Idiopathic delayed note syndrome
September 12, 2012 11:58 AM Subscribe
I supervise a person who has enormous difficulty finishing her case notes. My efforts to remediate her so far have been unsuccessful. How can I help her finish her work?
posted by The Elusive Architeuthis to work & money (39 answers total) 8 users marked this as a favorite
I am the supervisor for a clinical worker. Like most clinicians, each visit with a patient is documented in a note in the record, which has to be signed to complete it. We switched over to an electronic medical record with computerized notes a few months ago, and after an initial period of difficulty and grumbling, almost everyone in the group achieved a rhythm where they finished their notes after their patient session or at most a few days afterwards. However, this person seems to be incapable of actually signing her notes, leaving them to accumulate in her inbox.
She is very nice, but generally kind of anxious and inefficient person who is bad at multitasking. She has been here for a very long time, and is generally beloved by her patients--spending lots of time talking with them in person and on the phone. Her patient sessions usually run over time by at least 1 hour. However, she is very good at the clinical aspects of her work, just not the record keeping. This person has always had difficulty finishing her notes, but when we had paper charts the sheer accumulation would usually get her to finish them up in a few days. Now there is no physical presence clogging up her desk.
The problem is that those notes MUST BE FINISHED. There are legal, regulatory and billing issues around having things unsigned for long periods, and she's way out of any reasonable grace period on most of these. My institution does not have a formal policy on this though--apparently they are in the process of writing one, but it's slow going. So far higher-level intervention in the case has taken the form of my superiors asking me to get her to finish stuff.
I've looked at the notes, and they're very detailed and pretty complete. Most of them just need a couple of concluding sentences and an electronic signature. I have looked at them with her, and if these were my notes it would take no longer than 5 minutes to complete each one. It is apparently taking her an average of about 25 minutes to complete a single note (which are already 90% done), which, no wonder she's falling behind (to the tune of 500+ unsigned notes at the moment).
I let things go on too long before getting really hardnosed about it, because she had some very significant stressors in her personal life earlier this year, and I honestly did think she would get caught up. I think there is a very substantial component of shame and perfectonism going on, and possibly also some actual compulsiveness, but I'm not sure how to help her.
I've talked to her about it on multiple, multiple occasions and she always says the same thing, which is that she was behind for X reason but is starting to get caught up now and she just needs to take some time on the weekends, etc. Meanwhile she continues to fall behind. Here's what I've done at this point:
-she has agreed to complete 50 notes per week. So far this is a big failure; she's still falling further behind.
- we are meeting on a weekly basis for a progress check. Again, so far this is unsuccessful.
-I've found time to give her the equivalent of a week just to complete some of her backlog of notes. (These days are mostly upcoming--the scheduling required some time to set up). But this is obviously not a long-term solution.
-She already works less than full time.
-She understands why she needs to have these done and that she is risking both her job and the practice's accreditation
-I and another manager have met with her to make sure she is comfortable with the EMR system. She hasn't learned a lot of the expert tips/tricks, but she is comfortable with all the basics.
-I've tried to give her help on structuring her time, focusing on essentials, setting external limits on how long she works on a single document (I suggested using a timer).
-I have considered completing some of these for her, and just have her look them over and sign off on them, but I have a lot of my own work to do and can't really do it in the numbers she needs.
I do not have the power to fire this person directly, although probably I could make it happen if I showed that she had failed remediation efforts, but I would really rather not. She is well-liked, a good clinician, and has had a very rough year. But the number of unsigned notes stretching back months is approaching the ludicrous and attracting unwelcome attention from higher administration.
What else can I do to help her 1) finish her astounding backlog of unfinished work, and 2) stay on top of new notes? I'm running out of managerial tricks.