Book excerpt: Career ladders

by Johanne Brautigam, RN, BSN, CCDS and Mindy Davis, RHIT, CDIP, CCS, CCDS

Career ladders are a relatively new concept for CDI. With the adoption of the inpatient and outpatient CDI programs, there is a greater need for a ladder program because there will likely be individual shifts in jobs and an increase in leadership needs. Career ladders help recognize specialists who are motivated to take on added responsibilities with compensation. When the CDI department focuses solely on documentation integrity, it is easier to develop a career ladder. In contrast, CDI specialists whose duties extend beyond documentation integrity would require a career ladder that is more creative and encompasses more requirements.

Considerations for a career ladder depend on the size of the CDI team. A small team may not have enough differences in job duties and levels to have a ladder, so manager and specialist levels may be all that are available. Including a second-level reviewer, senior CDI specialist, or CDI trainer/educator can be options to build out the ladder.

For teams in larger healthcare systems with many hospitals/practices, a career ladder is imperative to the function of the department. With teams dispersed in a vast coverage area, supervisors and leads may be needed to assist in daily managerial duties. A career ladder will identify candidates for these positions and gives specialists a pathway for advancement.

It is necessary to create career ladder considerations to maintain fairness and guide applicants equally. Some considerations to make include deciding, for example, whether to restrict the number of positions at each level. The higher up the ladder, the less positions will be needed. Levels can be skipped if necessary and if the CDI specialist has an exceptional record.

Determine how to handle two applicants who work together on major projects. They must designate each person’s specific contributions to the project for it to adequately function within the career ladder requirements. Committee participation should also be considered in the application process as a project, depending on the involvement, such as committee chair vs. committee member. Time allotted for project work is not guaranteed during scheduled work time. That would have to be arranged with the manager.

CDI specialists should start each level with a clean slate; there cannot be an inclusion of previous work. The clinical ladder will reward the specialist who is motivated and invested in the team. It acts as an example to the rest of the specialists and prevents the feeling of stagnation.

Editor’s note: This article is an excerpt from The CDI Director’s Cut: A Guide for Effective Program Management.