When our company started the effort to educate the interdisciplinary team (IDT) on the Patient-Driven Payment Model (PDPM), we needed to decide what information needed to be relayed and in what order. Organizing an outline was like peeling an onion. How were we to educate on PDPM when the nursing staff was unaware of our current payment model? How were we to succeed when the nursing documentation wasn’t up to par? How were we going to get the message across that PDPM could precipitate revenue loss in a way that was directly meaningful to those who needed to alter their performance the most? The task seemed daunting. Several staff members were not buying into the information. Change within the organization had occurred often, and as a result, many nurses had become jaded.
Taking an organized approach to the problem, it became clear that we had to start the education early and adapt to the facility’s technology and workflow infrastructure. Things that we could not change in our health record software required workarounds (i.e. paper forms). Departments that previously operated as silos needed to enhance communication in order to improve efficiency. With a fixed timeline, we all had to work as a team.
Although the content of our PDPM education evolved as we learned more information, we knew that change must be initiated in a systematic way:
1) Everyone needs to give the same message. The IDT members that are placed in charge of the education: managers, directors, members of the administration; they need to know the plan and adhere to the deadlines. The focus needs to be on consistency and dispelling myths. Without consistent information, the staff will be confused about what the priorities are and ultimately make no effort to change.
2) Be available for questions. Presence on the units is essential, as it reminds staff of their accountability, and allows them the opportunity to clarify the new information. Without the presence of the educator, staff will assume things and speak to each other, thereby unintentionally spreading misinformation. Also, when they see a member of the management team present and talking about the new information, they know that it is important and therefore are more likely to follow the new policy.
3) Don’t change too much too quickly. Decide which task is going to take the longest to educate, troubleshoot, revise, and prepare for pitfalls. With PDPM, many different topics have to be taught over the course of months. The education should be gradual and the topics that are presented later should build upon what has already been learned. It is normal that the education you gave last month may need a slight revision. PDPM is an enigma. When more information becomes available, the education will become more finite.
4) When new information is relayed, the follow-up needs to be impactful. When in-servicing on a new topic, the educator should make it known the expectations, with a review to ensure accountability. If the message was misunderstood, it needs to be clarified at the time. Promote the communication between the frontline staff of different departments. For example, if the MDS coordinator identifies a staff nurse as a poor documenter, then he/she should feel comfortable and empowered to help educate the staff nurse about proper documentation on the unit at the time. Constructive criticism does not have to go through the individual’s supervisor. It should come from the expert, and it should come timely from the occurrence of the erroneous documentation.
5) Be positive, factual, and take the emotion out of it. You’re going to get negative feedback at some point, so expect it, and formulate factual comments ahead of time as a response. Refrain from exerting an authoritative approach and take the conversation in the direction that assures staff that you’ve considered their previous feedback and have made changes that benefit all parties involved. Acknowledge that change is sometimes cumbersome, but it needs to be done and you’re here to help.
6) Consolidate information where you can. There should be one primary source; for example, a policy book, or a shared folder. When there are too many versions of things, it creates unnecessary confusion. Do a facility-wide cleanup of files and file folders on the network. Create reference binders and materials to ensure that the staff has the same information regardless of the unit on which they work.
7) Involve affected staff in the rationale for change. Emphasize the reason “why” the change is happening, then follow with the “how.” The staff needs a reason to be engaged in the conversation so it’s a dialogue and not a lecture. You can open the education off with a question such as “What have you heard about PDPM?” or “What barriers are you encountering when you document on your Med A patients?” The dialogue will help you think of other obstacles for which to prepare.
You need to push the boundaries of comfort in order to effect change. Depending on the roles and responsibilities of the IDT members, changing the expectations may be required. If your facility is heavily relying on your medical record software, it is a mistake. Remember: people are the most important resource and they need to know the “why” for them to change habits. You need to sell them on the change by filling in the gaps of information, recognizing their contribution, and encouraging progress.