Penny M. Crow, MS, RHIA, SHRM-SCP

By Penny M. Crow, MS, RHIA, SHRM-SCP, and Christine Kalish, MBA, CMPE

I learned early in my career that most people do not know what a registered health information management administrator (RHIA) does. For example, my friends and family knew I worked in hospitals, but I wasn’t a nurse. I was a risk management administrator, “whatever that was.” When I started a billing company, they knew I wasn’t the practice receptionist or administrator, but I worked with clinics sending out bills. And, when I ran a behavioral health center, I was the boss but not a therapist. My frustration came to a head during the 2007 AHIMA Annual Convention and Exhibit in Philadelphia, PA during the House of Delegates meeting when colleague after colleague complained about the lack of respect health information management (HIM) professionals receive from other health professionals. They vented that they weren’t “at the table” for crucial conversations but were always brought in later to “clean up the mess.”

I realized that I couldn’t think of a single time that I wasn’t at the table for those conversations. What made me different? I can assure you it wasn’t my charming personality or my scariness. When I went to graduate school, where I started researching thinking patterns, leadership development, and psychology of the workplace, I started to realize that I think differently from many of my peers.

Fast forward many years, I am now a consultant with the Brittain Kalish Group (BKG) in a role that allows me to combine my HIM skills with my industrial and organizational psychology skills. BKG’s CEO and co-author of this essay, Christine Kalish, is a practice executive who often manages all the pieces of a healthcare organization. She knows firsthand the challenges that HIM professionals encounter. If you attended either of the past two AHIMA annual conferences, you may have heard the two of us speak in the leadership tracks. Our passion is to help leaders think differently to lead differently. We want to share some of the lessons we have learned along our healthcare leadership journeys.

Lesson #1: Understand why you chose to be an HIM professional.

If you don’t understand why you are in this field, it will be challenging to convince others to include you “at the table” for the executive-level strategic conversations. Know, understand, and be able to verbalize what you can offer to the discussion. It is essential to know the direction of the organization. That direction will be your guide, so you can determine when to say “yes,” “no,” or “not yet” to the diversions that occur. Be someone who can look at things from another person’s perspective and ask clarifying questions. Add value to the discussion by knowing for yourself what the HIM perspective can provide. The NeuroLeadership Institute says it another way: “All leaders should have three essential habits: lead with clarity, close the knowing-doing gap, and effective leadership requires effective inclusion.” Each HIM professional and healthcare executive must demonstrate the value of what they bring to the table.

Lesson #2: Influence can be more important than a formal title of leadership.

Listen to what others say with the intent to receive the message. Hearing is a sense, but listening is a skill. Don’t wait for the clinicians, finance, and IT folks to learn “HIM speak.” Speak in their “language” to express understanding while demonstrating the HIM perspective’s value.

Lesson #3: When a problem occurs, think through a solution strategically rather than jumping to action.

We believe, and this is demonstrated, that intentional thinking leads to better creative problem-solving rather than being reactionary. Think about it: You cannot be creative and reactive at the same time. In healthcare, we don’t always have time to do something right the first time, but we still find the budget, resources, and technology to “fix” it repeatedly. As HIM professionals and healthcare executives, we have found that focusing on the big picture has resulted in financial benefits for our organizations rather than operating in the crisis mode process.

Lesson #4: Leadership tomorrow does not look like yesterday.

The workforce is different—not right or wrong, but different. We are operating with five generations in the workplace at once. Both hard and soft skill requirements are changing, as artificial intelligence is replacing some jobs and expanding others. Then we added a pandemic that created a need for social distancing in the office setting, sending some employees home to work. This all means that HIM professionals must stay flexible and adaptive, constantly learning new skills to meet the demands of our staff, colleagues, and profession.

Lesson #5: Recognize the financial impact your role has on your organization.

Many will assume that we refer to coding and the revenue cycle, but our financial acumen goes much further. We need to understand cash flow management, account payable management, payroll basics, budgets, financial reporting, internal controls, and audit management. We don’t need to know how to do financial management’s daily operations, but, at a minimum, we need to have practical knowledge of reports and communicate information to the C-suite for decision-making.

Lesson #6: Understand the basics of risks and compliance management.

As HIM professionals, we have so much more to offer than just providing the legal medical record. When we come to the table with knowledge of the laws and regulations applicable to our organizations, we are the subject matter experts as HIM professionals. Be familiar with the accreditation, credentialing, and licensing required by the professionals within your organization. When we understand different specialties’ nuances, we can serve as collaborators, advisors, professional peers, and lead emergency preparedness. Do not leave cybersecurity and information blocking rules to the IT department. As HIM professionals, we have much to offer and should be volunteering our knowledge to the technical folks.

Lesson #7: Know the daily business operations of your organization.

That knowledge involves us in strategic planning, project management, communications, marketing, quality management, compensation, information technology, human resources, and new business ventures. Too often in our careers, we have seen HIM professionals silo themselves within the HIM department without connecting the business dots across the organization. As the AHIMA website’s “About Us” page says, “our people work at the intersection of healthcare, technology, and business.”

We challenge you to think about whether you are at the table for strategic organizational discussions. If you are,

  • How do you show value to the team?
  • What skills are you demonstrating as an HIM professional?
  • Do the other team members miss your input when you are not present?

If you are not at the table, ask yourself, “Why not?” Have you gotten so caught up in the minutiae of daily HIM operations that you have siloed yourself and are devaluing what you can bring to the table as a result? Our experience has shown that it isn’t the C-suite that is overlooking expertise most of the time; rather, many HIM professionals do not step up and out to demonstrate why they should be at the table. If you recognize yourself in this second category, what can you do? Read more, listen to TED Talks, ask questions, get a mentor, or set an appointment with various colleagues in the organization to educate them on what you bring to the table. Get out of your box, and show the world that you add value to the discussions and are not the cleanup crew. Your HIM experience can prevent many mishaps and minimize chaos in the organization. You are valuable, so remember to show up!


Penny M. Crow ( is a principal/compliance officer at the Brittain-Kalish Group.

Christine Kalish ( is the CEO at the Brittain-Kalish Group.

1 Comment

  1. Great advice for advancing your career in health informatics and acquiring a seat at the table!

Comments are closed.