CMO Reflections: Hard Lessons from Leadership

Welcome to the second edition of the Alaska Regional Hospital e-newsletter. As I continue to reflect upon my first year, I thought I might briefly share one of my most recent insights pertaining to the concept of effective leadership. If any of you have not read material by leadership guru Simon Sinek, I would recommend both “Start with Why” and “Leaders Eat Last.” I have found both books incredibly powerful as well as enlightening in regards to how hard it is to find meaningful ways to motivate oneself and others and then sustain the motivation.

As a physician and surgeon, my personality is much better suited to quick and attainable results. Evaluate and diagnose, formulate an action plan, deliver on that action plan and, hopefully, the patient improves and move on to the next challenge.

Leading people is anything but this process. Leading people is much harder than rodding a threepart femur fracture or repairing someone’s digital nerve under the microscope. I could do the former fairly well and in a reasonable amount of time. I am still stumbling my way through the latter, and it is rare on any given day that I feel I have fully completed a task or project and can move on to something else entirely.

I was commenting on this very fact one day when it struck me that effective leadership is really about listening, empathizing, looking outward, and then trying to find the common ground so that you can move the process forward, sometimes by inches and rarely by yards. It is the long view; something that is not an intrinsic strength of mine.

So, my recommendation to those of you that find yourselves in positions of leadership in your groups or even here at the hospital, understand that your frustration with the process at times is completely natural and understandable. How you respond to that frustration is the mark of an effective leader. Leading people is challenging work and is not for the faint of heart or those without patience and resilience. My best advice is simply to always refer back to the “why” that brought you to this point in the first place, and then realize that each small movement towards your ultimate goal is something to celebrate.

Coding Corner

Accurate and timely coding is a critical and often underappreciated part of our role as physicians. Without providing an accurate record of a patient’s episode of care, other providers will not have a clear picture of what was done and, more importantly, how the patient responded to our efforts, both positive and negative. Accurate coding also helps codify a patient’s risk for an adverse event, including mortality, which directly impacts both ours and your publicly-reported care quality metrics. Finally, the medical record is the only way that you and the hospital can document the work you performed and the resources used to care for the patient, which ultimately translates into the compensation both of us receive for providing the care.

As such, it is the task of our coding and documentation improvement (CDI) specialists to help all of us become more accurate and thorough with our coding efforts and it is the reason that some receive queries. So, I thought this would be a good forum to highlight some of the most common queries we see across the organization, and also provide some tips as to how you might include information in the medical record to potentially avoid future queries.

Documenting Nutritional Status

This is an increasingly important component to document because a patient’s overall nutritional status is so very critical to their ability to heal, tolerate infection or surgery, or even survive a health event. In order to avoid a documentation query, it is required that one clearly identify both the patient’s type and acuity of their nutritional status. Please refer to the diagram here for a more detailed explanation and please reach out to our CDI team if you wish for additional information.