Guest Post: Defining expertise, determining professional advancement

by Donald A. Butler

I have a question for all of the CDI professionals who feel they have achieved a genuine level of expertise (be it after two, three, or even five years): What do you consider as avenues for continued professional advancement, satisfaction, and development?

I’ve been thinking a lot about this question and musing on the idea of “expertise.” Specifically, I’ve been thinking about Patricia Benner’s book “From Novice to Expert: Excellence and Power in Clinical Nursing Practice (Commemorative Edition).”  In her book, Benner says the “expert” no longer relies on an analytic principle (rule, guideline, or maxim) to connect her or his understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnosis and solutions. She writes:

“Capturing the descriptions of expert performance is difficult, because the expert operates from a deep understanding of the total situation…” (p. 31-32).

This is not to say that the expert never uses analytical tools. Highly-skilled analytic ability is necessary for those situations in which the “expert” has no previous experience. Analytic tools are also needed for situations in which an expert perhaps receives inaccurate information or doesn’t have a grasp of the situation. When alternative perspectives are not available to the expert (in this instance, the clinician) the only way to resolve the issue of the incomplete/inaccurate grasp of the situation is by using analytic problem solving (Benner, p. 33).

An ACDIS poll asking the question, “How long did it take you to get up to speed as a new CDI specialist?” shows 34% say it can take anywhere from six months to a year to reach a comfortable level of proficiency in the role.

A more recent poll dug a bit deeper into the question asking, “How long do you think it takes to achieve an ‘expert’ level of proficiency as a CDS?” Many say it takes about two years but the majority suggests that an “expert” level of proficiency can be reached with one to three years of experience. This is not to suggest that achieving “expert” level should be an end-goal. Continued learning should never be stopped or even slowed, as there are always new and interesting tidbits to soak up. To the same “expert” poll question cited above, 32% responded: “Never, the rules are always changing.”

At some point, however, I suspect CDI core activities may become largely routine (dare I say even boring?). After reaching an “expert” level of proficiency, how does one maintain personal or professional interest, engagement, and excitement in their job?

Of course, one can challenge oneself by considering the component of team growth, by expanding CDI program goals and focus, and by focusing on building a better CDI program and team. (For some ideas on possible areas of program growth and expanded roles, read the related blog posts: “Finding a definition for failed CDI programs,” and “Commit to your own personal and professional achievement.”)  However, at this point, I am thinking more about the perspective of the individual CDI specialist.

Some of my own CDI staff members have been with our program since its inception five and a half years ago. I consider each of them outstanding experts in the CDI field but I sympathize with those who are feeling some frustration building. Part of that frustration, I suspect, stems from areas in which our CDI program needs continued focus and improvement, although I can’t help but think that another part rests on that purely personal professional level.

So I am writing this blog post in hopes that members of our ACDIS community and other CDI professionals at large will offer their own thoughts, dreams, and goals about where expert CDIs hope to travel on their professional pathways. What avenues are folks discovering and pursuing to continue their professional growth and personal interest in their chosen careers?

The following are a few ideas I had about potential professional roads that might be worth exploring:

• Leadership roles: There are other positions beyond the CDI specialist role, such as supervisor, team leader, manager, and director, to name a few.
• CDI advocate: No matter what your formal title or position, there are always opportunities for energized staff to advocate program improvement and expansion.
• CDI liaison: Healthcare is always changing and facilities need input from a variety of vested professionals. Consider working with other teams on special projects to analyze and improve performance related to specific DRGs, ROM/SOI, quality/core measures, ICD-10 implementation, or other matters.
• ACDIS local chapters: There are more than 30 local chapters across the country networking with other CDI specialists in their area. To energize your career, join a local group and help the leaders coordinate an event. If you don’t have a group in your area, consider starting one and/or becoming an ACDIS Chapter Leader. There’s nothing like mentoring new CDI programs and CDI staff members to help you feel energized about your chosen profession.
• Conduct research: If you feel as though your CDI program is working on the cutting edge of a particular issue, put a little extra time aside to prove your hypothesis. Gather the data from your own facility and then seek input from your CDI friends at area facilities nearby. Armed with the data, you can search industry publications to see whether others have opined on your concern. Reach out to other experts in CDI and compile your analysis. Such efforts in the CDI field represent new opportunities, as so little has yet been done in this field.
• Publications: If you have done the work to craft a research project, consider submitting it to peer review journals for publication or presenting your finding at a local chapter meeting or ACDIS National Convention. It is worth noting that ACDIS offers a variety of venues for CDI professionals to share their thoughts including CDI Talk, the ACDIS Blog, CDI Strategies, and the CDI Journal.
• Consulting: Those who reach the “expert” stage may consider changing gears and helping others start programs of their own by becoming a consultant. Many firms are looking to hire experience CDI specialists these days. If you like to travel and don’t mind being away from home for small stretches, this might be the role you’ve been waiting for.

Of course, there is a host of other options, from working for a CDI staffing firm or traveling CDI agency to becoming a mentor to new CDI staff within your own facility. My personal answer to this question is that I find professional satisfaction in attempting to navigate around the obstacles standing in the way of CDI advancement in my department and organization. I also find personal satisfaction in the variety of ways that I stay connected to the ACDIS community. I write the occasional blog post and make sure that I am active on CDI Talk and participate in other ACDIS committees.

Let me know your thoughts on how to expand your professional expertise—even after you’ve earned the label “expert.”

Editor's note: Butler entered the nursing profession in 1993, and served 11 years with the US Navy Nurse Corps in a wide variety of settings and experiences. Since CDI program implementation in 2006, he has (at the time of this article's original release) served as the Clinical Documentation Improvement Manager at Vidant Medical Center (an 860 bed tertiary medical center serving the 29 counties of Eastern North Carolina).