The ancient anecdote of the chicken and the egg poses a fundamental question: which comes first? This proverbial query serves as a metaphor for understanding the importance of our motivations, or our "WHY." In any industry, knowing your WHY is crucial to determining the direction of your efforts. Coupling this idea with the concept of the "Cobra Effect" highlights the necessity of placing purpose in proper perspective, guiding organizations toward meaningful outcomes.
The Evolution of ICD Coding
In the beginning, there was ICD coding. Originally designed as a data collection and analytics tool, the International Classification of Diseases (ICD) coding system soon evolved into a critical revenue instrument for healthcare organizations. Initially, the accuracy of this system heavily relied on the clinical documentation provided by practitioners. The quality of patient care, reimbursement, and overall healthcare analytics depended on how well clinicians recorded their observations and treatments in the medical record.
As the healthcare landscape grew more complex, it became apparent that the documentation might not be as transparent or accurate as needed. This gap motivated the introduction of Clinical Documentation Improvement (CDI) programs. What started as an initiative to enhance documentation gradually transformed into Clinical Documentation Integrity (CDI), emphasizing the importance of integrity alongside improvement. Improving documentation is meaningless without the assurance that it reflects the true clinical picture.
The Rise of Clinical Validation
As the healthcare field continued to advance, clinical validation emerged as a necessary component of the CDI process. It became essential to confirm that the documentation accurately represented the patient's health status and clinical picture. This additional layer of scrutiny ensured that care providers were not just meeting documentation requirements but were genuinely conveying the patients' conditions.
The evolution from ICD coding to CDI to clinical validation parallels the Cobra Effect concept concerning human nature. The Cobra Effect illustrates how, in our attempts to solve a problem, we may inadvertently create a solution that exacerbates the issue. It serves as a reminder that while pursuing objectives, our actions must align with our fundamental purpose.
The Cobra Effect*
In colonial Delhi, the British authorities faced a dangerous cobra problem and implemented a reward system to pay locals for every dead cobra brought in. Initially, this approach seemed effective, as the number of dead cobras increased. However, locals began breeding cobras to collect the bounty. When the authorities discovered these farms and canceled the program, the breeders released their cobras back into the wild, resulting in an even larger snake population than before. This anecdote exemplifies the "cobra effect," a term coined by economist Horst Siebert, highlighting how misguided incentives can lead to unintended consequences.
Aligning with True Purpose
Humans have an innate ability to find a way to achieve their goals, but it is crucial to ensure that our WHY is in harmony with our true purpose. When organizations lose sight of their core values or motivations, they risk encountering the Cobra Effect, where their attempts to improve lead to unintended consequences.
Peter Drucker, Father of Modern Management, argued that a business's success and revenue should stem from its core purpose of providing value and solving customer problems, rather than focusing solely on financial gain. By aligning strategies with this principle, organizations can create sustainable growth, ensuring their actions contribute to real value for their customers and society at large. It is essential to remember that the business of healthcare revolves around delivering quality patient care. We must recognize that it truly is — “No Mission, No Margin.”
By aligning our strategies with our True North, we can cultivate better outcomes. This alignment fosters a commitment to integrity and accuracy in documentation practices, ultimately enhancing patient care and operational effectiveness.
Conclusion
The story of the chicken and the egg serves as an important allegory in understanding the significance of our motivations in any industry. As we reflect on the evolution of ICD coding and the role of CDI and clinical validation, it becomes clear that the best results emerge when our actions are driven by a well-defined purpose.
By recognizing the importance of our WHY and navigating through the complexities of human nature, we can ensure that our efforts lead to meaningful, positive change in our industries. Embracing the lessons of both ancient anecdotes and modern concepts like the Cobra Effect can help us navigate our paths with clarity and intention, ultimately fostering a culture of integrity and excellence.
Lastly, the allegory of the chicken and the egg illustrates the interdependent relationship between mission and margins. Which comes first? That is the question we all have to ask ourselves.