Q&A: Temporary staffing

Q: Are you using contingency staffing in your inpatient programs? If so, do you require any pre-testing to evaluate competency? What has you experience been with using these temporary workers?

Response #1: We currently have more than 10 open positions due to a new expansion plan. We have six contract CDI specialists working with us for the time being. We have had contract staff in the past as well, but it is always a pretty significant undertaking. We require telephone interviews and require all “applicants” to have Epic and 3M 360 experience (our platforms we use every day) and a CCDS certification. We also require candidates to share a query example from a previous contract, just to see how they formulate their question and the indicators used. Our program has strict query processes and pretty high standards, especially when considering the price of contract staff.

The ramp up is usually a few weeks. I only expect orientation to include system-specific processes and policies, we should not need to provide any CDI-specific education or direction as I believe contract staff should be subject matter experts and the best of the best in the field. This is what we’re paying for. Our expectation is that contract staff be meeting our internal productivity metrics (10 or more initial reviews, 21 or more total reviews daily) within a month at the most. If after a few weeks we can tell they cannot keep up or do not have the experience/knowledge, we end their contract.

We, too, have had variable experiences. We’ve had some excellent CDI specialists and some who I don’t personally believe were prepared to work in contract roles as that is a fast-paced position that requires the ability to adapt. Contract employees in general require a lot of oversite and auditing as their work is still a reflection of our department and reputation. If you can find the right people, it is worth it.

Response #2: We do have contract staff working with the CDI team. This is our process we follow:

The new staff member’s resume is sent to me by the contracting agent, and I review the information to see if their skillsets match and are a good fit for the team’s needs.

If I feel the person has the skillset, the contractor trains them on our process flow with a contractor who is already part of the team currently in a shadow process format.

The CDI internal audit team begins to audit the person at the beginning of the new month. The audits are the same audit features that our permanent staff are held to.

I follow the audit team notes and comments for improvement for two months to see if the individual is improving (or not) and relay this information to the contractor agent.

I have weekly meetings with the contractor agent each week regarding their staff and my team needs.

Response #3: We are using interim staffing for our inpatient program. This is new for me as I have been fortunate in my long CDI career to not have to go that route. With all the growth and competition, we have had to explore other options to close coverage gaps and vendor CDI staffing has been helpful.

We have found that testing the candidates is very helpful to ensure the skillset aligns with our standards. We administer a proctored exam with the requirement to have the same passing score we use for internal candidates.

If they pass the exam, we then move them forward to an interview with our leadership team. In that interview we discuss the goals, expectations, and culture of our program. If that goes well, we extend the offer.

Ramp up time is usually fairly fast with only normal barriers of access/IT, etc. We hold them accountable to the same productivity standards as our internal staff. We meet regularly with the vendor leaders to ensure all our expectations are being met. We have had a few that, despite the screening, were not able to meet our requirements and the vendor was very quick to dismiss them from our team.

Overall, it’s been a good experience and I would recommend it to help with those staffing gaps.

Response #4: I would echo what other respondents have said and reiterated that it is very important to test the interim staff to ensure they can meet your projected standards. We found that proceeding without doing so set us up for failure. My recommendation is also to share the productivity standards up front with the interim staff and if there are any red flags, don't move forward with them. There are some staffing agencies that screened their candidates better than some. 

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly newsletter for members of the Leadership Council. For the purposes of this article, all Council member answers have been deidentified.