CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement Michelle Callahan, RN, BSN, CCDS, CRCR Regional Manager, Clinical Documentation Integrity Kaiser Permanente NCAL Revenue Cycle, Oakland, CA Jillian Fore, RN, MPH, ACM Clinical Documentation Integrity Senior Consultant; Former Interim Director, Clinical Documentation Integrity Kaiser Permanente NCAL Revenue Cycle, Oakland, CA CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement Electronic Health Records CDI work-at-home options Economic Pressures The presentation will detail: • Policies • Procedures • Productivity expectations • How to manage relationships among the team and with providers • Successful management of telecommuting staff About Kaiser Permanente Northern California • Founded in Oakland, CA, in 1945, Kaiser Permanente serves a diverse population in Northern California • Nationally, we currently serve 8.9 million members in nine states and the District of Columbia – Northern CA serves more than 3.3 million members in 21 hospitals and 233 medical office buildings – We have 7,129 physicians and 74,985 employees, of whom roughly 65% are represented by a labor union • We have the largest civilian electronic health record in the world • Kaiser Permanente’s approach to the CDI program supports two important organizational goals: – Our support for work-at-home programs is in keeping with our long history of energy conservation and environmental stewardship – KP is dedicated to being the best place to work, offering employees multiple options for fulfilling their responsibilities CDI: Growing a New Program In the Beginning Growing Pains • Regional program with regional accountabilities • Individual medical center characteristics • Place regional CDI staff in multiple local facilities • Space challenges • Staffing issues • Interacting with local staff and physicians • Day-to-day management Rethinking Initial Assumptions Ask ourselves: What was the TRUE benefit of having CDI staff located on-site? Back to the Drawing Board ? ? ? ? Who will do the job? Consider Where will the telecommuting as an option work be done? Why should the work be done this way? How will you support this model? Considerations: • Leadership approval • Technological requirements • Staff satisfaction • Go green! Telecommuting as a Win-Win • Creating a recipe for success – Intensive new hire training program – Clear requirements around quality and productivity – Practical tools and a safe work environment – Detailed policies and procedures – Regular connections and follow-up • When possible, hire self-driven people with success working independently Position “work from home” as an earned benefit, not a guaranteed benefit. You Can Establish a Virtual CDI Function in Any Organization Getting Started Lay the Foundation Establish the Framework for High Performance Set Ongoing Performance Expectations and Guidelines • Telecommuting policies and procedures • Performance expectations and guidelines • Ensure high performance before offering telecommuting as an option • Equipment • Signed telecommuting agreements • Support staff who require additional assistance • Performance management/ improvement processes • Monitor performance trends • Home office assessments • Support staff performance with honest and timely feedback Lay the Foundation • Telecommuting policies/procedures – Check with your human resources department to determine whether there are existing telecommuting policies/procedures – Revise current HIM/coding telecommuting agreement/policy/procedure • Equipment – Determine which supplies/equipment your organization is willing to supply – Identify a specific plan for IT issues – Document accountability for damages to equipment supplied by employer • Home office assessments – Ergonomic evaluation – Environmental safety assessment – Adequate space/accommodations Establish Framework for High Performance • Clear department policies and desk-level procedures – Recommended accompanying procedures • Absence notification • Communication expectations • Productivity and quality expectations • Performance management/improvement process • Telecommuting agreement • Telecommuting procedure (including all requirements w/check-off list) • Competency validation • Provider query procedure/query compliance procedure • Chart review completion Set Ongoing Performance Expectations and Guidelines • Productivity and quality – Ensure high level of individual staff performance prior to allowing telecommuting • Identifying performance opportunities – Management monitoring of performance trends – Ongoing discussion regarding comfort level and employee self-assessment of needs and areas of opportunity • Supporting staff performance – Give honest and timely feedback Staying on Course Building and Maintaining the Team Control the Things You Can Foster What You Can’t Control • Training – Initial CDI training – Continuing education • Work flow and workload • Relationships – With providers and facility distribution – Begin with specific work flow – Allow personalization as staff become more experienced – Identify opportunities to assign work based on areas of program focus staff – Build opportunities for engagement – Develop incentives for physicians • More relationships! – With other team members – Institute daily connections and opportunities for team building Staying on Course Managing Across Distances Management Adjustments • Adjust management-to-staff ratio • Clear, realistic performance expectations • Make the extra effort to connect with individual staff members Performance and Data Sharing • Work hours • Identified performance metrics • Performance data Staff Adjustments Retention Strategies • Career paths • Recognition programs • Incremental work-at-home increases • Peer-to-peer kudos cards • Manager-designated awards • Goals include clear action plan for performance • Take responsibility for education, as needed • Remain connected to the home site • Identify process improvement opportunities Management Adjustments • Staffing and responsibilities of management – Will take more time and energy than traditional staffing; adjust management-to-staff ratio accordingly – Establish and document clear, realistic performance expectations – Make an extra effort to connect with each staff member regularly Performance and Data Sharing • Performance monitoring and communication – Monthly review of work hours (through electronic systems) – Weekly or monthly review of designated performance metrics – Facility- or service-level performance data (response rate drilled down to provider level) – Consider blind performance data sharing Retention Strategies • Consider promotional level within organizational/departmental structure • Increased accountability and additional responsibilities/special projects • Employee recognition program • Incremental work-at-home increases Staff Adjustments • Increased staff accountability – Clear action plan for performance under goals • Education • Returning to home site – Staff responsibility to identify process improvement ideas Potential Pain Points The Right People • Self-driven with high levels of personal accountability • Professional • The right experience • The right temperament • Skilled communicators The Right Sponsorship • From regional leaders • From local leaders The Right Systems & Support • Downtime procedures • IT escalation plan The Right Performance Management System • Performance feedback • Ongoing communication • Data sharing • Remote education and mentoring • Implement staff ideas for improvement The Right Places • Proximity to home facility The Right People • • • • • • • • • High level of personal accountability Professional Autonomous Chart review experience Experience and success with high-volume/high-stress work environments Ideally not straight from inpatient floor nursing Expertise at public speaking, education, presentations Previous experience within the facility Previous experience with electronic heath record and high level of comfort with basic computer programs – Consider new employee testing in this area The Right Sponsorship • Gaining approval and acceptance – Leadership • Thorough and thoughtful plans prior to presentation • Utilize current organizational goals and initiatives to support this work model • Consider a trial • Regular performance feedback Michelle Callahan, RN, BSN, CCDS, CRCR Regional Manager, Clinical Documentation Integrity Revenue Cycle Kaiser Permanente, Northern California Region [email protected] Jillian Fore, RN, MPH, ACM Senior Consultant, Clinical Documentation Integrity Former Interim Director, Clinical Documentation Integrity Revenue Cycle Kaiser Permanente, Northern California Region [email protected] Questions? In order to receive your continuing education certificate for this program, you must complete the online evaluation which can be found in the continuing education section at the front of the workbook.