May 1, 2012

The ICD-10 Tale: Act II, Scene 3: “An Evening with IT”

By David Block, MD, PhD

[Scene: the private meeting room at The Humble Dragon, the town's largest Asian buffet. Corey Sue LaChienne is facilitating a meeting of everybody at Crossroads Medical Center CMC in information technology. At the front table is Hamilton Beach, the CFO ("My hippie mom named me, hoping I would blend..."). Also at the table are Waylon Yu, head of compliance, and Wiener Counter, from Billing. Marie, head of medical records, is bent over a corner table, struck by news from her MR and CDS staff: "Fritz Charcuterie's wife ran off with a blues harmonica player. It's been going on for a long time... and you know why a girl wants a guy like that. Well, Marie, now's your chance..." Corey Sue insisted that every stakeholder in information processes at CMC be present, including hardware and software techs. She stands. The room quiets.]

Corey Sue: I want to thank all of you for coming tonight. I'm Corey Sue LaChienne, a professor at State, and a mediator and facilitator. You know the hard times CMC and everybody connected to it are having. We need to talk about it and figure out how to collaborate-work together-so we all make it through. This is a private and confidential meeting where you can say what you want, and what you need to. It doesn't leave here-right, y'all?-unless you want it to. [She looks at the front table with professorial intent, and then each person in the room. Everybody signifies agreement.] This is the time to speak up. Everybody has a stake in this.

Dixie, a CDS: Well, let me start by saying that the doctors could give a damn about this. It's a joke to them, and they think I'm a joke, too. We've got ICD-10 coming in October 2014, and I'm scared. If they don't play ball and give us what we want, we're gonna fail. [Waylon clears his throat, and looks uncomfortable.] Coding and documentation make up our public face and our reputation. The geeks down in technology haven't a clue about what we're risking. Billing and Accounting don't know our names, but they know how to stick notes on my desk to get one doctor and another to put a number on a bill. [Wiener punches a "Hey, hold on just a minute... We've got 3-sigma issues of our own..." Dixie pauses for a breath. People are looking uneasy.]

Corey Sue: Dixie, I hear you saying that you don't see all the stakeholders working on this together. Right?

Dixie: Yes... and I'm damn tired of it!

Marie [jumps up, lets out war whoop]: You go, girl! Git'em.

Dixie. You are one big warpath, and we love you for it. [Everybody exhales; a few smiles; some nibble on a plate of General Tso's chicken. Dixie shrugs.]

Dixie: I'm scared. And it's all on my shoulders, and the other CDSs', and Medical Records, and yours, Marie... [Drops shoulders]

Corey Sue: Any responses?

Wiener: Well, I have to say that sometimes, I just feel like I'm a worker here... Not that there's anything wrong with that... just... I'm only a paycheck.

Hamilton: I never knew that, Wiener. I thought you felt a part of things, that you knew how important you and your folks are. Why... we call you "Wiener's Beaners...!" And I try to put you on every committee I'm on... You do a lot for us...

 


 

Wiener: Yeah... well... why don't you like us for who we are, not what we do for you?

Cost Accountant #1: I wasn't trained to be part of a group! I'm not sure I want to be! Why should I? It's why me and the others are... nerds...

Felicia from Medical Records: Me, too! I was taught just to work by myself... me and my chart and my grouper and my coding regs. That's all I need.

Corey Sue: These are the issues that I'm hearing: Some folks feel left out and alone even though they think they ought to be or they were trained to be. [Folks nod.] Some folks don't feel engaged because just getting a paycheck doesn't substitute for personal recognition-kind of like in that bar, Cheers: where everybody knows your name. [More nods] And some folks feel like they're asked to come to the party, but then nobody really cares. [Nods, especially from Wiener and Hamilton.]

Estelle, from Billing: Look... when we have a problem down in Billing, we just go to the guides... or [laughing] to Dixie. [Dixie smiles sweetly, politely offers her a middle finger.] Come on, Dixie... we go bowling together! [Dixie sniffs.]

Waylon: But I have regs and guides PLUS I have to solve my problems by getting people to do what I need them to. Me, and Hamilton, and Wiener-we're different from most of you!

Marie: You think I don't have to motivate people, and change their behavior, and work with them on results..?

Hamilton: I guess you do... I never thought of that.

Corey Sue: So, let's add on our issues about different styles of problem solving. [Agreement all around.] What else? Hamilton?

Hamilton: I know that we all have different ideas about urgency. In the boardroom and up in the main office, we talk about getting projects ready five or even ten years in the future. Dixie, you don't have ONE year. Neither do you, Waylon. Some of our IT problems we punt down the line, some we better get solved now... This ICD-10 stuff seems a ways off, but the conflicts among us that are getting in the way of that project two years from now darn well better get resolved NOW.

Waylon: And sometimes I'm not sure what you, Hamilton, and the CEO want when you talk about "getting something done." I'm not sure YOU know! We're out there in the hospital, talking to floor nurses and doctors and everybody else about "results," but we don't know which you think are the important ones that we need to be managing. IF we need to be managing them at all.

 


 

Corey Sue: So...

Marie: Well, count me in on this. We need to settle exactly what everybody means by "urgency" and "expectations."

Cost Accountant #2: Well, who is going to teach me-or us-this stuff? I don't mean just now. I mean ALL THE TIME. Every day. My mentor. My teacher. My network here in CMC that all have the same kinds of problems. WHY ARE WE LEFT ALONE TO SINK OR SWIM? Is that really the best way to make us want to be a part of CMC and its future?

Dixie: And what about those doctors? Let's say we get all our problems solved, just like we're talking about. That's what we're here for, isn't it? But it still leaves THE DOCTORS. [Loud groans of agreement.]

Corey Sue: We're doing exactly the work we need to be doing right here, right now. And as for the medical staff... well... Ken Cohn-himself a physician-has done a lot of research in this area as part of the American College of Healthcare Executives program. His book, Getting It Done, shows that individual physicians have exactly the same feelings and concerns that you have:

  1. Docs are not trained to solve organizational problems as members of a team;
  2. Money does NOT buy a doc's engagement in the life of the organizations;
  3. Docs are asked to take part in projects just because they have "MD" in their names, and NOT because anybody really wants them to participate for who they are and what they bring to the table;
  4. Docs have very different skill sets and approaches to problems that are never integrated into the life of the organization;
  5. Docs have a different notion of urgency;
  6. Healthcare organizations don't level with docs about expectations and fears and concerns;
  7. And, docs don't get that constant help that would make them feel a part of what all you guys are doing.

Docs have exactly the same issues and concerns that you have because, like you, like me, they are just folks.

Dixie: Well, I'll worry about those poor little dears when I really believe they worry about me.

Corey Sue: Then get ready, Dixie, because a new day is coming to CMC. Now, let's take a break, and then get back to some serious work.

[People get out of their chairs and break up into familiar groups. A thoughtful Marie sits down with Dixie and her friends, and listens intently to the tales of Fritz Charcuterie, MD. Fade out.]

About the Author

David Block is a physician and has a PhD from New York

University. He taught linguistics and medieval literature for three years in Illinois before entering the Abraham Lincoln School of Medicine at the University of Illinois, graduating with honors in 1979. He is a registered neutral in the State of Georgia and is a founding partner of HealthCare Mediation, LLC, in Athens, GA.

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