Multi-facility CDI management requires planning,
communication
map that supports staff in their daily work. This will go a
long way to sustaining the goals of the program.
by Fran Jurcak, RN, MSN, CCDS
Implementing and monitoring a
CDI program across a system with
multiple hospitals is a complex and
challenging experience. It requires a
great deal of planning and attention
to detail to ensure success. If you want to do it as seamlessly
as possible, you must:
»»Establish departmental policies and procedures
»»Develop a process flow map
»»Schedule educational sessions prior to the go-live date
Once this preparatory work is complete, you can deploy
CDI across the system.
Communicate second
Although some minor changes in process may be necessary due to variances in facility size, physician service lines,
and number of CDI staff, the variances in the processes
from facility to facility as outlined in this article should be
minimal.
You can prevent miscommunication and identify barriers to a successful transition through careful planning (see
the chart on p. 18 for a breakdown of recommended CDI
program implementation activities). Once you implement
the program and put your plans into effect, appoint a strong
leader with the capability to ensure that processes are maintained across all facilities. This person should have the time,
talent, and energy necessary to achieve this task.
Plan first
First, take the time to develop and establish policies and
procedures that can guarantee consistency among facilities.
The following is a process I recommend:
»»Develop appropriate policies related to the CDI process.
At a minimum, these should include communication of
concurrent queries to the provider as well as reconciliation
of unanswered provider queries prior to implementation.
»»Implement a consistent set of tracking tools across all facilities. Complete your measurement methodology prior to the
start date. Ensure consistent education and training of all
staff, CDI specialists, and coders. Doing so provides all staff
members with a common knowledge base to support the
daily functions of the team. Establish a clear process flow
To ensure ongoing success of a multi-facility CDI program, you must be an effective communicator and establish
a process of effective communication. Many CDI directors
struggle to manage programs where the distance between
facilities is too great to travel on a regular basis. In such situations, communication via conference calls and Web-based
access work well. Still, face-to-face meetings create team
cohesion and acceptance, so do not neglect at least annual
visits to individual facilities. Aim for monthly or at least
quarterly visits as a best practice.
To that ensure clear and consistent communication occurs:
»»Establish a network email group
»»Schedule monthly face-to-face team meetings and set clear
agendas for those meetings
»»Arrange one-on-one meetings between the CDI program
manager/director and individual CDI staff members at
least monthly
»»Set regular site visits for each facility
»»Share metrics regularly
Make attendance mandatory at all virtual (telephone or
Web conference) CDI team meetings. This measure ensures
that CDI staff receive communication consistently. While
consistency of goals and expectations is important regardless
of the distance between facilities, the greater the distance, the
more important this communication becomes.
Make it a priority to speak regularly via phone with each
CDI specialist when face-to-face meetings cannot occur.
Communication should be delivered via a detailed agenda so
that all team members receive the same information.
Electronic data entry and Web-based tracking tools provide the most reliable method of monitoring metrics across
a system. This also allows for live viewing of the data for
evaluation of data correctness.
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July 2012
© 2012 HCPro, Inc.
Evaluate and enforce third
Although I recommend that each facility monitor the
same statistics/data points to ensure consistent evaluation
of CDI program success, some situations make such applesto-apples comparisons inappropriate. For example, case-mix
index, query rates, and CDI staff productivity may differ
based on the size of the facility, its service line offerings, the
percentage of its record that is electronic, and the number/
type of payers being reviewed.
Although you may create reports for the system leadership using data collected from multiple facilities, you should
create a separate report trending individual facility data. This
enables you to evaluate an individual CDI specialist’s performance.
Query rates by facility may differ, too, due to physician acceptance and participation. Differences in physician
­buy-in/support for a CDI program impact the amount of
time it takes an individual CDI specialist to review and query
a given chart. Therefore, comparing CDI specialists’ statistics
between a large teaching facility and a small general community facility in the same system is not reasonable. Instead,
trend behavior over time and compare individual programs
to like-sized facilities with similar service lines.
Enforcement of system policies and procedures typically
falls to the system CDI program manager/director with a
dotted line of communication to facility leadership, such as
the HIM manager/director or director of case management.
This clear chain of command allows facility leadership to
stay invested in the program while supporting the overall
CDI mission of the entire system.
Review and revise last
Maintaining a cohesive and successful CDI program
across multiple facilities requires constant attention to detail
and establishment of clear pathways of communication.
Remember to:
»»Develop policies and procedures that allow for accurate
work function and measurement of CDI metrics prior to
system rollout. This will allow for identification of clear
guidelines for success and openly detect process issues that
may need refinement.
»»Identify clear goals and expected outcomes and communicate
them to the CDI team. This will allow for a successful transition to system accountability of a multi-facility CDI program.
References
Section III:6 System Implementation 177, NYS Project Management Guidebook:
www.cio.ny.gov/pmmp/guidebook2/SystemImplement.pdf.
Keys to Successful System Implementation: Process Analysis, The Healthcare
Informatics Associates Consulting Team: www.hia-inc.com/pdf/HIA-White-PaperProcess-Analysis.pdf.
Editor’s note: Jurcak is an ACDIS Advisory Board member and the
director of CDI Practice for Huron Healthcare in Chicago. Contact her at
fjurcak@huronconsultinggroup.com.
Recommended activities for implementing CDI across a system
Pre-implementation activities
Develop system policies and procedures
Implementation activities
Schedule educational sessions for CDI
Post-implementation activities
Provide ongoing education
team and physicians
Develop system process flow map
Utilize process flow map
Review/update process flow map quarterly
Identify measurement methodology
Report metrics at system level
Report metrics at local and system level
Identify tracking tool
Provide data entry
Implement quarterly quality review to
Schedule education
Identify barriers to success at local and
ensure data accuracy
Transition ownership to local level
system level
Source: Huron Consulting.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, please contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
© 2012 HCPro, Inc.
July 2012
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