Note from the Instructor: Embracing discomfort by fostering collaboration and growth

by Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS

We all have t-shirts that are our favorites. Mine are three of varying colors that are worn to the point of being paper thin, even friable I would say. These shirts are at least 10 years old, yet I love how they feel and cannot seem to part with them. When I try to wear a different t-shirt, it just isn’t the same. It is itchy, bothersome, the fit is just not right, and it can be aggravating to the point that I get irritable and physically uncomfortable and need to change.

A bit much, isn’t it? Some of you are diagnosing me already. I recognize that unless I continue the pursuit of a replacement t-shirt, I eventually will be in utter despair when my last favorite t-shirt falls apart. I exaggerate, of course (not really). But why am I sharing my clothing debacles? Where am I going with this?

We often see this same irritability and despair within CDI and healthcare in general. We stay in our comfort zones (silos) throughout the day. Yet how often are we bombarded with little irritations? Like the diagnosis that is never clarified. The coder who does not agree with your principal diagnosis (PDX). The provider who never answers your queries. The wound nurse (WOCN) who never aligns with nursing on the staging of the pressure injury. The quality coordinator who keeps asking why you cannot just code it as fluid overload. These nuanced irritations throughout the day, day after day, create bigger internal discomforts, which over time, create dissatisfaction within our role or the organization. So how can we address these?

It begins with the individual. Some individuals are more likely to remain complacent, non-argumentative, and go with the flow. They are overflowing with high levels of “emotional intelligence.” Then we have individuals who will fight the good fight. They will argue, kick, and scream, yet fail to achieve results. This is their comfort zone. Both are internally irritated yet they show different external behaviors. 

We know that organizations value high levels of emotional intelligence. They also value a lean and efficient process through strong collaboration and focused initiatives on employee satisfaction. So, what can we do?

Here are some tips to help move the irritation to comfort and collaboration.

First, understand yourself. Are you complacent or do you argue the point? Both are inappropriate. Try to understand your own personality and behaviors. There are many self-assessment tools out there like Myers-Briggs, the Big 5 Personality Assessment, DISC, and StrengthsFinder. When you understand your personality traits, it provides insight into your behaviors.

Second, realize that we all have differing thoughts and perspectives. These are guided by our environment and experience that we bring to the table. We are also fundamentally selfish creatures and will always work to protect ourselves. Whether you are one to withdraw, or always speak up, you are protecting the self. It is not comfortable nor easy to change these behaviors. What we can do is recognize the impact our behaviors have on others, which assists us to modify those behaviors to achieve better outcomes. Ask others, or even your leader, what they observe about you. Request their feedback on your behaviors in certain situations. 

When our behaviors are initiated based on achieving situational resolution, we can move forward through a collaborative effort. Always remember this phrase, “respond, don’t react!” This way, you can contribute effectively, efficiently, and gain insight and support from others. You should always work to build bridges and connectors, rather than dams and roadblocks. 

Let’s look at some of the previously mentioned examples and see how we can move out of our comfort zone, address the irritation, and move toward a more satisfactory work life.

The diagnosis is never clarified.

Examine the root cause. Is there confusion on the clinical indicators for the diagnosis? Ask the providers. Perhaps there needs to be facility-defined clinical indicators. If it is a lack of knowledge of the needs for coding the diagnosis (e.g., acuity, specificity), then work with the coding team to develop education and provide it. In this manner, you gain insight from those causing the irritation and garner support to address the situation, creating value for numerous teams.

The coder does not agree with your PDX.

First, ask why. Is it a Coding Clinic or Official Coding Guidelines for Coding and Reporting that you are not aware of or do not fully understand? Or perhaps you see clinical validation for the condition that is not evident to the coder. Ask coding to provide you with the official documents to help you understand. Perhaps meet for lunch to build the relationship, or over teams to review the documents together. Ask what you can help the coder with as well. What matters is that you both give equal respect to one another and the skills each possess to learn together.

The provider never answers your queries.

We all have that provider who seems to ignore, deflect, and argue with the query presented. What we fail to realize is that everyone wants to do the right thing, they just need incentive (and I do not mean monetary) to do it. The action is to dig into providing the incentive. Providers want to know why their documentation is being questioned and why they need to take time from their patients and family to respond. Build the relationship with the provider to understand what matters to them in their role. Are they strongly invested in the pursuit of quality measures, registry work, or the reduction of patient safety indicators and hospital acquired conditions? Show them how quality and clarity of documentation impact those areas. Or perhaps they are performing specific research and your team can do a pilot project to assist with that data. The goal is to respond to them in a way that is beneficial for both parties. When you can bring value to others, they will respond kindly. 

Another perspective on this is to realize that healthcare today is increasingly demanding. Provider tasks have increased beyond reasonable measure, and everyone has their limit. Giving grace here and there goes a long way. Hand them a candy bar on the floor, send them a thank you note, tell leadership how appreciative you are for their assistance. 

As a last resort, meet with your leader to escalate the situation rather than continue to avoid the issue.  Often a conversation with leadership from both sides smooths out the roughness.

The WOCN who never aligns with nursing on the staging of the pressure injury.

Work to understand the misalignment. Is each group using differing staging definitions? Again, bring the groups together to gain insight and understanding. Make a statement at the beginning of the meeting like, “We are here to understand one another and achieve resolution.” When you set the tone, it helps to set expectations for behavior. Then each can succinctly share their perspective to develop a plan of action and establish a standardized workflow and process. If tempers rise, a quick reminder of the meeting’s goal to understand one another and achieve resolution can often dissipate the negativity.

When we find ourselves in the itchy, irritating, confining t-shirt longing to put our old one on for comfort, take a breath and sit in the discomfort a bit longer. Take the next step to address the discomfort, stretch boundaries, build bridges, and develop collaborative relationships. It will fit better in no time.

Editor’s note: Wilk is a CDI education specialist with HCPro/ACDIS, which is based in Middleton, Massachusetts. Contact her at dwilk@acdis.org.