2023 CDI Week bonus Q&A: Professional development and staffing
As part of the 13th annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Ashley Wells, MN, CMSRN, RN, CCDS, CDI consultant with Medovent Solutions in Dallas, Texas, answered these questions. She is a member of the ACDIS Furthering Education Committee. For questions about the committee or the Q&A, contact ACDIS Associate Editor Jess Fluegel (firstname.lastname@example.org).
Q: In the 2023 CDI Week Industry Survey, 84.39% of respondents agreed or strongly agreed that they have received sufficient materials to perform their job well. What materials do you find important to be provided to CDI staff?
A: In my opinion, there are several moving parts of what needs to be provided to CDI staff to excel in their role. Before I started my CDI career, I was a nurse educator and primarily worked with nurse residents. It should come as no surprise that when I transitioned to CDI, I continued to use my “educator brain” to advocate not only for myself, but for other peers who were also new to the department. To start, staff should have awareness of and easy access to the reference tools required to conduct their daily work. However, we all know that not all charts, queries, or provider interactions present themselves in ideal “textbook” fashion. Knowing this, I would also say that supplementary materials to help support the staff to navigate these fuzzy situations and ongoing learning needs should also be introduced early and often. Lastly, I’d point out that both CDI staff and their leaders are not mind readers. The concept of expectation management is also critical in the “materials” conversation and orientation. Staff should be aware of and clear on the expectations placed on them in relation to the department’s goals and metrics as well as what their leaders expect of them.
Q: About 11% of respondents reported not feeling valued or respected by their managers. What have you found that best helps communicate to a CDI team that they are valued and respected by a CDI leader? Have you noted any change in the need for or method of communication over the last few years?
A: Since the CDI landscape has changed in the past few years with many programs operating in a completely remote or hybrid setting, leadership strategies also understandably had to evolve. As a staff member, strategies that seem to have favorable responses are scheduled one-on-one check-ins, CDI social hours (remote or in-person), celebratory efforts such as bridal/baby showers, and providing an open forum to discuss any issues or personal news. I’d like to commend CDI leaders for going through the “trial and error” to find that delicate balance of leading, coaching, and celebrating their staff’s personal and professional contributions to the team.
Q: In response to the statement “My CDI team is adequately staffed for the workload we have,” only 22.71% of respondents strongly agreed, and more than 30% either disagreed or strongly disagreed. Have you experienced an increase in workload for CDI teams or issues with hiring enough staff? Why do you think this workload vs. staffing issue exists for so many departments?
A: The healthcare industry continues to move forward into value-based reimbursement, causing organizations to “do more with less” when it comes to their resources (financial, technological, and human). Both organizational and CDI leaders must creatively leverage their technology and strategic initiatives to increase documentation integrity without necessarily increasing costs by hiring more personnel. To align with value-based reimbursement trends, CDI departments’ ability to capture risk adjustment and chronic conditions in our endeavors are critical. This is on top of the fact that our modern-day patients walking into acute and secondary care settings are sicker with multiple chronic comorbidities. This could cause CDI staff to spend more time on their reviews, projects, and provider education to ensure these conditions are documented and reported accurately. Despite this, I want to recognize the ingenuity of the variety of CDI departments featured in ACDIS publications or ACDIS Podcast episodes who openly share their barriers, successes, and strategies to make do with what they have.
Q: More than half of respondents reported their department had no career ladder for advancement in place (53.31%), though 13.72% said their department is discussing implementation of such opportunities. What advice would you give to an organization seeking to provide some type of professional advancement or development opportunity to its staff? What advice would you give to CDI specialists seeking professional development opportunities in an organization that does not offer them?
A: For those seeking professional development opportunities, are you overlooking any possible growth and learning experiences in your own backyard first? I recommend starting by being an advocate for your professional development and doing an audit of your current situation. Could you reach for the low-hanging fruit within your own workplace? Share your professional goals with your leader and ask if there are opportunities within your CDI department that you could explore, such as leading some staff or provider education, becoming involved in any quality initiatives that your department is participating in with another team, or maybe assisting with creating or revising an existing workflow process. This alone can start you on your way to becoming a subject matter expert and place you into the growth mindset to seek continual growth and learning. While the thought of sharing your professional goals with your leader or teaching a group of people may be anxiety inducing, do it anyway. You’ll learn about your strengths, what you enjoy, and how much you already know (or the areas you can grow) in CDI.
Using the backyard analogy, could you venture out a little more, such as investing into an ACDIS membership? If not, you’re sleeping on the different opportunities included in your membership! Not only will you get the CE opportunities and industry updates, you are also given opportunities to grow your CDI neighborhood a little bit more. I’m talking about networking—but don’t worry, it doesn’t have to be awkward! Did you read an article or participate in a CE offering where you felt inclined to reach out to the speaker? Do it. The worst that can happen is that they don’t respond, but the ones I’ve reached out wanted to network and share their CDI playbook. Join your local chapter and once eligible, apply for one of the voluntary committee positions. You’ll get to network with very bright and proactive CDI professionals, which can open the door to new opportunities you didn’t think existed otherwise.
For me, after joining the Furthering Education Committee in 2022, I was able to write a submission for the CDI Journal and got to participate in the CDI Week webinar. From there, I had other CDI professionals contact me this past year and through those collaborations, more opportunities ensued. Sometimes your professional development growth may require you to step outside of your comfort zone, and that’s a really exciting thing to own.
When the time comes, don’t be afraid to apply for interesting job roles or roles you may be a little underqualified for. The experience of interviewing, hearing about different CDI programs, and receiving feedback is invaluable, whether you move forward with that company or not. This can also help inspire you on your next professional endeavor.
Q: An encouraging 73.97% of respondents agreed or strongly agreed that they receive adequate feedback and recognition regarding their job performance. How is feedback given to CDI staff where you work, and how often? How can departments better recognize their staff members’ successes?
A: The survey results mirror my personal experiences so far in my CDI career. Feedback and recognition have been given often in one-on-one check-ins, staff meetings, and when I have solicited it from my leaders and peers.
Departments can better recognize their staff members by celebrating the wins—big and small. It can be as small as giving kudos for a particularly challenging provider interaction that had a great outcome, recognizing someone who taught at a staff meeting or provider group for the first time or who is an effective query writer, or congratulating the team for making it through a new process implementation. We live in a society where we focus so much on the negative or on the scarcity of resources, so sometimes receiving recognition for the little things can help staff feel seen and heard for their contributions.