Guest post: Full speed ahead or one step at a time—CDI leader decisions

By Barbara Anderson, RN, MSM, CCDS

The average adult, according to various sites on the internet, makes roughly 35,000 decisions per day—deciding everything from what to have for breakfast to what time to go to bed and all the decisions in-between. Interestingly, about 250 of these decisions are related to food.

Technology continues to greatly affect the number of decisions we are required to make each day. It also provides an infinite amount of information that is available to support and/or complicate decision-making. Stephen Covey, author of The 7 Habits of Highly Effective People, has said “I am not a product of my circumstances, I am a product of my decisions.”

For leaders, who make decisions that affect other people and circumstances, the stakes are even higher. The saying then would be more like “My team or my department is not a product of the current circumstances but rather is the product of decisions that I have made or will make.” That is surely a huge responsibility.

Some decisions may just be one big decision that will leave its mark for years to come or several small decisions that can gradually move the mark. Big outcomes often take many small baby steps to achieve success. Most often, too, decisions come down to two options or possible paths to take. Only having two options may sound simple, but it doesn’t mean the decisions are always easy ones. In fact, most leaders’ decisions are not easy at all. According to Bill Murphy, Jr., in a June 2019 article on Inc.com entitled “5 Simple Decisions Successful Leaders Make Every Day-Only Simple Doesn’t Mean What People Think It Does,” there are five overarching types of decisions leaders face; I’ve adapted them for CDI here.

Long-term versus short-term decisions: Let’s say your seasoned CDI staff morale is declining.  The team requested some ability for a flexible schedule that includes one day a week remote work and alternating daily hours, but you have not yet found a way to make this happen. Your leadership prefers that you allow for some changes in a year from now, after other planned hospital staffing changes occur. You, however, are also aware that the larger hospital down the street is recruiting your staff for their CDI program expansion.

After some thought, you decide to push the leadership for a change within three months because you realize if you don’t, you will be hiring and training new staff or continue working with a dissatisfied team. In this example, if the short-term decision isn’t made, either of these outcomes will detract from longer term goals of the department and the organization.

Adhering to your own vision or hearing others’ ideas and compromising: Let’s say that your vision for the CDI department is to work more closely in collaboration with quality to ensure that quality measures, patient safety indicators, and hospital-acquired conditions are well monitored and addressed for your facility. The CDI team of late has been bringing to your attention that several related activities to this end are taking away from time spent to get all their traditional CDI work accomplished. They are not able to get to all the new records or complete all their follow-up reviews every day.

In response, you take the time to meet with the CDI specialists, brainstorm ideas on what is working and what is not. You then meet with quality and come up with a resolution that tweaks your vision and now is a more palatable vision for staff to embrace.

Deciding between yourself and others: You may face this kind of decision on a regular basis. As an example, it may have to do with the pros and cons of taking time off when there is really no one to cover you. The bottom line is that you as a leader do a better job when you take the time to rejuvenate yourself. When you respect that time for yourself, you send a message that self-care is important for others too, and that you support a work-life balance.

Deciding between yes and no: The underlying condition here is that life is too short for always saying no to new opportunities. At the same time, you won’t want to take every opportunity that comes along. Each possible opportunity takes weighing and thought, and then finally a bold act to answer yes or no. For example, a CDI leader I worked with needed additional hours of a CDI specialist to cover an open position. The CDI specialist who volunteered to do so was having difficulty keeping up with his part-time workload. There had also been recent complaints from staff of his negative attitude in interactions with others. Although the leader really needed the coverage, she decided to look for alternative ways to cover. At the same time, she put more focus into coaching that CDI specialist. She did not let her need for coverage and an easy answer push her to make a wrong decision.

Deciding between what’s more and what’s better: This speaks to innovation and moving towards the future. For the CDI leader, this could mean evaluating CDI tools and weighing costs, efficiencies, and current and future drivers. How beneficial and/or necessary are computer-assisted coding tools, options for outpatient CDI benefit tracking, or population management tools? The CDI leader does not act alone in these budget-impacting decisions but bears the burden of documenting the current and potential future states of CDI with strong recommendations for action.

All these possible decisions can occur several times daily or be a one-shot decision annually before budgeting discussions. Regardless, they are all important decisions that mold and shape every CDI program for years to come. Never underestimate the role that the CDI leader plays in day-to-day and fiscal-year-to-fiscal-year CDI program sustainability.

Editor’s note: Anderson is an RN by background, having worked in various roles and settings. She has worked in performance improvement consulting for more than eight years, specializing in CDI, and currently is a manager at Huron Consulting Group. Contact her at baanderson@huronconsultinggroup.com. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.