Radio Recap: Hitting restart on your CDI program

What happens when your CDI program is struggling and can’t seem to right itself? Rather than succumbing to the trials and disbanding the department entirely, many CDI programs hit the restart button to remake their program better than when it started. In fact, 26% of respondents to the January 31 ACDIS Radio poll restarted their CDI program in the past.

“That’s a strong indicator of where we were a couple years ago, too,” said Madhura Chandak Bajaj, FACHE, MSPT, RHIA, executive director of clinical integration at JPS Health Network in Fort Worth, Texas, on the show. “Don’t let anything stop you from doing what needs to be done and what needs to be done for your team.”

But, how do you identify what needs to be done—what problems caused the original program to fail? Bajaj suggests conducting an audit of the program first to see what’s working and what needs adjusting.

“The audit findings combined with what I saw on the ground really proved to me that there was a need for us to look at the CDI program very closely, even if that meant starting over from scratch,” she said on the program.

Focus on your staffs’ needs first, said James Montgomery, RN, BSN, CDI manager at JPS Health Network. Even if there are financial or other opportunities for improvement, everything will fail without a solid team.

“Most of the [restart] initiatives at the time I joined the team focused on team building,” which helps set the program on the right track, he said. 

Bajaj also suggests doing a cultural assessment of the team. “When you see instability in the team, you can feel the unrest,” she said. “It’s important to put your people first.”

Once the CDI program is reborn and the CDI staff have a solid team culture, you’ll need physician buy in, according to Montgomery.

While the team at JPS Health Network provided physician education and that all-important face-to-face time with the providers, Montgomery also said they’ve been able to bring everyone to the literal and metaphorical table through task forces.

“One of the best opportunities we’ve had in this process was in creating a multidisciplinary task force that included our EHR team, our CDI team, our coders, our physician coders, and several of our key physicians within the hospital […] solely geared toward making improvements in the documentation,” he said.

Those physicians participating in the task force not only can represent the needs of the physician group as a whole, but they also serve as informal physician champions to the rest of their peers.

Through partnering with the physicians on the task force and through rounding, the CDI team has also learned “how to tailor our educational delivery,” Montgomery said. “The physicians work on such a limited timeframe. Even the amount of time we have with them in meetings is very limited,” so the CDI staff have tried to instill open and honest communication with the physicians in order to best serve their needs.

Though JPS Health Network is two years removed from their official restart date, they’re still working to improve, said Bajaj.

“It’s not an overnight revolution,” she said. “It definitely is an evolutionary process.”

Editor’s note: To listen to the complete January 31 episode of ACDIS Radio, click here. To learn how to register for ACDIS Radio, click here. To read a recent article about CDI mission creep—a common cause of program failure—read this article from the March/April edition of CDI Journal.