Leading the Change When Developing an Ambulatory CDI Program

This monthly blog will discuss all the components of quality clinical documentation with a comprehensive approach to cover all areas of the healthcare industry.

By Jill Olmstead, MSN, NP-C, CCS-P, CDIP, FAANP

The eight-step change model developed by leadership and change management guru John Kotter provides a theoretical framework that can be followed when developing an ambulatory clinical documentation improvement (CDI) program. Experienced CDI professionals are looked to as leaders to help navigate the changing landscape in the healthcare industry. Their inpatient expertise will be invaluable to translate lessons learned from the inpatient to outpatient landscape.

Step 1: Creating a sense of urgency

Articulate the healthcare organization’s vision. Your organizational leadership will be setting the stage to creating a sense of urgency to develop an ambulatory CDI program. Your inpatient HIM leadership should have an open dialogue with their ambulatory coding leadership to identify gaps or missed opportunities in clinical documentation. Key data sets to review to create the sense of urgency will be the denial and compliance reporting information. When creating a sense of urgency your content expertise will be viewed as invaluable when bridging this partnership.

Step 2: Form a Powerful Coalition

Participate in a workgroup of inpatient and outpatient coding and CDI professionals. We have more in common than we realize. The nuisances of coding guidelines and rules can overshadow the fact that we all have the common goal of maintaining the integrity of clinical documentation.

Step 3: Create a Vision for Change

Develop an outreach plan with your ambulatory coding colleagues. This gesture will set the stage for an open dialogue to meet new colleagues and even develop a new skillset. Provide an opportunity to review current inpatient processes, including policies and procedures and discuss how to translate towards the ambulatory arena. The ambulatory setting is a faster paced environment. How would you translate the inpatient query process to an outpatient setting? The outpatient’s experience is now condensed from days to minutes. The provider’s face to face time with his or her patient is usually 15-30 minutes, with the expectation of completing the clinical documentation, coding, and billing within 24-48 hours.

Step 4: Communicate the Vision

Publish your informal workgroup in your local Hospital newsletter. If your health organization has a partnership or affiliation with a physician group, explore employee or local newsletter opportunities to showcase your coalition-building work.

Step 5: Remove Obstacles

Coordinate monthly or quarterly meetings on your calendar. Dedicate time on your calendar for monthly or quarterly meetings to maintain these informal relationships. Inefficient time management is one of the greatest obstacles to overcome when achieving great accomplishments.

Step 6: Create Short Term Wins

Showcase your efforts and highlight your new partnerships. Reach out to the public relations department and request to set up a table in your cafeteria to share information on the importance of clinical documentation. Coordinate your efforts with hospital-driven health awareness programs. The importance of collecting accurate health data and documenting completely is touched by all.

Step 7: Build on the Change

Outreach to your provider network for a multi-disciplinary approach. Invite a provider champion to your inpatient and ambulatory CDI professionals group. Set-up a meeting in your Hospital cafeteria and request one of your cardiologists to give a brief update on new medications for Heart Failure. You will be trying to set up a time in between their inpatient rounds and starting their morning or afternoon clinic, so do not be discouraged if the meeting does not happen the first time scheduled. Collaborate with your provider colleagues to develop educational material for providers and CDI specialist to use on key documentation concepts. Discuss challenges that each professional encounters and start a “walk in my shoes” dialogue.

Step 8: Anchor the Changes in Short Term Wins

Present at your Local CDI or Coding Chapter meeting. Share your new informal relationships bridging the ambulatory and inpatient CDI professions. Invite one of your physician colleagues you have reached out to within your informal work group to present with you and share the experience.

By taking the first step to open the door, no matter what your practice or employment setting is, will open doors for you as a CDI professional. The unintended consequences of what you receive from offering your expertise and sharing your knowledge will be 10-fold and more.


Kotter, John P. Leading Change. Boston: Harvard Business School Press, 1996.


Jill Olmstead is a gastroenterology nurse practitioner at St. Joseph Heritage Health.

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