Here are more ideas about keeping staff productive and reasonably content. You may be amused that I set the goal as keeping staff “reasonably content” as opposed to just plain “content.” You don’t have to run services for long to realize that trying to keep clinical staff joyous is not an attainable goal. The work life of mental health providers can certainly be rewarding, but it can often be frustrating, challenging, and sometimes downright upsetting. I was always impressed that staff used the Kleenex in my office more than did my patients. And the paperwork/documentation part of the work is inherently annoying and, yes, can literally bring clinicians to tears. That’s why I think it’s appropriate to see practice management initiatives as more geared to reducing the pain than promoting high levels of personal satisfaction. The personal satisfaction comes from seeing clients improve over time.
Some EHR features can keep staff from bolting to another agency or solo private practice or moving on to sell real estate. These features are part of what I call the “Anxiety Reduction” role that a good software solution can offer staff. Think “EHR as Xanax for Acute Paperwork Anxiety” and you’ll get what I mean.
Let’s say you’re a clinician that just started a new job in an agency that has different workflows than the ones in your prior setting. Or you’re really talented working with distressed clients but pretty terrible at keeping track of what paperwork is due, what you have to include in each type of paperwork, and the status of your backlog. Before we instituted an EHR that guided staff through the process, most of my people seemed to exist in a perpetual state of worry and stress related to getting their paperwork done on time and according to state requirements – requirements they weren’t all that clear about in the first place.
That’s why we developed ClinicTracker in a way that clinicians would see it as an ally, as an administrative assistant of sorts, rather than as a burden. We wanted them to realize that they didn’t need to run to a supervisor or the compliance people to figure out what was due when and what they needed to include in each note, summary, or report. And we didn’t want them poring through their files to see which notes they had completed and which were delinquent. I wanted a system that didn’t make the clinicians work hard to remember and implement the documentation requirements. They might be upset if they’re far behind, but at least they knew how far behind they were and what needed to happen to catch up.
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Here are several ways we tried to make staff see ClinicTracker as a friend and not a foe:
- Over the years we developed a library of templates that outline what to include in, let’s say, a progress note or a 90-day treatment plan review. Staff knew what was required because the system could stipulate what information they had to include before they could save or lock the form. They didn’t have to remember to include the diagnosis or information about abuse history or who was involved in each session. Everything they had to cover was right in front of their eyes – whether they paid attention in the paperwork orientation trainings or not. ClinicTracker was there reminding them all along: “OK, my friend, you owe a discharge summary on Johnny Smith, so remember you have to include the following information – and, by the way, I won’t let you finalize the document unless you have it right.”
- Clinicians could also rest assured that the system wouldn’t make them waste time double entering information or retyping stock terms or phrases. If we could put information in a drop-down list, we created a drop-down list. If the system could bring forward information it knew and put it in the paperwork (like names, dates, medications and the like), that’s what the system would do. Where appropriate, the system even asks clinicians if they want to load information from a prior note or summary. If that’s what they wanted, that’s what they got.
This feature became hugely popular because it allows clinicians to bring the text from the prior progress note and modify it for documenting the current session. It also got clinicians to remember prior sessions and fit the current one into a context. We added a feature that allows you to create a library of phrases for clinicians to include where appropriate. It could be one of those standard sentences you always see in reports like, “This client made good progress over the past month and achieved all goals and objectives.” Another popular one is “The patient came to the session well-dressed and alert.” You can set these for the clinic as a whole. But clinicians can also make their own library of phrases.
A cautionary note: You have to keep a balance between using pre-stored options and opportunities for free text and allowing for narrative and integrative thinking. Neither you nor, likely, your state office of mental health want to see documentation that repeats the same information and formulation note to note and summary to summary. You and they want to see some thinking going on, not just cutting and pasting from prior offerings. That’s why, in ClinicTracker, you’ll see text boxes everywhere, especially in paperwork sections that call for some integration and formulation. Drop-down lists are great for making it easy to select simple information to include in paperwork. But they’re not meant to replace high-level analysis of clinical functioning or treatment progress.
A primary way our EHR helped staff reduce anxiety about paperwork is that we positioned ClinicTracker to be like Radar O’Reilly in the 1972-1983 TV show M*A*S*H. Radar O’Reilly was the supply clerk famous for anticipating things way ahead of the officers and putting words in their mouths because they needed him to do so. He once said, “These are the forms to get the forms that enable us to order more forms, sir.” In that spirit, we created ClinicTracker to be smarter than anyone about which paperwork was due when. Then we got ClinicTracker good at notifying staff where things stood. ClinicTracker became an early warning system for paperwork and, frankly, a bit of a task master at making sure overdue paperwork got done. We eventually developed Workflow Builder to give administrators infinite control over setting up workflows for paperwork as well as all the other administrative processes in the clinic – like what had to happen when processing an intake or discharging a case.
How did I know we were making progress optimizing the process? The first time I saw a new staff member take an empty Admission Summary template into an intake interview. She used it to make sure she didn’t miss gathering essential information. That was a good moment.