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Hands On Help

Leading the Change to ICD-10 from Any Seat

LESLIE: With the new ICD-10 implementation date firmly set by CMS for Oct. 1, 2014, it is time for us to take another look at the priorities of HIM professionals during this transformative time.

PATTY: One clear priority for HIM professionals is leading all or some of the ICD-10 readiness activities in their departments and across their enterprises. We observed at the recent AHIMA Convention and Exhibit that the state of preparedness varies significantly across U.S. hospitals and physicians' practices - from hardly started to already testing systems and doing parallel processing, and every stage in between.

LESLIE: Some organizations took advantage of the one year implementation delay and kept to their original timelines, while others rearranged priorities depending on other organizational initiatives in play this year. Some focused ICD-10 preparation solely on clinical documentation improvement, helping the physicians get more comfortable with new more detailed documentation requirements that are needed for accurate ICD-10 coding. Others focused more on technology upgrades.

PATTY: Most organizations are a year closer to more comprehensive EHR systems, and some are well on their way to implementing Computer Assisted Coding (CAC) as a way to minimize loss of productivity during and after the transition to ICD-10. Coder education on ICD-10 was largely delayed, although coder assessments were undertaken, and educational programming is being planned and budgeted for 2013 and 2014.

LESLIE: Whatever the focus has been in 2012, clearly there is still a lot to do - not just the obvious assessments, training, and technology testing, but also parallel processing, workflow redesign, staffing plans, and identifying the contingency plans for all of the "what if X happens."

PATTY: Listening to HIM leaders from around the country, I am impressed with the level of support most HIM directors are receiving for ICD-10 readiness; however, it is interesting to also hear about the challenges of working collaboratively with other disciplines that are also affected by the implementation of ICD-10.

LESLIE: I met many HIM professionals at the AHIMA Convention and Exhibit who already have formal responsibility for leading the ICD-10 implementation at the corporate level in healthcare systems, or at the individual facility or group practice level. These people are generally leading multidisciplinary teams in conducting facility assessments and developing implementation plans across the enterprise, and they are moving forward at a good clip. The stories that concerned me were from people in organizations that were not well under way and for whom leadership of the ICD-10 implementation was fragmented or struggling with internal organizational politics.

PATTY: Implementing ICD-10 is a great example of the large-scale change projects that John Kotter writes about in "Leading Change" and in "The Heart of Change." More than most experts, Kotter understands and addresses the emotional side of change leadership. He stresses the importance of leaders creating sufficient urgency from the beginning of the project and continuing to maintain that urgency throughout the transition; that is something we can do leading from any seat.

LESLIE: I first heard about the concept of leading from any seat when Benjamin Zander, orchestra conductor and author of a fascinating book, "The Art of Possibility," spoke at an AHIMA Convention and Exhibit many years ago. He explained that the conductor of the orchestra has the formal authority and responsibility to lead the musicians in creating beautiful music, but that his orchestra played its best when he recognized that his musicians were informal leaders from their various vantage points. The orchestra played better when he encouraged everyone to express their ideas and perspectives, or even to take charge when he or a colleague was missing something important. In revisiting this book, I recalled that he cites the example of a second violinist in a famous string quartet who stepped in to play an important passage for a viola player when he noticed his colleague had apparently forgotten what notes came next.  Zander writes, "without missing a beat, he played the notes perfectly in tune and voiced like a viola on an instrument tuned a fifth higher."

PATTY: It is a critical that HIM professionals recognize the opportunities and their responsibility to lead from any seat.

LESLIE: It's especially critical because of their subject matter expertise and unique vantage point in the healthcare organization in which they work.

PATTY: Being able to recognize the opportunities requires a keen awareness of the functioning of the whole system, the threats and opportunities facing the project team, and the will to make sure those threats and opportunities are known and addressed by the team.

LESLIE: Exactly. It isn't only the formally appointed leaders of the ICD-10 transition teams that must lead the coming change. While many HIM professionals are designated as the formal leaders, even those who are not in that position can be active as informal leaders. From HIM directors, to coding managers and supervisors, to individual coders, all HIM professionals can step up and demonstrate their deep subject matter expertise and use their knowledge of how people in their organizations respond to the stress of change to facilitate a successful transition to ICD-10.

PATTY: In your book, "Leading a Business in Anxious Times" you and co-author Katharine Baker described the most common emotional symptoms that emerge in organizations under the stress of major changes. It isn't unusual to see an escalation of conflicts, blaming, absenteeism, turnover, and generally lower levels of morale and job satisfaction during times of change, which result in poorer performance.

LESLIE: That's why successful change projects require more of us than technical skills and subject matter expertise. Successful change requires emotional awareness of the system and authentic leadership - a calm, thoughtful presence; a clear vision; exceptional communication; and the courage to step up and lead when colleagues forget the notes that should come next.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. You can follow Leslie and Patty on their Twitter accounts, @FoxatCARE, and @pattytsheridan. Leslie and Patty invite readers to send their thoughts and opinions on this column to or

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