented conditions, clarifications, and coded diagnoses are clinically valid and compliant.
7.
8.
Conducts follow‐up reviews for all cases, prioritizing according to LOS and DRG.
Utilizes process flow map (concurrent and post discharge). Includes CDS/PC mismatches.
_____________________________________________________________________________________________________________________
CDS must achieve at least an 85% in each of the areas below:
1.
Overall accuracy score
CDS score
= __% overall accuracy score
2.
Critical objectives/behaviors score (#2 and #3 above)
CDS score
= __% for critical objectives
ACCOUNT # ADMIT DATE DISCHARGE DATE INITIAL DRG FINAL DRG CLARIFICATION DRG change (Complete or incomplete case) Comments: Accuracy:
* Taken from accuracy objectives above
Confidence level and $ impact
Focus of review: _____ coded and reconciled records from _______________ to current, to determine CDS’s accuracy. Findings/recommendations: 22
Impact of CDI Measurement Tools
Management observations
CDI staff perceptions
• Improved baseline accuracy scores of CDI staff > 90% • Critical aspect of performance evaluations
• Ability to remediate low performers and reward high performers
• Group ownership of metrics with coding & medical staff • Easier identification of individual and team strengths and areas for improvement • Increased transparency & accountability
• Improved self‐confidence in role and in meeting outcomes
• Less repeat findings on CDI audits
• Improved morale in relation to team productivity
• Increased trust in CDI leadership
• Perception of “clear goals”
• Higher level of engagement and ownership of individual and team benchmarks
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Empower!
“The best executive is the one who has sense enough to pick good men to do what he wants done, and self‐restraint enough to keep from meddling with them while they do it.” —Theodore Roosevelt
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Additional Challenges
• Lack of cohesiveness between coding and CDI staff
• Few individual or team goals related to CDI benchmarks
• Difficulty with engaging challenging physicians
• Limited understanding of contributions to network
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St. Luke’s CDI Empowerment Model
• Professional development based on:
– Assessment test results
• Recognition of individual CDI abilities
• Utilization of CDI staff strengths
• Improved conflict management & crucial conversations
– CDI program benchmarks
• CMI
• Physician and staff engagement
• Interaction with professional coding staff
• Severity, impact rates, and quality metrics
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Impact of St. Luke’s Empowerment Model
Management observations
Staff perceptions
• Improvement and consistency of quality of work
• Increased CDI awareness of how their individual and team performance impacts overall hospital and program outcomes
• Increased level of engagement
• Concurrent CDI involvement in quality committees, initiatives, and taskforces
• Increased role confidence
• Increased autonomy and job satisfaction • Greater desire to self‐manage team obstacles and issues
• Stronger relationships with coding and medical staff
• Improved ability to address and manage conflict
• Improved employee satisfaction scores
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Retain!
“His legacy is that he figured out how to get and retain the best workforce.”
—Nicolas Heymann
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Factors That Improve Retention of the “Right” Staff
• Screening process aids in candidates’ “self‐selection.” • Transparency with an open and honest work environment. Give and GET feedback! • Clear expectations with personal and professional goals.
• Provide a growth path or “lattice.”
• Assist CDI staff to recognize the asset they are to the healthcare system.
• Reward and recognize hard work.
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Select, Measure, Empower, Retain
“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction, and skillful execution; it represents the wise choice of many alternatives.”
—William A. Foster
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Impact of Critical Elements
• Corrected and sustained increase in CMI of > 25% for over 4 years
• Mitigation of network erroneous patient safety indicators (PSIs) by nearly 50% in 1 year
• Decrease in erroneously coded MI mortalities by more than 10% in Q4 of CY 2015
• CDI participation on quality improvement committees
• CDI participation & education in medical staff meetings
• CDI self‐report increased confidence, engagement, ability to build better relationships and empowerment
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The Future for St. Luke’s CDI Program
• New branding campaign for St. Luke’s CDI program
• New CDI workflow model
• CDI “Steps”
• Creation of “Leadership Lattice” within CDI program
– Educator
– Speaker
– Specialized reviewer
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Recommendations
• Utilize pre‐hire CDS screening tools
• Evaluate CDS performance post‐orientation utilizing an accuracy tool and development plans
• Utilize peer audits
• Provide professional development for CDI team
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©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Thank you. Questions?
[email protected]
In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide. 34
©2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.