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Successful Collaboration in Healthcare: Review of Colleen Stukenberg’s New Book

I moved Successful Collaboration in Healthcare: A Guide for Physicians, Nurses, and Clinical Documentation Specialists to the top of my list of books to review because I was intrigued that a nurse would write a guide to collaboration.  As mentioned in  Nursing Collaboration, most of the valuable clinical insights that I have learned have come from interactions with nurses.

I liked what she wrote about communication differences (p.20):

Whereas nurses may focus more on the person and patient knowledge bases, physicians may concentrate on the case knowledge….Although all three aspects may be important when considering the patient’s plan of care, the person considering one set of knowledge may not think the other set of knowledge is as important….Although the physician and the nurse may focus on different aspects, their ability to collaborate for the benefit of the patient should not be affected.

She recommended using the situation, background, assessment, recommendation (SBAR) format to standardize information transfer (p.17).

Ms. Stukenberg’s analysis of the role that physicians and nurses can play regarding financial issues also intrigued me (p.36-37).  For example, reimbursement can nearly double if pneumonia and a urinary tract infection (UTI) that was present on admission cause a major complication in an elderly patient.  Clinical scenarios (p. 107-110) illustrate the importance of physicians and nurses working together, for example when a nurse notes cloudy, foul-smelling urine on admission, contacts the physician to order a urine culture, and when it comes back positive, the clinical documentation specialist makes certain that the chart notes support that the UTI was present on admission.  If not documented properly, payers may conclude that a UTI represents a hospital-acquired condition that they do not need to reimburse.

Ms. Stukenberg wrote that clinical documentation improvement programs are in their infancy and represent a source of competitive advantage for hospitals that are willing to invest in improving documentation and care processes.  Success depends on:

• Hiring the right staff, who are clinically knowledgeable, understand coding and the impact of proper documentation on finances, and know how to communicate with coders, case managers, nurses, and physicians
• Providing the right tools, using a computer program to review charts in real time and match physician documentation with diagnostics (coders can only code off physician documentation)
• Assuring administrative support, especially senior hospital leaders who understand complexity, see the value of their investment, and support the documentation specialists’ credibility when physicians or nurses challenge new processes
• Having a trusted physician advisor who is well-respected clinically, able to explain coding to physician peers on a strategic level, and be a liason when needed to weigh in on important issues
• Educating coding personnel, clinical documentation specialists, nurses and physicians on an ongoing basis
• Monitoring case mix, length of stay, complication co-morbidity(CC), major complication comorbidity (MCC) capture rates,  reimbursement, and effect of documentation on hospital finances 
• Implementing systems to prevent people from reverting to previous habits once their training period ends

 Implications in an era of healthcare reform

I interviewed Ms. Stukenberg by telephone and learned of a number of benefits of investing in improved clinical processes:

• RAC (recovery audit contractors): Being proactive regarding documentation criteria for admission avoids the need to payback money already spent on patient care
• Improving transitions of care: As I wrote in Collaborative Handoffs, approximately 80% of readmissions within 30 days of discharge are preventable
  Reconciling medications, calling  patients within 48 hours of discharge to make sure that they are taking medications as ordered and have scheduled outpatient appointments with their caregivers, monitoring weight of patients with heart failure, and including family caregivers and community providers in predicting home-going needs are all tasks that clinical specialists can facilitate
• ICD10 implementation: By 2013, providers will need to use a more detailed coding system; it is not too early to develop systems that facilitate adoption of the new standard
• Public reporting: in an age of increased transparency and scrutiny, doing processes correctly the first time can improve clinical and financial outcomes and build an organization’s credibility and brand recognition
• Building a culture of collaboration: As I wrote in Collaborative Culture, a culture built by healthcare professionals from the ground up (rather than imposed from above or by outside regulatory agencies) helps to sustain improved clinical processes.

Readers who would like to communicate directly with Ms. Stukenberg can reach her at MCRN@AEROINC.NET.  Her book is also available through www.crcpress.com.

This 113-page book is loaded with practical strategies for improving healthcare collaboration and clinical and financial outcomes.  I believe that it is a must-read for middle-level and senior healthcare leaders in this era of healthcare reform.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure: I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

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