Am reading a new leadership book and learning about passive vs active approaches.  I'm not a real passive kind of person...go-getter is more my style...so this book is right up my alley!  It talks about how silence isn’t always the best option, some things are deserving of us speaking up.  I see a real correlation with the documentation sector in the area of quality.

Even after allowing for my go-getter personality in the mix, I do grow weary of those in this profession who consider there to be an issue of quality in the EMR, yet don't stand up and say anything when they see so many errors. Either blatant nomenclature errors, or when what's charted doesn't match what was done in the encounter. Seeing issues of quality and hearing physicians’ frustrations about being forced to adopt method over material, I am discouraged that more folks aren’t pushing back and demanding better quality in their EMR-generated notes.  I can't tell you how many physicians have told me personally, "Well, I guess it's good enough quality for my standards," or "well, it's as good as it gets in our system."  Other comments like, "well, it wasn't in my click list, so I just didn't chart it," make me cringe that the document doesn’t match the encounter.  What sitting ducks physicians are set up be when they are told, “This is how we have to do it now.”

Hogwash.  

Giving in and re-writing the rules of quality because of some software limitation should never, ever be acceptable to us or our physicians.  We must be in the face of the nay-sayers who promise that lower quality standards are "okay" and "acceptable," and "after all, the insurance companies are paying the claim, right?” like insurance companies should be setting the quality standard for the nomenclature. 

But instead of speaking up, we often succumb to these lower standards, new definitions of quality which are defined by what's really achievable in our EMR rather than what actually took place in the patient encounter.  Silence is often erroneously equated with acceptance.  Passive approaches with silence to the contrary indicates a belief that the current system is correct, standard.  I contend that in these cases, silence just isn’t the answer.  Passivity isn’t the right approach; we will not reach our quality goals with anything other than deliberate, active efforts to the contrary.  Anything other than an intentional "no" is, in effect, a "yes."  

Especially when a vitally important standard or truth is at stake or being mangled by some, sometimes it is simply wrong to let a contrary opinion be aired without any challenge or correction.  One of the worst things we can do is show a kind of feigned academic respect or artificial cordiality to allowing serious, libelous quality errors that leave our physicians open to questions about their quality.  Our physicians deserve more.  At least, I think mine do.

Now, I'm not advocating that we pick arguments with everyone all the time.  Arguing for argument's sake, seeking out the next heated discussion - this isn't a good way to conduct business, nor a great way to lead your team. Neither am I stating that point-and-click EMR technologies aren’t a good way to document some patient visits.  On the contrary, Eagle’s Landing offers our own templated system to our physicians, we train on how to set up/configure/use templated charting, and we point out ways physicians can move from tradition dictation to templated charting in some cases.  But we never, ever promote a method-over-material concept.  When the holistic description of the patient encounter is compromised or pared down, it is time to return to dictating the visit.  

Many folks just don't address quality, as if it's some unspoken, hush-hush, don't-talk-about-this part of their computer system.  This couldn't be further from the truth.  By and large, the physicians I talk to most definitely want quality in their documents.  And its absence is a real source of frustration for them.  So passive just won’t work.  Silence is not our friend.  Quiet defeat doesn’t put quality back at the top of the EMR priority list and it won’t send the message of how important quality really is. Quality documents are more than just good patient care - they are good physician care.

Nugget:  If quality is something you're passionate about, then we owe it to the physicians to stand beside them and be a vocal proponent of their cause, not giving into silent, passive agreement to compromised quality standards.