Bring a physician to lunch: A case study
When Bernice Baker, RN, BS, CCDS, began working as a CDI specialist at Union General Hospital in Blairsville, Georgia, just over a year ago, her hospital’s CEO had one request: “We need more education.”
Physicians were unhappy with the fact that the majority of the educational offerings took place in the evening, according to feedback. They preferred quick meetings during lunch, Baker says. So she brainstormed, then had a eureka moment—why not do a lunch-andlearn program?
The first event took place in May 2015 on a Tuesday afternoon and consisted of two 30-minute sessions with slides and a verbal presentation. The first session started at noon, for those who had an earlier lunch. Then, at 1 p.m., the same information was presented again, for those who had a later break. The half hour in between sessions provided time for physicians to ask questions and relax. And, of course, the facility served a nice lunch.
“Physicians have unpredictable schedules, so we wanted to come up with something where they could choose one session, or come at the end of one session and see the beginning of the next one,” says Baker.
For the first five or 10 minutes, Baker, who is a solo CDI specialist, discusses business and general updates. For the remaining minutes, she delves into a specific topic. The topics are usually based on needs identified by the CDI department. Often, this includes common culprits such as pneumonia and acute respiratory failure. Other times, the CDI team selects a topic based on the diagnoses or procedures that elicit the most queries. In earlier sessions, CDI staff would spend a few minutes discussing CDI in general— what it is, its mission, and why it exists. (Read the related article regarding the importance of the CDI mission statement on p. 20.)
The CDI team gets physician feedback about their preferences for lunch-and-learn topics.
“[The physicians] need to be a part of setting [the meetings] up,” says Baker. “They want to see less of me, not more, and they want fewer queries. Having their input helps us tailor education for their needs.”
The CDI department also partners with other departments to discuss more complex topics, like quality scores and public data reporting.
Following each session, Baker creates a bulletin board to highlight informational takeaways. For example, she posts tip sheets and related documentation forms. This encourages a continued conversation as well as ongoing input and feedback. “The board is good for those who can’t make the meetings, and it gives physicians another chance to see the information and be reminded to ask me questions,” says Baker.
Initially, Baker offered the lunch sessions every two weeks, and attendance was excellent. The cadence became too frequent over time, however, so the team scaled back to monthly sessions. In the future, she plans to offer them quarterly, on both Tuesdays and Thursdays, to allow for even more flexibility with physicians’ schedules. “We want to do whatever works for them considering the limitations of their time,” says Baker.
Before the lunch program started, Union General Hospital did not have a true CDI program—instead, the program had been an extension of the case management department’s record review efforts. Baker, who had two years’ experience as a CDI reviewer and a background in quality prior to her arrival at the facility, expanded the focus of her reviews beyond the financial perspective to improve quality and capture a more complete clinical picture.
Providers want to put the patient first, so the role of CDI is to help them capture within their documentation the care they’ve provided, says Baker.
“Physicians are open to [improving documentation] for the sake of accuracy and reflecting what is correct so they can give better patient care,” she says. “If our documentation reflects a better and clearer picture for the next provider, we improve care for that patient.”
“Physicians are open to [improving documentation] for the sake of accuracy and reflecting what is correct so they can give better patient care,” she says. “If our documentation reflects a better and clearer picture for the next provider, we improve care for that patient.”
She adds, “Physicians need to know that you are their champion and their friend. Let them know that you are there to help them, not change them, and work with them to figure out what needs to be improved and why.”
For those facilities struggling to engage their physicians, Baker has one last thing to say: “Don’t give up! Some physicians love to argue, which is fine. Listen patiently. Keep on trying, and usually they’ll come around.”