Some recent conversations with MTs and coders have me questioning whether we are often their worst enemy. Right now I know that there are some sharpening their claws for the strike, but hear me out. Traditionally our profession is more reactive than proactive. I think that is an undeniable fact. Although we loudly voice what we do not like about the current state of the profession or where it is trending, we seem to shy away from the more successful proactive approach…or we begin to get involved, hit a speed bump, run back to safety and say “I tried and nothing changed.”
MTs are used to being the behind-the-scenes person who “types what we hear” (we hate the term but I think our actions, or inaction, speak louder that words) and dare not question the physician or offer ideas on improving dictation practices even though it could lead to reduced errors and increase patient safety. Coders are seeing changes pushed onto them as well even though physicians are ill-prepared to provide them the information they need to implement new changes.
We let vendors develop systems that we use on a daily basis without insisting on being part of the development and complain heavily after the fact about how it could be better. I recall a few years ago during a meeting where a vendor showed his nifty EHR that was in development. It was nice. It had a place for all medications, allergies, past medical history, etc. When asked if there was a shortcut key that would import that information into the record as the MT was typing, there was a look on his face where he realized that he should have thought about that. He mentioned that maybe he should have MTs give him ideas…wonder if any volunteered after the meeting. Obviously the EHR field has evolved immensely since then, but the main point is still relevant.
Over time I think we have allowed ourselves to be marginalized to a point where we have no voice. Even worse than not having a voice is that many have no idea what they should be voicing their opinions about. The age-old ostrich head in the sand. A discussion with some “seasoned” professionals recently led me to realize that even those in a position to know what is important to them, often simply do not read much, or any, of the information being sent to them.
Healthcare and healthcare documentation is changing at an exponential rate. We are seeing a push to the EHR with promises of cost savings and increased patient contact time despite after-the-fact corrections, the healthcare law that congress recently put into action changes the face of medicine to a degree that is unknown at this point, privacy concerns over the inability of many countries to ensure privacy is pushing work back onshore, MTs are being asked to know more for a lower rate of pay, we know we will need close to double the coders to handle ICD-10 even though there is currently a shortage….the list could go on and on.
I have heard professionals state that AHDI, CDIA (MTIA) - now gone, AHIMA, etc, are not saying or doing the right things; however, what are the complaining individuals doing to shape the future of this profession other than complain on a blog or forum? Interestingly each of these groups are run by people just like you and me who decided to be a part of shaping their association based on what they feel is best for the future. Being a part of the change is much harder than the Monday night quarterback approach that we see so often.
I do think each professional owes it to themselves to, at the very least, know the issues. That is what a professional does. We would not see a doctor, lawyer, banker, etc as a professional if they did not keep up with trends in their profession yet that is standard practice for many in this one. Although membership in a professional association is a great way to gain access to the information, there are endless other opportunities to find the information.
So here is the basic test on whether you are informed or not. Can you answer these three basic questions with confidence?
1) What is “meaningful use” and why is this term currently very important?
2) Why is the topic of the “narrative report” such a hot topic in healthcare documentation?
3) How does the recent HITECH Act affect you as an MT?
4) What is ICD-10 and why do some see it as critical while others see it as being a bad idea?
5) How is the Affordable Care Act affecting healthcare?
These topics have been mentioned frequently and loudly in professional emails, webinars, and meetings as well as discussed in various healthcare documentation publications. AHDI, AHIMA, MGMA, AMA, and other professional associations have shared the information as well. We should all be an informed professonal and in turn be the ones educating others. Every non-student should know these topics by heart now. If not, there is a problem.
So where do you stand? Are you going to react to what someone else decides is right for your future and hope for the best or be proactive and shape that future the best way you can?
Technology and as important, professionalism when dealing with technology remains the most frequent weaknesses in allied health.
Today’s topic is a combination of both professional development and technology. It is a critical issue that is often overlooked and sadly many healthcare specialists do not realize how it may be affecting their opportunities.
It used to be that you walked into an office, looked someone right in the eye, shook their hand and presented yourself. Working in a virtual environment means there is little face-to-face contact. Your instructors, networking contacts, recruiters, and eventually employers only know you by what you show them. One of the first things you say about yourself is through your email address. Sexy_mt@, mtmammawannabe@... is just not professional. It makes an initial statement that you most likely do not want. Not only does it mean that someone seeing your email address has no way to recall who you are (you want them to see your email and think of your name instantly), but it also comes across as unprofessional. In speaking to many recruiters over the years, one of the most recurrent themes is that unprofessional emails result in shredded resumes. Scary to think just how many MTs might have trouble finding a job simply because of an email address.
So here are some non-negotiables when it comes to your professional email address:
- Avoid references to your hobbies, politics, religion, children, marital status, etc. While these are things to be very proud of, they should be used for personal communication only and not professional/educational communication.
- Your email needs to have your name in it and be clear, i.e. firstname.lastname@, lastname.firstname@, firstnamelastname@, etc.
So go ahead and get started on the right foot. If you cannot create a new email with your Internet host, visit gmail.com and click Create New Account. Go ahead, do it now, and begin using your new professional email for all your professional correspondence. Reply in the comments below when you have made your new email and started using it.
I was reading a blog entry comparing large MTSOs to Wal-Mart. The author made some interesting points that inspired the reader to think; however, she had a few grammatical errors. What struck me as off was that the comments seemed to suggest that since this MT made “glaring” errors, the substance of the article was not worthy of reading. The author apparently was to be shamed and discarded as seemingly irrelevant simply because of “mute” versus “moot” and other simple oopsies. While reading the comments I was almost yelling “WHO CARES??? Get off your pedestal and listen to the message!!”
This left me scratching my head and wondering if MTs have lost touch with who they are and what their role is. Why do we as MTs feel that we are the gatekeepers of grammar? Isn’t that a faulty view of our role? I was taught that our main focus is on patient safety. We transcribe dictated material and alert the physician when we notice a potential safety issue.
A prime example occurred at a meeting I attended a few years ago where an auditor gave a presentation on what she did. She showed us a transcription and asked us to find the errors. We saw “tylenol” instead of “Tylenol” and declared it proudly. We saw “you’re” instead of “you are.” We even found some subject-verb agreement errors. The auditor kept track until we declared ourselves finished. We were so proud. A group of 20ish MTs had ripped that document to pieces and proved our relevance in healthcare documentation…or did we… After ensuring we were finished the auditor thanked us for proving her point that we have forgotten what our role is truly about. None of us noticed that there were four separate doses of morphine in the record as active prescriptions scheduled at different times which constituted a very lethal dose had they been administered. (a result of the physician increasing the strength but failing to DC the previous dose) Oops. Result- Pretty words, dead patient.
So why did a group of about twenty people with 20+ years experience for many including several instructors miss something that should have been glaring like a neon sign?
I think the reason is that we have moved away from patient safety and into the world of grammar keepers. We are fighting a battle that no physician/facility really cares about. In every example above, patient safety was never a concern; however, the one issue that was a severe risk was completely missed. In practice we have allowed so many style variations in templates that our QA spends the majority of their time checking style instead of critical patient information.
With the push towards the mandatory EHR, the role of the MT is changing overnight. The grammar keepers are being pushed aside for those who can bring value to the table. It is a very different way of approaching healthcare documentation. It requires one to look at the substance and disregard what is meaningless to all but other grammar keepers.
Now I am not saying that grammar/style is irrelevant, but I am saying it MUST not be how we define ourselves. It should be secondary except in cases where it honestly affects patient safety…And no..Safety is not affected just because we feel we want to throw our hands in the air. "I told the patient to go their" is understandable despite being grammatically correct and do not even get me started on "your, you're" or the use of commas.
I think we need to get back to substance over style. We have to refocus and get back on task. What is said must be more important than how it is said. In a blog, the writer’s interesting points could be missed leading to a lack of enlightenment for the reader which only stifles knowledge. In the case of a patient record, it could end up harming the patient. Unless we can wrap our mind around our true purpose, we are going to have little success showing outsiders why we are relevant.
We have all seen the yes people. These are the ones who agree with whatever the leader says. They have no critical thinking skills or at least choose not to use them.
This group is severely frustrating for true leaders. True leaders need followers who will challenge their message. They want a follower to alert them when their plan may be flawed. This is another all too common follower type in this industry. Poor leaders assume that these followers are good because they do not challenge the message. Too often we chastise, embarrass, and attempt to shut down those who disagree with the message lending many to resort to just nodding the head. Survivors
The survivor is a center of the road follower. They tend to feel that it is better safe than sorry. They have become proficient survivors of change by not bucking the system. This is the typical MT and coder in my opinion. They have seen changes come and go that often leave them at a significant disadvantage, but they feel their options are limited. They are reactive and ultimately fade out as they become obsolete.
Ironically, many MTSOs are in the same boat. Faced with challenges to lower costs they utilize questionable practices such as offshoring to countries with no privacy laws and questionable quality all in an effort to drive the cost of business down. Effective Followers
Effective followers are dependent, critical thinkers who are active in the process. They are proactive and demand real, purposeful change. They see themselves just as valuable to the organization as the leaders. They are less concerned about being liked than doing the right thing. They seek to bring about positive change. They are not afraid to stand up and let leaders know that their message is wrong. They are often viewed as trouble makers by those in authority because they refuse to comply with a direction they cannot support.
This industry is in dire need of Effective Followers. We should all strive towards this category, not yielding to pressure when we feel the message is wrong. Our industry is struggling to be relevant in an age where speech recognition and the EHR seek to make us obsolete. Without effective leaders to demand a new course for the industry, we have little change for success.
So what type of follower are you?
Today I recalled one of the most interesting talks at ACE a few years ago from Kathy Dempsey. She likened us to lizards that frequently must shed their skin in order to live. If the lizard does not shed its skin, it dies… So how capable are we in shedding the old in order to make room for the new? 75% of all change efforts fail. Those are some scary statistics. Those goals to lose weight and exercise come to mind; however, it applies to all aspects of our personal and business life. Kinda scary when you think about all the wasted opportunities.
The analogy is true, especially in this industry. Healthcare documentation is changing at warp speed. We went from computers to speech recognition to natural language processing and here comes this EHR “thing” that is being defined as it is being implemented. Some are panicking but many are seeing this as an opportunity to define a new future for this industry.
In this industry, we are often very complacent when it comes to new technology and change in general. It is amazing to me how often I see people regurgitating information from other sources without understanding it and/or without questioning the information's validity, where it came from, and what the motives might have been. We have to shed this superficial learning and instead embrace an in-depth learning experience.
We as healthcare documentation experts or in training to be experts must keep our minds open to the new changes. Change will happen with or without us. Change does not care if we use it or it leaves us behind. For those Med-Line students who are reading this, you are definitely fortunate to be with a school that is keeping current with technology and health information management. You will learn the tools necessary to succeed. Those who stay abreast of technology and learn to use it as a resource to position themselves in this new and exciting era are going to see some pretty cool and exciting things happen in this industry and in a relatively short amount of time.
So how good are you at shedding the old and embracing the new?
Going to school while also juggling work, family, home and the many challenges life throws at us each day could challenge the time management skills of Stephen Covey himself. At times, you might feel ready to throw in the towel and give up on school all together. It is in these moments that you must remember the value of investing in yourself. Giving up on school and turning your back on your education will be a decision you regret for years and years to come.
Take the long view
The chaos of life always threatens to derail us from our goals because the urgency of today can obscure your long term goals. When the hot water heater breaks, your kids get sick and you have deadlines looming at work, it's hard to remember exactly why you're also adding the pressure of school. Taking the long view of things and reminding yourself that school is a temporary state can help you get through the day to day. You will not always attend school and when you're done, you will look back on your most difficult days as your greatest learning moments.
When the pressures feel like they have risen to an unsustainable level, it helps to have a vision of success to look at as a reminder of why you're making sacrifices today. Success experts recommend creating a vision board with images of what success looks like for you in the future. These board's serve as a constant visual reminder of exactly what you're working for. When the daily grind threatens to pull you under, these images can keep you focused on the long term.
Take care of yourself
Keeping your eyes on the prize and reminding yourself of your long term goals can help you manage the stress of attending school while attending to your life. Some days, though, you will simply need to slow down and take care of yourself. You work hard and deserve that bubble bath, a play date with your kids, a great movie or whatever activity renews your spirit. Taking this time to enjoy life today will give you new energy to work for your goals tomorrow.
Going to school is tough. You're asked to sacrifice time and energy you don't have for future goals. But, at the end, you will look back on this time with a sense of accomplishment and pride for what you achieved.
This week we will discuss the five types of followers. Please reference the diagram to see the followership patterns ranking the degree of critical thinking to the level of activity. As you can see there are significant differences between each.
The alienated follower is a thinker. They know when the path is wrong, but somewhere along the line they realized it was useless to go against the flow. Although once open about their disagreement with the direction things were headed, they now keep silent knowing in their heart that nothing will change. This category is especially worrisome as the individuals truly want to have their opinions embraced. They want real change but feel it will never happen.
Sadly, this is probably one of the fastest growing in our industry. Too often we have heard fellow workers and association members raise the white flag in surrender as they feel nothing will change and it is no longer worth fighting. Over the course of this past year I have had more than a few members reach out to voice their admittance to this category with many leaving for AHIMA or no representation. This is quite likely a significant reason our individual professional members dropped over 12% this past year although other issues, such as the economy cannot be discounted. Sheep
Sheep are not thinkers. They are passive, timid creatures. They follow whatever they are told, doing whatever they are told, stopping when they complete the task, waiting to be told what to do next. They abdicate all decision making to their leader. These type of people are loved by bosses who have poor leadership skills, judgement, and self-confidence since they do not challenge the message.
I think we could go on all day about the sheep. These little workhorses get things done alright, but have no true understanding of why. They can only spout off talking points with no real understanding. Often leaders erroneously feel these individuals are great followers because they do as they are told. This category is especially dangerous as our industry is changing rapidly. We need all individuals to think for themselves so they will not be left behind.
(continued from part I)
Competence and Focus
Effective followers do not need to be told to enhance their skillset; they do it because they can self-analyze. They know their own weaknesses and seek to minimize them. They do not need people to hand them training. Instead they seek it out. The weak follower only takes on continuing education because it is necessary, such as to retain their credential. It always puzzled me that CMTs struggle at the last minute to get in their CECs. Shouldn’t this be an ongoing process regardless of the need for the credential? It amazes me that the students are often the ones who seek out continuing education while the practitioner often is too busy. Lastly, and critically, the good follower looks for weaknesses in the plan in order to prevent a later crisis. How often have we seen a good idea fail or get off on a bad foot because someone thought “people will just trust us.” The failed but often used “assume good will” comment has proven ineffective and should be taken as a warning sign when heard. It is a red flag that must not be ignored. People do not assume good will especially in an industry where changes happen that may or may not be in their best interest. They cannot afford to not think critically about how plans might affect their bottom line. Effective followers understand this and ensure that plans take this into account. Instead of pushing “assume good will,” they prove they have good will.
This is one area where we often ask people to ignore and people eagerly acquiesce in order to avoid conflict. Strong followers must have the courage to step up and say NO if they feel something is not right. Going with the flow just because a majority decide is not a justification for supporting an idea that one feels is flawed or harmful to the company or association. The follower must have the integrity to stand up even if doing so is viewed as defiance. The honest follower must make their concerns known and seek clarification. Maybe their understanding was incorrect, maybe not.
If it sounds like the definition of a follower is similar to the definition of a leader, then you got it. Followers should be eager, self-reliant, and willing to think about what is being asked. Followers must be willing to take a stand when they feel the direction is wrong. Followers are not silent, second class citizens who are required to agree. In essence, the best follower is a miniature leader. Too often followers submit to those who have been in service for a longer amount of time or because they have a high position of authority. How many times have we seen a failure or near failure that we knew was coming but yet we allowed ourself to be silenced. How much better off would we have been if followers had demanded that plans be better developed, better communicated, and better implemented in order to prevent pitfalls. Every leader needs a strong follower who can serve to move their agenda forward when it is sound and yell stop when it is not. An ounce of prevention is worth a pound of cure.
I challenge everyone to look at the areas where you are a follower and ask yourself if you are an effective follower or just filling a seat. Do you think you are an effective follower? What is your gut feeling when you hear the word follower? Reply in the comments and explain why.
There are 5 main types of followers that we will discuss next week:
We spend a lot of time teaching people how to be a good leader, but very little time teaching them to be good followers. We even view the idea of being a follower as a bad thing, something to be shunned. How often have we seen some leadership book tell us to stop being a follower and start being a leader? Ironically we spend most of our time in the role of a follower. Many of us are leaders in the workplace and in our professional association. Now think about the other roles where you are a follower, at church, at school, in committees where you serve as a member, as a citizen of this country, etc.
Few have thought about followership, despite the fact that the followers are often the ones who ultimately determine if a project succeeds or fails. It is not the leader who has the true power. The follower is in control of what happens and is the key to moving an idea forward or shutting it down. The greatest general in the military will never succeed without the soldier. Steve Jobs could not succeed without individuals bringing his ideas to light. An MT company fails without effective MTs. ICD-10 implementation will fail without coders moving it forward. Associations fail without effective members.
Many have no idea what followership is all about, even though it is something we do all the time. Often the strong leader makes a terrible follower. We sit on committees and detach from the process, we just nod our head, or we simply agree with everything the leader says. When we disagree with something, we allow ourselves to be silenced into submission even if failure could be imminent. I would argue that a person who cannot be a good follower probably has no place as a leader since their limited skill set makes them unable to truly lead.
Qualities of Strong Followers
Ability to Think for Oneself
Good followers are intellectually invested in the project. They think for themselves and feel free to disagree with the leader if need be. Their disagreement is intended to improve the idea, not subvert authority. Sadly many high-quality followers are labelled as troublemakers and excluded from the process because the leader is only able to see their own way of doing things. The exception would be the follower who dismisses an idea in order to push their idea or agenda forward. When this happens, the best outcome is often removal of the follower.
Good followers are committed to a project and do not need micromanagement. Strong followers do not need to be begged to take on an assignment. They realize that volunteering for the project/committee entails taking on assignments, so they volunteer readily and make it a high priority. How often have we chaired a committee where some members could not be bothered to attend meetings, let alone handle a task offline? Chairs often have to send many reminder emails to the members in order to get them to do their task? Ask any chair and often they will tell you that the number one challenge is getting members to do what they say they will do.
The same could be said about governance with the individual who runs, is elected, and then shuts down. How often have local board of directors referred all national association questions to the national board of director instead of serving on committees and following the news so that they would be in the know. I like to think of these people as seat warmers. They have the position, they enjoy the authority and respect, but they are largely wasting time and damaging the system.
(to be continued tomorrow)
In the meantime, what is your initial feeling on the idea of being a follower?
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