Guest Post: When it’s okay to fail

by Rachel Mack, MSN, RN, CCDS, CDIP

^{“Let it go, let it go}

^{That perfect girl is gone}

^{Here I stand In the light of day}

^{Let the storm rage on}

^{The cold never bothered me anyway.”}

^{-Disney’s Frozen, 2014}

It’s very unfortunate that some of the best learning experiences are the most difficult to go through. I have been fortunate enough to be the SCL Health CDI Educator for approximately one year. We are like many programs in that we are going through – how shall we say – growing pains. Our director was hired on in April of 2013 as the leader to systemize our seven hospitals into one svelte CDI program that previously had no real vision, policies, or productivity standards. Needless to say it’s been a difficult couple of years. In her first year my director had to terminate two employees that were not good matches for our CDI program and were not meeting beginner-level CDI metrics. She shared that it was one of the most challenging things she ever had to do.

Circle now to 2015. Our program has a dedicated educator—me. We have a stream-lined interview process. I’ve created an orientation manual. I’ve trained two very successful CDI specialists who are reviewing and querying at a high level and really “get” CDI (you CDI folks know exactly what I mean). We’re on fire and almost fully staffed. We also have a third new staff member who arrived with several years’ experience.

Unfortunately, I noticed early on that this experience wasn’t as intensive as we’d hoped. She never used an encoder. She didn’t read records thoroughly. She couldn’t identify chronic respiratory failure in a COPD patient. Or acute renal failure in a septic patient. She didn’t know how to perform a follow-up review. She had never heard of Guillain-Barre syndrome.

I began internally panicking. “What am I doing wrong?” “What do I tell my boss?” Then the positive, glass-half-full side of me kicks in. “Everything is fine!” “She’ll get it!” “It will all work out!”

And I chose to ignore some glaringly obvious signs that this person was not a good fit for the job.

Then our CDI team lead at her site shadowed her for several days, and reported back to me the same findings. She missed an easy encephalopathy query. She had sepsis in her notes, but not in the encoder. She had shortness of breath as a principal when congestive heart failure was clearly documented as the cause. The CDI team lead asked me if I’d noticed any of this.

More panic. And sweating. I was so terrified of failure—and the vulnerability that brings—that I wasted several weeks of this person’s time, as well as my own time, and our team lead’s time. All because of my horrifying fear of failure.

I finally confronted our CDI compliance and quality analyst to discuss the situation and explain that this was not a good match and, in my opinion, we may need to start taking the steps to move her out of CDI. With her direction and the help of my director that was the decision we made.

That was the easy part. Now comes the actual conversation: “You’re not performing well.  I’m not sure your experience matches what we were looking for. You’re not a good fit for this role.”

I had never had to have this conversation with an employee. With my heart racing and my stomach in knots I laid out all of the (very well-prepared) points I needed to make.

Then she cried.

I choked back tears, conveyed empathy, but stood my ground—the role of a CDI specialist is too important to not have the best people doing it. One of our facility’s core values is stewardship—we are entrusted with the resources provided to us. And when the CDI role is not well-matched, it can be a recipe for disaster.

I went home feeling terrible. I wanted to feel good and like I did the right thing. But I felt terrible.

The next day, however, she came in and said “thank you” for my honesty. I was shocked and humbled.

What I took away from this experience is this—the worst things are occasionally the best things for us. This experience forced me to get creative along the way—I made more educational pieces and improvements for the orientation manual. It increased my ability to be patient and have empathy with others. It taught me to trust my gut and confront problems before they spiral out of control.

Thomas Edison said, “I have not failed. I’ve just found 10,000 ways that won’t work.” Cheers to failure. Hopefully less than 10,000 for all of you. I quoted the movie Frozen because I truly hope the storm rages on. Bring on the failure—the cold never bothered me anyway.

Editor's note: At the time of this article's original release, Mack was a CDI Educator for SCL Health.