Q&A: Performance improvement plans
Q: Our CDI leadership group is currently working on developing clear role expectations and corresponding accountability steps specifically for our concurrent CDI staff. As part of this work, we’re looking to outline minimum standards for the role and define the appropriate points at which staff would transition into a PIP.
Does anyone have examples that outline expectations or minimum performance standards for CDI roles, metrics, thresholds, or productivity/quality indicators that determine performance concerns, and criteria/processes for initiating a PIP?
Response #1: Our process consists of setting key performance indicators (KPI) based on the tool we use to support the CDI team. We use standard KPIs set up in an Excel spreadsheet—Initial reviews of 8–10 and follow-ups to meet 25 per day. This gives time for query follow-up, breaks, education, committee work, and other unexpected activities. Depending on whether you have residents or not you may need to raise or lower those numbers.
We also track number of queries and whether they have a financial impact—we base this on number of queries with financial impact out of initial reviews not total queries sent. Response rates have a split expectation—CDI need to hit 95% and providers need to hit 100%, etc.
A sliding scale has been set up for our new CDI staff and the expected outcomes for each KPI, based on months of experience. Month 1–3 is generally a very low expectations with a mentor who follows their cases. Month 3–6 they are on their own and their productivity is increased weekly until they are at reaching 25/per day and our auditor monitors all queries and looks for missed opportunities. New seasoned CDI specialists are expected to be up to speed by month 2.
We monitor all CDI staff weekly for any areas in need of improvement. The leadership team discusses each person’s performance based on KPIs, denials received that had a missed opportunity, and any audits—including validation percentage correct. Each week we pick two individuals to focus on for improvement.
If a person falls below the minimum expectations, they are the focus for that week. We do give intense re-education to anyone who falls below consistently.
Our career ladder includes CDI 1 (no certification), CDI 2 (certification earned), CDI-3 (leads, auditors, and educators). The leveling is based on years of clinical and CDI experience.
Response #2: Clear role expectations and aligned accountability structures are foundational to a high‑performing concurrent CDI program and it sounds like you’re approaching this with the right mindset.
Your question around KPIs is spot‑on—metrics are only meaningful when they reflect clearly outlined goals and when the supporting workflows are designed to make those goals achievable. Defining expectations, standardizing processes, and ensuring efficiency upstream are what ultimately allow teams to be held accountable without feeling micromanaged.
Adding staff into unclear or inefficient workflows rarely drives the improvement leaders are looking for. In contrast, when minimum performance standards, workflows, and outcomes are aligned, the improvements in KPIs become visible, measurable, and something you can reinforce and celebrate consistently.
A few things that I’ve found effective are:
- Role expectations and minimum standards for concurrent CDI
- Practical, defensible productivity and quality indicators
- How other organizations structure thresholds for performance concerns
- Supportive, structured approaches to PIPs that avoid punitive framing
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly newsletter for members of the Leadership Council. For the purposes of this article, all Council member answers have been deidentified.