Every week, I try to read at least one book from the business section of Amazon.com. To be sure, many of them are rubbish. The really great ones change the way I think – Blink, for example, by Malcolm Gladwell. This week’s book is Good Strategy Bad Strategy by Richard Rumelt. This book is neither rubbish nor changes the way I think but it articulates many of my own feelings about both business and nursing.
Mr. Rumelt should have talked to nurses before he wrote his book. Good nurses are excellent at planning strategy except we call it care planning. On the business side of things, we often confuse strategy with goals. Or we think a mission statement or ‘shared vision’ is the answer to growing business. We have entire strategic planning events where a grocery list of goals is put forth. But in business, we rarely come up with good strategy.
Strategy is the part we gloss over. Strategy is the part where we roll up our sleeves and do things to accomplish the goal. A good strategy takes into account the obvious hurdles. A bad strategy is easily recognized by buzzwords and cliché’s. Nurses do not write, “Dress wound appropriately using innovative and imaginative methodologies and the latest technology to outshine the competition.” I would love to see a surveyor go after that order. They simply determine how to best treat the wound. In other words, they write about specific orders.
The greatest barrier I have found in strategic planning is an agency is fear. Great strategy means making focused decisions and setting priorities for the organization. It is not a democracy. There may be other needs in the agency that are not being met while resources are focused on another area. The ‘shared vision’ may not be universally shared when attention is focused on only one part of the agency.
However, like all businesses health care sells widgets. Our widget is patient care. A blog readers states that documentation is akin to a receipt for payment. So, the first question you should ask is whether or not your clinician skills are where they need to be and if the documentation supports payment. Only when the answer to that question is a confident, ‘Yes!’ can you address other areas in the agency. So, most home health industry leaders agree that clinical care and subsequent documentation is critical.
But, what is the strategy? I have seen many that don’t work. Reading notes as they come through the door and writing deficiency reports is not the answer. The value of note outside of the context of a chart cannot be determined. Scolding the nurses as though they were two year olds is not good leadership. I didn’t read that in a book. It is just a gut feeling. Electronic programs such as Episode Master are great tools but like a hammer, it is limited in scope. You cannot build an entire building with only a hammer as a tool and you cannot build clinical excellence with Episode Master. So really. What is your strategy? What are the specific steps that need to be taken to improve your clinical skills and documentation?
Assuming documentation is your Achilles’ Heel, think of all of the other problems improving documentation can solve. Billing is done timelier and more efficient. Marketing is easier when good documentation allows for communication with referral sources. It is easier to assess skills of clinicians when they are documenting appropriately. Surveys are conducted by surveyors instead of terrorists. Money earned is money kept. The list can go on forever.
So whether it is documentation or another area in your agency that is jeopardizing your future, be strategic about it. Find the problem. Diagnose the cause of it. Get all the information you can and then make the hard decisions. Limit your focus to what is ailing you.
You cannot fix everything wrong with your agency in one fell swoop and yet, if you have a bad survey that is exactly what will be expected of you.
If you are feeling creative today, post a comment about what your strategy is for the future. Or, email me with your comments.