Is there such a thing as a perfect CDI program?

In the world of CDI, it often feels like all the stars must align for the perfect program to exist. After reading recent articles on the CDIA community - “CDI Strength: Beat Risks, Boost Sustainability” by Mike Kertes, and “I have a clinical background and want to become a CDS; do I need a coding qualification?” by Nour Alatari - it prompted me to think about what this alignment entails and what a program might look like if the stars don't align.

It is widely accepted that active executive support, a symbiotic relationship between Clinical Documentation Specialists (CDSs) and Health Information Services (HIS), high levels of engagement from medical staff, and a focus on behavioural change through relatable CDI-specific education are all crucial elements of a robust and sustainable CDI program. These elements not only help the program survive but also enable it to thrive. However, if one or more of these elements are missing or inconsistent, does it mean the program can't succeed?

There are many reasons these essential elements might be absent in a CDI program. If an executive team has agreed to implement a CDI program, one would assume they are supportive of it. But this support may wane if the executive team changes. New executives might not fully appreciate or support the CDI program in the same way, leaving the program to maintain significant levels of engagement with medical staff on its own. Similarly, changes in the CDS/HIS relationship could directly impact the support and progress of a CDI program.

One risk is that if these elements are inconsistent or absent, the program may shift its focus to compensate for these deficits. This could mean spending more time building relationships with disengaged medical staff, seeking support from disinterested executives, or engaging HIS departments that feel threatened by the CDI program. While these practices are essential, focusing solely on one element could lead to neglect of other important aspects of the program.

As Nour Alatari concludes, there is a “dynamic interplay between clinical insight, technical proficiency, and patient safety. By embracing diversity and fostering continuous learning, healthcare organisations can empower CDSs to thrive in their crucial role of ensuring accurate and comprehensive patient records, while also enhancing patient safety and quality of care.” This highlights that CDI programs are not static; they rely on various support networks and must be flexible to accommodate changes within these networks.

Perfection in CDI programs is a myth.

Success is more likely when stakeholders acknowledge the opportunities within their programs and support CDSs in focusing on what works well while planning strategies to address areas that are not perfect. Recognising that CDI programs are not inflexible structures dependent on a single entity means that success is observed when flexibility is applied, and change is seen as a positive feature that can facilitate growth and sustainability. Managers and leaders of CDI programs must identify opportunities and develop strategies to maintain connections with essential support networks. Two main concepts are at play here: thriving and surviving. CDI programs can survive when key elements are compromised, but to thrive, certain measures must be implemented to plan for inevitable environmental changes.

• Ensure that CDI is embedded into the culture of organisations so that it becomes the norm, not the exception. CDSs must be active in key medical meetings and maintain respectful relationships with all clinical staff.
• Implement succession planning strategies to prevent the derailing of programs when changes occur.
• Maintain a focus on complete transparency within the program to avoid misunderstandings, especially among key stakeholders.
• Identify clinical champions who are fully engaged with CDI and maintain an inclusive relationship.
• Continually acknowledge that change is inevitable, and perfection does not exist. Conduct regular reviews and risk assessments of programs to identify opportunities for growth. Remember, the stars may not always align, but with the right adjustments, programs can continue to be their best version.

The final word. 

In the ever-evolving landscape of CDI, success is not about achieving a perfect alignment of elements but about recognising and embracing the dynamic nature of the journey. Flexibility, strategic foresight, and a deep commitment to collaboration are what allow programs to thrive, even when circumstances shift. As CDSs, HIS teams, and executives navigate these changes together, the goal should be to foster a culture where CDI is not an isolated effort but an integrated, resilient practice. By planning for the inevitable, valuing adaptability, and staying connected with key stakeholders, CDI programs can remain not only sustainable but transformative - proving that even when the stars don’t align perfectly, success is still within reach.