1. RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
Kurt Lewin’s force field analysis provides a
framework for planned change. According to this
theory the status quo is maintained when Driving
forces equal the Restraining forces. Change
occurs when the driving opposing force is
stronger than restrains, this includes a desire and
perception that change will improve the situation.
Lewin's Change theory
Driving Forces:
Desire to change: Senior leadership and upper
management’s desire to change current CDI process
Support of Senior leadership and upper
management‘s willingness to provide new resources
including human resources, education , training
and technology.
Readiness of existing senior CDI nurse’s to
move forward and support for new team members
in providing training and building a strong team.
Physician Champion: Senior leadership’s support
to assigned Physician Champion who is willing to
help CDI team and develop collaboration between
physician and CDI team.
Restraining Forces:
CDI Process: The current CDI process was mostly
focused on retro reviews and query generation at
the time of coding and billing, resulting in holding
CDI nurses to be away from the floor and less
interaction and opportunity for teaching and
learning about clinical documentation.
Unawareness about CDIP: Lack of knowledge
about current CDI program by physician resulted in
query not been responded on timely manner.
Documentation System: Existing paper based chart
review was taking time of CDI nurses in traveling
and searching for medical records and sometime
missing of query placed, subsequently in resending
of queries and consumption of CDI nurse’s time in
clerical job compare to teaching and working with
physician to improve documentation.
Shortage of CDI nurses to cover all facilities and
number of patient’s medical records.
Lack of Self Image as CDI Nurses: The existing
CDI system and process was not generating regular
reports which can give regular feedback to CDI
nurses about their productivity. So CDI nurses were
not aware of their input toward the achievement of
institutional goals.
Force Field Analysis of CDI Nurses at Seton
Hospitals
Unfreezing Stage: (Need Identification)
Need was identify to change the process of:
• Retro review query generation system.
• Paper based documentation system.
• Expansion and strengthening of CDI team
with the help of senior team members.
• Education and training of CDI nurses
• Regular feedback on productivity.
Changing Stage: (Practice Change)
Change in review process: Concurrent review and
query generation was emphasized.
Electronic medical record: With the help of IT
department electronic review and query generation
was introduced.
Recruitment of CDI nurses: New nurses with
higher education were hired to build the existing
CDI team.
Training and education: The current and new
hired CDI nurses received classroom and field
base training and education by consultant and
senior CDI nurses of the team.
Collaboration between CDI and Coding
department: Official buddy system was
introduced between CDI and Coders to verify
differences in working DRG and final DRG prior to
final Coding. This allowed both CDI nurses and
coders to learn from each other in the clinical and
coding world.
Self-Image Improvement and Professionalism:
With the help of IT department CDI management
team was able to generate financial reports on
regular bases which reflects on CDI team’s
productivity. This in return improves self-esteem
of CDI nurses and image of CDI department
among other departments.
Analysis of CDI department using Stages of
Lewin’s Change Theory:
Cont.: Stages of Lewin's Change Theory
Refreezing Stage: (Future Vision)
• Knowledge is power and team building is the
key to success.. Prepare for ICD- 10 and get
ready to work in collaboration with physician
and coders to clarify the deficiency in
documentation and final coding that indicates the
severity of illness and reflects on CMI.
• Easy accessibility and availability via regular
meetings with physicians, and visible presence
on units
• Professionalism: CDI nurses needs to upgrade
their knowledge and skills as a CDI professional
by getting certified as CDS, get involved in
research base activities and attending
conferences and continue educational sessions.
Senior management needs to approve
educational budget for CDI nurses so they can
participate in ongoing educational activities.
References:
Grossman, Sheila C., and Valiga Theresa M. (2009)
Duff, M.R., Kirivali-Farmer, K.R. (1994)
Acknowledgment:
Carl Donna, RHIA, MLA, Manager HIM, Seton
Northwest Hospital
Kemevor, Nellie (US - New York) Consultant
Deloitte
LaVerne Romberger, MSN,CCM, CCDS .Manager
CDI Department at Seton Hospitals
Phyllis Rydolph RN CCM, Seton Northwest
Lewin explains the process of change into three
distinct but related experiences: Unfreezing,
Changing and Refreezing.
Unfreezing is the state in which people have a need
to learn new behaviors and to change, thus bringing
about a disequilibrium.
Changing occurs when people begin to examine,
accept and tryout the change.
Refreezing is the state in which people see their
behaviors and attitudes as a part of themselves.
Seton Hospitals Austin, Texas
Nelofar Nagji RN. MSN. CCM. CCDS.
CDI Nurse’s Vision for Change