Q&A: Orienting new staff remotely

As a benefit of membership in the ACDIS CDI Leadership Council, ACDIS Associate Editorial Director Linnea Archibald sends out “missed connections” emails with questions from Council members on a regular basis. Anyone with experience related to one of the questions was invited to respond and Archibald connected them with the question-asker.

In order to share the information more broadly, the answers to popular topics are periodically compiled and shared in Q&A-type articles in the monthly Leadership Council newsletter, the CDI Leadership Insider (CLI). This Q&A was originally shared in the December 2022 edition of the CLI. Please note that questions and answers have been de-identified for the purposes of this article.

Q: If your CDI team is completely remote, how do you successfully orient new hires? How long after hiring do you allow the new hires to also work completely remote?

Council member answer #1: We have oriented staff remotely since the pandemic. New hires come onsite for one to three days to pick up equipment and ensure all their logins, phone, and applications are set up properly and then we use Zoom for precepting and mentoring for 12-13 weeks.

Once orientation is over, they continue remotely and communicate via phone, email, and text. We stay connected even though we are remote!

If a CDI is struggling, we can ask them to come onsite but because my leaders and preceptors are remote too, it hasn’t been an issue.

Council member answer #2: Our CDI team is completely remote. Since July 2021, we have onboarded 10 new CDI specialists to our team all in the remote environment. We utilize Zoom (or Microsoft Teams). We have a 13-week orientation that includes one week of revenue cycle orientation, two weeks of MDC training, and one-on-one orientation.

Each new CDI specialist gets a preceptor (or two) throughout the 13 weeks. Usually, the amount of time spent in a meeting each day decreases as the weeks go on. The beginning is time intensive with most of the orientation being on a meeting with screen sharing. As the orientee gets more and more independent, the reviews can happen without being on a meeting and either email or afternoon meeting follow-up.

We do not have office space, so our orientees are remote from the time they start. If there are productivity concerns, we do deep dives into time spent in the system, cases, etc. After orientation we also have assigned mentors on a rotating monthly basis for six months. This really gives the new hire someone to go to for questions for the first nine months. After that, they have probably developed some relationships and go-to mentors of their own.

Council member answer #3: We have successfully trained four new CDI staff fully remote in the last few years and they are completely remote from the start. We meet the first day so that we can meet in person, and they can get their computer equipment. That day, they go home late morning and get set up and start their orientation process. We have an orientation manual that allows them to self-navigate through the CDI orientation. I plan for check-ins regularly to answer questions and ask questions to make sure they are getting what they need from the information. We require them to do this with their camera on.

Once they get past the logistical stuff and onto the Official Guidelines for Coding and Reporting and MDC information, they have reading to do on their own, webinars, and online modules that correlate with each MDC. We also have “classroom” time to go over diagnosis and related coding information regularly (again, with cameras on).

Once we’ve covered all then MDCs, they focus solely on chart reviews and have a CDI partner to review each case with them in the beginning. This is all done via Microsoft Teams with a camera on at first. As they gain independence, it is up to the individual as to camera usage. We have a lot of fun during remote training.

Council member answer #4: We are completely remote, and we use WebEx. For the first few weeks, the preceptor and orientee have shared assignments. As the orientee gains skills and confidence, the preceptor begins to pick up cases (increasingly as the weeks go by). The preceptor continues to review the orientee’s cases for a while, but the orientee is able to become increasingly independent while still collaborating with the preceptor.

We also created a 12-week orientation binder with weekly objectives. Each week the orientee must meet the goals (which are extremely concrete and not open for interpretation). If goals for the week are not achieved, we take a “pause” and repeat the week. If there are multiple pauses, we reconsider if this is the correct role for the new hire. Because of this, we are very selective in our candidates.

Week 13 is semi-independent with an assigned persons to direct questions as needed.

Council member answer #5: Our CDI team is 100% remote and covers seven different facilities. We have transitioned orienting new hires to remote orientation. Essentially, they can work remotely from day 1 (but are not working independently until about 12 weeks after they start).

Depending on if they live near one of the facilities or not, they may have 4-5 days of in-person orientation (including system orientation/onboarding), or we may ship them their equipment and only do remote orientation. We utilize lots of screen sharing and connecting virtually throughout the orientation period.

Interviewing for open positions is also done completely virtually.

Council member answer #6: My facility has two different approaches to orientation. We are 100% remote for all onboarding and CDI work.

We have had times when we needed to hire non-experienced staff. This required building a 12-week remote orientation program via Zoom. The agenda is structured in the following way:

• Hospital orientation is remote and covers typical onboarding info.
• Foundations education covers:
  • What is CDI?
  • What is a DRG?
  • MS versus APR-DRGs
  • What is a principal diagnosis?
  • How to conduct a chart review
  • Compliant query practices
  • CDI medical director overview
• Education by MDC for common conditions that require query and cover clinical content and criteria
• Coding basics
• Query-specific education for what constitutes compliant query
• How to use the encoder

We also practice setting principal diagnoses, recognition of CC/MCC, and queries throughout the MDC education.

Once we are ready for the CDI specialist to start reviewing, we assign their units, have them pull that up, and demo via Zoom their reviews, building up over time. Once the CDI specialist is ready to go to their facility/manager as a working CDI, they are expected to meet half our productivity standards and build up to full over the course of six months.

We complete a competency checklist throughout the orientation once they are competent at a beginner level. If they are not meeting, we decide related to ongoing orientation.

When we have hired experienced CDI staff, we do a one- to two-week orientation based on what we do with new-to-CDI staff. We cover our organization-specific information and productivity expectations and do meet-and-greets with the coding team, CDI medical directors, and the CDI managers.

Since query compliance is a key focus area for us, we also do a full course on queries for all new staff, regardless of previous CDI experience.

We also have experienced new staff demo doing cases with us to troubleshoot any habits that don’t meet our processes and expectations. Just like with brand-new staff, we complete a competency checklist to make sure all areas are covered and understood.

Council member answer #7: Our team is 100% remote, and we follow a process very similar to what’s been outlined above. We do have the CDI specialist start completing reviews on week two and gradually increase this throughout the 12 weeks. It gives a hands-on approach to completing the process.

We have never been fortunate enough to recruit someone with CDI experience, but this process has worked quite well with brand-new staff members.

Council member answer #8: Our CDI department has been remote since 2017 and we cover 12 facilities spread across the state. We highly encourage using a webcam and we use Teams extensively.

New employees come onsite on day one to receive equipment and complete our HR processes. The remainder of their orientation is remote.

On day two, sessions are focused on meet-and-greets with our supervisors, manager, director, physician advisor, and senior director. We have found it very beneficial to incorporate time for the new staff to be able to associate names with faces. We also do a “New Employee Introduction” to the frontline team by having them provide a photo and answer a small survey and post it in our SharePoint/Teams site.

Our CDI educator has built two comprehensive new employee orientation sets. The curriculum is very similar to those others described. The have correlating PowerPoints, transcripts, and worksheets. One is for novice CDI specialists, and one is for experienced folks. The orientation is recorded, and each session has an associated live Q&A portion.

Education sessions take approximately two weeks. We then do “over-the-shoulder” reviews and query processes for approximately a week, depending on orientee needs.

Next, our educator has them perform independent reviews and will vet all queries. She will also review their accounts to identify missed query opportunities and provide them feedback/coaching as needed. This process will continue until she has confidence, they are ready to be independent, which usually takes two to four weeks.

Continuing support is provided through CDI buddies, supervisor touch bases, and an “ask questions anytime” approach.

We perform a comprehensive 90-day audit on new employees to validate successful orientation and offer additional education/support as needed.