We all want to have efficient and effective Clinical Documentation Integrity programs. Well defined workflow processes are a key to achieving this goal. The time spent to do a review of current CDI program and/or map (Value Stream Mapping) out your current and/or future state will prove to be time well spent. No detail is too obvious and should be documented in order to provide the education and understanding for the staff. Without staff understanding and adherence, the goals of efficiency and effectiveness are unachievable. All of the processes will require policies to hold staff accountable in achieving the Clinical Documentation Integrity outcomes desired. Many times it is helpful to bring in an outside expert to assist with the review of the program in order to make sure it is captured accurately. Experts with LEAN or Six-Sigma experience are also helpful as these tools are very good at keeping feelings out of the mix and proposing staffing needs based on formulas and timings.