Try a reflective, staff-focused CDI audit to drive department improvement

By Brian Murphy

On the new episode of Off the Record Dr. Nicole Fox offered up a terrific suggestion for setting up your new year for success.

A reflective CDI department audit.

Not a standard chart audit for query compliance and accuracy (though that’s part of it), but a person-to-person audit, with the goal of aligning individual strengths and interests with departmental roles and responsibilities.

I love this. CDI leaders take note.

You’ll find discussion of this topic at about the 24 minute mark of the podcast. I’m including a video clip of the discussion, too.

Individual and departmental goals should ultimately align with the mission of the organization and its strategic direction. Develop your goals with that overarching framework in mind.

If you don’t have a strong link to the administrators at the top of your organization, that should be a 2024 goal, too.

“I find one of the most common mistakes is that CDI programs may not have a direct line to hospital administration, so they’re not really sure (what the organization’s strategic goals are),” Fox says. “It’s a huge setback to start going in one direction with a goal and then realize that no one else cares about it.”

Cooper Health Care’s CDI team works closely with c-suite executives, including its quality and safety team (overseen by the VP of Medical Affairs), and revenue cycle, and remain in constant communication throughout the year.

But once established and with broad strategy and goals aligned, then comes the interesting part of the audit: Performing a deep-dive on individual team members. This includes chart audits and quality checks, but also fundamental inquires including:

• Is our staff happy?
• Are they functioning at the highest level?
• Are they pursuing career development activities?

“It’s making sure everyone is satisfied that we’re moving toward a collective Ikigai, I guess you could say, and that people aren’t stagnant in their roles, and continue to learn,” Fox said (note: Ikigai is a Japanese term for purpose/reason for being). This process of discovery steered one CDS into her true passion—mortality reviews.

This process involves 1:1 conversations between the CDI director and staff. Fox recommends asking thoughtful questions to elicit genuine conversation. And then taking the time to listen. For example:

• What’s giving you anxiety in your role?
• Do you have any crazy ideas for CDI?
• What have you heard (at conferences, in your trainings) and what do you think is on the horizon?

It takes time, but it’s time well spent.

Finally, Fox says it’s important to frame these audits not as critiques or “gotcha” moments, but as challenging your team to be the best version of themselves. “It’s not a critique, people sometimes get the wrong idea, they get a little defensive, a little bit closed off. That’s not what it’s about. It’s about how you can be even better, how you challenge yourself to be the best of yourself.”