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Evaluating the pursuit of advanced degrees in a health information profession: a gap analysis study

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Evaluating the pursuit of advanced degrees in a health information profession: a gap analysis study

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Evaluating the Pursuit of Advanced Degrees in a Health Information Profession:
A Gap Analysis Study

Toni D. Jackman

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

December 2022

© Copyright by Toni D. Jackman
All Rights Reserved

The Committee for Toni D. Jackman certifies the approval of this Dissertation

Jennifer Phillips
Sabine Simmons
Patricia Tobey, Committee Chair

Rossier School of Education
University of Southern California
2022

iv
Abstract
The increased use of emerging and disruptive technologies like machine learning and artificial
intelligence facilitates the need for health information professionals to transition from data-entry
technicians into operational and managerial positions (Abrams et al., 2017; Kaldec, 2016;
Kolbjornsrud et al., 2016; Manyika et al., 2017; Olenik, 2019; Stanfill & Marc, 2019). Research
shows that the average automation potential of jobs that require certifications or an associate
degree is 55% and that 91% of all health information professionals without advanced degrees
working in entry-level positions are at risk for potential job replacement (Olenik, 2019). These
data show the need for advanced degree education to prepare health information professionals to
maintain relevance in the healthcare ecosystem (Abrams et al., 2017; Fenton et al., 2015; Kaldec,
2016; Olenik, 2019). The American Health Information Management Association published a
2017 white paper called Health Information Management Reimagined (HIM Reimagined) to
reimagine the profession for the future. It recommended that 20% of their health information
professional membership obtain advanced degrees by 2027. Using the Clark and Estes gap
analysis framework, this descriptive quantitative study examined the knowledge, motivational,
and organizational influences of attaining advanced degrees within the health information
professional in the healthcare ecosystem.
Keywords: advanced degrees, disruptive technologies, health information profession,
knowledge, motivation, organizational influences.

v
Dedication
To my fab four, the “JackPack!” You can do all things through Christ who strengthens you!

vi
Acknowledgments
To my fantastic dissertation committee, Dr. Patricia Tobey, Dr. Jennifer Phillips, and Dr.
Sabine Simmons, I am eternally grateful for your time, expertise, commitment, and dedication in
guiding me in this journey. Your guidance and mentorship made this achievement possible.
Dr. Tobey, thank you dedication to the dissertation process, the accountability meetings,
for your ever-listening ear and for the spot-on advice and encouragement in the midst of chaos
and catastrophes! Your leadership and mentorship through the process became the driving force
for me to complete the process! Dr. Phillips, thank you for your instruction as my professor in
the OCL program, and your ability to make me read between the lines, parse, and refine
information. And thank you for your service! Continue to aim high, and fly, fight, and win in all
your personal and professional endeavors! Dr. Simmons, thank you for your support and
guidance as I stepped into collegiate academia from military service, and for being the
professional adjudicator for this project. Your assistance and your own educational goals were
my roadmaps in this journey. I would also like to thank Dr. Christi Lower, Annessa Kirby, and
the AHIMA Data Governance Committee for the assistance, approval, and distribution of my
survey to our professional membership for this research. Your efforts made this possible! Lastly,
I want to thank the survey participants, the health information professionals, whose dedication to
our profession and healthcare is beyond reproach. Continue to uphold to the AHIMA mission to
“empower people to impact health!”

vii
Table of Contents
Dedication ...................................................................................................................................v
Acknowledgments ..................................................................................................................... vi
List of Tables ..............................................................................................................................x
List of Figures .......................................................................................................................... xii
Chapter One: Introduction to the Study .......................................................................................1
Context and Background of the Problem ..........................................................................1
Organizational Goal .........................................................................................................3
Description of Stakeholder Groups ..................................................................................5
Stakeholder Group for the Study ......................................................................................6
Purpose of the Project and Research Questions ................................................................8
Importance of the Study ...................................................................................................8
Overview of Theoretical Framework and Methodology ...................................................9
Definitions ..................................................................................................................... 10
Organization of the Dissertation .................................................................................... 11
Chapter Two: Literature Review ............................................................................................... 13
The History and Role of the AHIMA ............................................................................. 13
Clark and Estes (2008) Gap Analysis Framework .......................................................... 19
Stakeholder Knowledge, Motivation, and Organizational Influences.............................. 20
Conceptual Framework .................................................................................................. 37
Summary ....................................................................................................................... 39
Chapter Three: Methodology ..................................................................................................... 40
Research Questions ....................................................................................................... 40
Overview of Design ....................................................................................................... 40
Research Setting ............................................................................................................ 42
viii
The Researcher .............................................................................................................. 43
Data Sources.................................................................................................................. 44
Participants .................................................................................................................... 47
Instrumentation.............................................................................................................. 48
Data Collection Procedures ............................................................................................ 50
Data Analysis ................................................................................................................ 52
Validity and Reliability .................................................................................................. 53
Ethical Implications ....................................................................................................... 54
Limitations and Delimitations ........................................................................................ 56
Chapter Four: Results and Findings ........................................................................................... 57
Participating Stakeholders ............................................................................................. 58
Determination of Assets and Needs ............................................................................... 64
Results and Findings for Knowledge Influences............................................................. 65
Results and Findings for Motivational Influences .......................................................... 73
Results and Findings for Organizational Influences ....................................................... 85
Synthesis and Findings ................................................................................................ 100
Summary ..................................................................................................................... 103
Chapter Five: Recommendations ............................................................................................. 105
Discussion of Findings ................................................................................................ 105
Solutions and Recommendations for Practice to Address KMO Influences .................. 107
Integrated Implementation and Evaluation Plan ........................................................... 130
Summary of the Implementation and Evaluation Plan .................................................. 151
Recommendations for Future Research ........................................................................ 153
Conclusion .................................................................................................................. 154
References .............................................................................................................................. 156
ix
Appendix A: Theoretical Framework Alignment Matrix (Quantitative) ................................... 173
Appendix B: Excerpts from Document Analysis ..................................................................... 174
Appendix C: Survey Instrument .............................................................................................. 176
Appendix D: Informed Consent for Research (Quantitative) .................................................... 191
Appendix E: Qualtrics Survey Information Sheet .................................................................... 194
Appendix F: Proposed Post-Training Learning Evaluation Survey Sample Questions for
Level 1 (Reaction) ................................................................................................................... 199
Appendix G: Pre-/Post-Learning Evaluation Survey Sample Questions for Level 2
(Learning) ............................................................................................................................... 200
Appendix H: Post-Learning Evaluation Survey Sample Questions for Levels 1–4 ................... 201

x
List of Tables
Table 1: Organizational Mission, Organizational Performance Goal, and Stakeholder Goals 7
Table 2: Knowledge Influences 23
Table 3: Motivation Influences 29
Table 4: Organizational Influences 36
Table 5: Data Sources 42
Table 6: Gender, Ethnicity, and Age Demographic Data 60
Table 7: Employment, Income, and Geographic Region Demographic Data 62
Table 8: Certificates, Degrees, and Credentials Demographic Data 64
Table 9: Assumed Declarative Knowledge Influences of HI Professionals 67
Table 10: Assumed Procedural Knowledge Influences of HI Professionals: School Selection 69
Table 11: Assumed Procedural Knowledge Influences of HI Professionals: College Task
Completion 71
Table 12: Assumed Motivation (Interest Value/Intrinsic) Influence of HI Professionals 75
Table 13: Assumed Motivation (Utility Value) Influence of HI Professionals 79
Table 14: Assumed Motivation (Self-Efficacy) Influence of HI Professionals 82
Table 15: Assumed Cultural Model Influences Within the Professional Organization 87
Table 16: Assumed Cultural Settings Influences Within the Professional Organization 91
Table 17: Summary of Knowledge Influences and Recommendations 109
Table 18: Summary of Motivation Influences and Recommendations 113
Table 19: Summary of Organizational Influences and Recommendations 121
Table 20: Outcomes, Metrics, and Methods for External and Internal Outcomes 133
Table 21: Critical Behaviors, Metrics, Methods, and Timing for Evaluation 135
Table 22: Required Drivers to Support Critical Behaviors 138
Table 23: Evaluation of the Components of Learning for the Program 145
xi
Table 24: Components to Measure Reactions to the Program 148
Appendix A: Theoretical Framework Alignment Matrix (Quantitative) 173
Table C1: Survey Instrument 177
Appendix F: Proposed Post-Training Learning Evaluation Survey Sample Questions for
Level 1 (Reaction) 199
Appendix G: Pre-/Post-Learning Evaluation Survey Sample Questions for Level 2
(Learning) 200
Appendix H: Post-Learning Evaluation Survey Sample Questions for Levels 1–4 201

xii
List of Figures
Figure 1: White Paper Recommendations From the AHIMA 2017 Education Task Force 4
Figure 2: AHIMA Organizational Chart 15
Figure 3: AHIMA Career Map 34
Figure 4: Conceptual Framework 38
Figure 5: Motivation for Returning to School for an Advanced Degree Survey Results 76
Figure 6: Results for Potential Barriers Which May Delay Pursuit of Advanced Degrees
in the Next 5 Years 83
Figure 7: Themes From Singular Open-Ended Final Question 99

1
Chapter One: Introduction to the Study
This study’s problem of practice and focus was the lack of advanced degrees, specifically
master’s and doctorate degrees, within the health information (HI) profession in the healthcare
ecosystem. The increased use of emerging and disruptive technologies like machine learning and
artificial intelligence facilitates the need for HI professionals to transition from data-entry
technicians into operational and managerial positions (Abrams et al., 2017; Kaldec, 2016;
Kolbjornsrud et al., 2016; Manyika et al., 2017; Olenik, 2019; Stanfill & Marc, 2019). Research
indicates that the average automation potential of jobs that require certifications or an associate
degree is 55% (Olenik, 2019). Approximately 91% of all HI professionals without advanced
degrees working in entry-level positions are at risk for potential job replacement (Olenik, 2019).
Therefore, the need exists to upgrade skills or transition into new occupations and work roles
(Olenik, 2019). Advanced degree education is necessary to redefine and prepare HI professionals
to survive the changing healthcare landscape (Abrams et al., 2017; Fenton et al., 2015; Kaldec,
2016; Olenik, 2019).
Context and Background of the Problem
The American Health Information Management (AHIMA) is a 94-year-old, global non-
profit organization representing credentialed HI professionals in health data, informatics, and
information management who work with health data for over one billion patient visits each year
(AHIMA, 2022e). Their mission is to equip their professional membership to serve healthcare
organizations in these domains: informatics, data quality and analytics, privacy, risk, and
compliance, revenue cycle management, consumer health information, and clinical data coding
(AHIMA Career Map, 2022; DeAlmeida et al., 2019; Johns, 2013). The AHIMA professional
members are credentialed registered health technicians and administrators within the specialties
2

of informatics and data analysis, health data privacy and security, clinical data coding, and the
practice of documentation improvement within electronic health records. AHIMA HI
professionals maintain specialty health information and informatics credentials earned through
national examinations after completing a certificate program or associate, bachelor’s, and
master’s degree programs specific to the field. Except for the certificate and workforce
development programs, new graduates can only sit for these exams if they graduated from
collegiate programs accredited by the Commission for Accreditation of Health Informatics and
Information Management (CAHIIM) specific to the profession. Post-graduation, students
complete national examinations to earn the registered health information technician (RHIT),
registered health information administration (RHIA), or additional specialty credentials in one or
more core health information areas. Newly credentialed professionals are encouraged to seek
membership in AHIMA for professional guidance, mentorship, volunteerism, and continuing
education opportunities.
Research to determine the necessity for advanced degrees began with a 2013 survey of
the active, credentialed professional membership, which discovered that only 322 of 67,000
members (0.48%) held doctoral degrees in law or medicine or held PhDs (Brodnik et al., 2013).
Additional AHIMA research discovered that less than 12% of credentialed HI professionals held
graduate degrees in 2016. Subsequently, another survey determined that at least 651 of the 1453
member participants (44%) desired to return to school to obtain doctoral degrees (Brodnik et al.,
Morey et al., 2017, Olenik, 2019). The research culminated in a 2017 white paper, which
included a recommendation and call to action for the profession to increase credentialed
professional members with graduate degrees to 20% of total membership within 10 years. This
call to action was to fill emerging health technology managerial, supervisory, and operational
3

positions. However, recent innovative technology advances, federal healthcare policy changes,
healthcare organization structural transformations, and changes in the “ownership” of health data
and information forced AHIMA leadership to rethink the profession’s impact on the healthcare
ecosystem, the current methods to acquire knowledge and education in the field, and the
effectiveness of the current curriculum and degree relevance in healthcare (Abrams et al., 2017).
Organizational Goal
The goal for this study was that by 2027, the American Health Information Management
Association (AHIMA) will increase the number of members who hold relevant health
information, healthcare administration, and business graduate (master’s or doctorate) degrees to
20% of the total professional membership to meet changing healthcare needs. The goal was a
2017 recommendation from the AHIMA Council for Excellence in Education (AHIMA CEE)
task force strategic plan and white paper called Health Information Management Reimagined
(HIM Reimagined). HIM Reimagined developed recommendations to (a) create and obtain
qualified, prepared professionals to benefit the organization and (b) maintain professional
relevance within the healthcare ecosystem to sustain the profession. The AHIMA organization’s
overarching goals depicted through the recommendations were to ensure the specialization, core
knowledge, skills, and technical expertise of AHIMA HI professionals, to facilitate the
preparation of HI professionals who can provide operational support in any healthcare
organization, and to ensure HI professionals with bachelor’s and master’s degree practice at a
broader level to become leaders in healthcare organizations to benefit the organization, the
patient, and the healthcare population (Abrams et al., 2017).
Figure 1 depicts all four recommendations from the white paper. The white paper
indicated that to meet the first recommendation, the AHIMA organization and their 501(c)3
4

organization, the AHIMA Foundation, must increase academic scholarship funding, increase the
number of available, qualified faculty to teach graduate education, and implement graduate-level
health informatics curriculum competencies to increase the value of and demand for this field of
graduate education (Abrams et al., 2017).

Figure 1
White Paper Recommendations From the AHIMA 2017 Education Task Force

1. Increase the number of AHIMA
members who hold relevant
graduate degrees, (e.g., Health
Information Management, Health
Informatics, MBA, MD, MEd,
MPH) to 20% of total membership
within 10 years.
2. In collaboration with other
health and health-related
organizations, in the public and
private sectors, build a mechanism
to ensure availability of research
that supports health informatics
and information management.
3. Increase the opportunities for
specialization across all levels of
the health information academic
spectrum through curricula
revision, while retaining a broad
foundation in health information
management and analytics.
4. The AHIMA Registered Health
Information Administrator
credential is recognized as the
standard for health information
generalist practice and the
Registered Health Information
Technician (+Specialty) credential
as the technical level of practice.
5

Although all four recommendations were relevant to the future mission of AHIMA, of the
four recommendations from the 2017 white paper, the first recommendation aligned with the
problem of practice for this study concerning the lack of advanced degrees in the profession. As
such, this recommendation was determined to be an achievable, measurable organizational goal
for the profession. Therefore, the organizational goal for this study was to increase the number of
HI professionals with relevant advanced degrees to 20% of the membership by 2027.
Description of Stakeholder Groups
The primary stakeholders are the active, credentialed HI professional members of the
AHIMA professional association. These stakeholders have paid annually renewed memberships
and carry one or more professional AHIMA credentials related to the health information
management field. The HI professional members contribute to the organization by volunteering
at their Component State Associations (CSAs) and at national level, and by contributing to the
profession through research and advocacy. HI professional members will benefit from
accomplishing the organizational goal, as the HI profession becoming a master’s-level profession
is relevant to the field of health information and informatics, as well as the healthcare ecosystem.
Additionally, the AHIMA as an organization is also a stakeholder, as the outcome from the HIM
Reimagined white paper recommendations will impact the future of the organization’s
governance over health information and informatics professionals. Lastly, the healthcare industry
is also a stakeholder, as the role of the AHIMA professionals is evident throughout various
organizations involved in the healthcare hierarchy in direct patient care, health policy, healthcare
technology, and healthcare finance.
The HI professional membership has two stakeholder groups: HI professional members
with active AHIMA credentials and graduate degrees and HI professional members with active
6

AHIMA credentials without graduate degrees. The professionals without graduate degrees
include those with certified credentials obtained from stay-at-home self-study programs, one-
year collegiate certificate programs, and those with associate and bachelor’s degrees in health
information specialties from CAHIIM-accredited programs. Therefore, the stakeholder of focus
is the group of HI professional members of AHIMA who hold credentials but do not hold
master’s or doctoral degrees. This stakeholder group can influence organizational change to
address this issue.
Stakeholder Group for the Study
The primary stakeholders for this study were HI professional members of AHIMA with
credentials, certifications, associate degrees, and bachelor’s degrees. This research aimed to meet
AHIMA CEE’s and HIM Reimagined initiative’s first recommendation and subsequent goal to
increase the number of their professional members with graduate degrees. As previously stated,
in 2017, approximately 12% of the total membership had advanced degrees. This stakeholder
group without advanced degrees explored the potential pursuit of graduate degrees to respond to
the AHIMA call to return to school reflected in the 2017 HIM Reimagined white paper. A
previous research study examined the first recommendation from the perspective of associate
degree program directors’ motivation to change their curriculum to meet the call to action from
the HIM Reimagined white paper for Recommendation 1. Still, it was unknown whether there
were previous attempts to analyze the specific goal of obtaining graduate degrees for 20% of the
membership between 2017–2027 (Brightwell, 2020).
Nevertheless, failing to achieve this goal is substantial, as the lack of credentialed
professionals in this field without the training, education, and leadership capability to operate
emerging technologies and perform at the top levels of healthcare will severely impact the
7

profession’s survival. Disruptive technologies may eventually replace entry-level positions held
by HI professionals with only certifications and associate degrees (Kolbjornsrud et al., 2016;
Manyika et al., 2017; Olenik, 2019). Table 1 describes the organizational mission, the
organizational performance goal, and the stakeholder goal for this study.

Table 1
Organizational Mission, Organizational Performance Goal, and Stakeholder Goals
Organizational mission

The mission of the AHIMA empowering people to impact health. The mission is accomplished
by having professionals who intersect healthcare, business, and technology to ensure
patients, their professional healthcare teams, and personal healthcare providers have access
to health data and information to impact healthcare outcomes. (AHIMA, 2022e)

Organizational performance goal

By 2027, the AHIMA will implement methods to increase the number of members who hold
relevant health information, healthcare administration, and business graduate (masters or
doctoral) degrees to 20% of the total professional membership to meet changing healthcare
needs.

Stakeholder goal

By 2023, 10% of the credentialed HI professional members of AHIMA without advanced
degrees have applied or be actively enrolled in accredited collegiate programs to obtain
relevant (health-related or educational) graduate degrees.

8

Purpose of the Project and Research Questions
This project aimed to evaluate how knowledge, motivation, and organizational factors
influence and impact the decision AHIMA credentialed HI professionals make to obtain
advanced degrees. Furthermore, the project’s purpose was to determine if AHIMA will meet its
goal of increasing the number of credentialed HI professional members with advanced degrees to
20% of the total membership by 2027. As previously indicated, the primary stakeholders for this
study were those HI professionals who are members of AHIMA who do not currently have or are
enrolled in graduate degree-producing programs. The research questions which guided this
project are as follows:
1. What knowledge, motivation, and organizational influences are necessary to achieve
the AHIMA goal of obtaining graduate degrees for their credentialed HI
professionals?
2. What are the primary reasons provided by HI professionals for not obtaining
advanced degrees?
3. What are the recommended change processes and implementation methods required
in the organization pertaining to knowledge, motivation, and organizational support
required to meet the goal?
Importance of the Study
Studying the lack of advanced degrees was vital to sustaining the HI profession. Failure
to meet the goals had the potential to impact AHIMA’s ability to have qualified, prepared
professionals to benefit the healthcare population and ecosystem for the profession’s future.
Recommendations from the Clark and Estes (2008) gap analysis will increase the future
sustainment of the HI profession in the healthcare ecosystem. The findings from this study can
9

potentially sustain the AHIMA organization’s future as a leading HI professional organization
within the healthcare industry and establish clear pathways for stakeholders to obtain advanced
degrees.
Furthermore, this study will help AHIMA increase graduate-level professionals in the
field and align AHIMA members with other HI professionals who have already pursued practice-
based doctoral degrees (Seegmiller et al., 2015; Tekian, 2014). Lastly, advancement in this area
can reform the AHIMA’s outdated entry-level educational and technical practice models,
allowing the profession to keep pace with changes in the healthcare ecosystem and ensure the
continuity and viability of health information.
Overview of Theoretical Framework and Methodology
This study used Clark and Estes’ (2008) gap analysis model as the theoretical framework
to evaluate the stakeholder group and aimed to assist AHIMA in its goal of seeing 20% of its
stakeholders obtain advanced degrees by 2027. The Clark and Estes (2008) gap analysis
framework used knowledge, motivation, and organizational lenses to illuminate the needs of an
organization and produce evidence-based change plans. This is accomplished through the
identification and analysis of existing knowledge, skill, motivational, and organizational gaps
and barriers. This study used the gap analysis framework to study the AHIMA credentialed HI
professionals lacking advanced degrees, analyze their motivation to meet the goal, determine the
AHIMA organizational influences and barriers to the stakeholders’ quest to obtain advanced
degrees, and offer performance improvement recommendations and best practices to meet the
goal to increase the number of advanced degrees in the profession. This study used a descriptive
quantitative methodology developed from the theoretical framework. The methodology used a
single survey to collect quantitative data based on the research questions. Study participants were
10

AHIMA HI credentialed professionals who did not hold certifications, associate degrees, or
bachelor’s degrees. This population was appropriate for the study, as the members of the study
population do not hold advanced degrees and are the professionals who were the most at risk to
have their positions and skills replaced by artificial technology and other disruptive technologies
in healthcare (Abrams et al., 2017; Fenton et al., 2015; Kaldec, 2016; Olenik, 2019).
Definitions
The following terms frequently appear used throughout the problem of practice and the
remainder of this study. The operational definition for these terms allows a greater understanding
of terms specific to the HI profession and related to the knowledge, motivation, and
organizational (KMO) influences of the Clark and Estes (2008) gap analysis model.
Advanced Degrees
Advanced degrees are graduate degrees, specifically master’s and doctoral degrees
(Abrams et al., 2017; Kaldec, 2016).
Credential
A credential is a certification that demonstrates a professional’s tested skills and mastery
in a specific area of study (AHIMA).
Disruptive Technologies
Disruptive technologies are technologies that act as catalysts in evolving industries,
moving those willing to adapt forward and leaving others behind (Kolbjornsrud et al., 2016;
Manikya et al., 2017)
Emerging Technologies
Emerging technologies are technologies that are reshaping healthcare and include
targeted and personalized medicine, robotics, 3D printing, big data and analytics, artificial
11

intelligence, blockchain, and robotic process automation (Singhal & Carlton, 2019; Stanfill &
Marc, 2019).
Healthcare Ecosystem
Healthcare ecosystems in the United States are connected components working toward a
common goal, which have the potential to deliver a personalized and integrated experience to
consumers, enhance provider productivity, engage formal and informal caregivers, and improve
outcomes and affordability (Kowalski, 2015; Singhal & Carlton, 2019).
Health Information Professional
Allied health professionals credentialed by the AHIMA, and trained in the latest
information management technology applications, whose job is the understanding workflow
process in healthcare provider organizations, and who are vital to the daily operations
management of health information and electronic health records (EHRs). They ensure a patient’s
health information is complete, accurate, and protected, are the link between clinicians,
administrators, technology designers, operations, and information technology professionals,
affect the quality of patient information and patient care at every touch point in the healthcare
delivery cycle, work on the classification of diseases and treatments to ensure they are
standardized for clinical, financial, and legal uses in healthcare, care for patients by caring for
their medical data and are responsible for the quality, integrity, security, and protection of
patients’ health information (American Health Information Management Association, 2022h).
Organization of the Dissertation
This study is organized into five chapters. Chapter One introduces the problem of
practice describing the lack of advanced degrees in the HI profession. This chapter also
highlights the organizational mission, stakeholders, and goals, provides a review of the
12

theoretical framework, and offers definitions used in the study. Chapter Two is the literature
review depicting the study’s scope. Chapter Three discusses the study’s descriptive quantitative
methodology, as well as the study’s data collection and analysis plan. Chapter Four describes the
data collection process, analysis, and results. Chapter Five provides recommendations for the
problem of practice and initiatives for implementing and evaluating the stated goals.
13

Chapter Two: Literature Review
Chapter Two outlines the problem of advanced degrees within the HI profession. The
first section focuses on the historical information about the AHIMA and the HI professionals
within the healthcare ecosystem. Section two examines the stakeholder characteristics and the
impact of healthcare technology on the profession. Section three reviews the AHIMA guidance
concerning the recommendation and call to action for their members to pursue graduate
education. The concluding section addresses the literature for the gap analysis framework factors
of knowledge, motivation, and organization to determine HI professionals’ declarative and
procedural knowledge, their interest and utility value, and their self-efficacy to pursue advanced
degrees.
The History and Role of the AHIMA
It is essential to analyze the structure of the AHIMA and the HI professional trade to
assess the lack of advanced degrees in the HI profession. In healthcare, professional
organizations have leading roles in influencing and developing health policy, advocacy, and
practice within their specific field and critical roles in the education and training of their
practitioners in the development of core competencies (Gibson et al., 2015; Shaw, 2014). For HI
professionals, the AHIMA is the premier organization to support physicians as medical
librarians. AHIMA is a global non-profit professional association, which uses a professional
governance and advisory council model to manage over 100,000 members. The professional
governance entities include AHIMA executive leadership, the elected Board of Directors, the
Commission on Certification for Health Informatics and Information Management (CCHIIM) of
elected and volunteer members, which creates and certifies examinations for its multiple
credentials, the Council for Excellence in Education (CEE) of elected members and volunteers
14

who govern educational and professional development, 52 component state associations, the
House of Delegates, a deliberative assembly and forum with elected and appointed officials from
all 52 state associations for membership and professional issues and professional standards
maintenance (AHIMA, 2022e; Brightwell, 2017; Wiggs-Harris, 2021). Lastly, the AHIMA
Foundation is the 501(c)3 fiscal sponsor of AHIMA (AHIMA, 2022e; Brightwell, 2017; Wiggs-
Harris, 2021). The advisory entities which support the AHIMA mission and vision include the
Advocacy & Policy Council, which advises AHIMA on critical areas for strategic engagement in
advocacy and public policy pertaining to health information, the International Strategic Advisory
Council, which helps AHIMA manage global brand expansion and position advancement in the
healthcare ecosystem, and a CEO Advisory Council to advise the AHIMA CEO. AHIMA also
has an international branch called AHIMA International. (AHIMA, 2022e; Brightwell, 2017;
Wiggs-Harris, 2021).

15

Figure 2
AHIMA Organizational Chart

Note. Adapted from https://www.ahima.org/who-we-are/about-us/, by American Health
Information Management Association (2022e), and https://www.ahima.org/who-we-
are/governance/cee/cee/, by American Health Information Management Association (2022g).

Credentialed HI professionals are non-clinical technicians and administrators who
combine business, science, and information technology to practice acquiring, analyzing, and
protecting digital health data and traditional medical information. (Biedermann & Dolezel, 2017;
Oachs & Watters, 2016; Sayles & Gordon, 2016). HI professionals encompass 60% of clinical
AHIMA
Executive Leadership
Board of
Directors
Education
Council
Advocacy
Council
AHIMA Foundation
(501c3)
Component
state
associations
AHIMA
International
AHIMA House of
Delegates
16

and non-clinical health professionals in the United States who use scientific and evidence-based
practices for healthcare solutions (Association of Schools Advancing Health Professions, 2021).
Specifically, HI professionals ensure health data availability, accuracy, integrity, and security by
applying health technology, administration, and management skills in various settings (ASAHP,
2021; Oachs & Watters, 2016; Stanfill & Marc, 2019). HI professionals use evolving healthcare
automation and technologies, including data governance, big data analytics, and health data
privacy and security. They also employ skills in coding terminology and classifications
necessary to facilitate health information exchange, clinical documentation integrity, revenue
cycle billing, and electronic patient registry construction (Sayles & Gordon, 2016).
Developments in patient care, reforms in healthcare delivery, and rapidly developing
technology are driving changes in the role of health information. The Health Information
Technology for Economic Clinical Health (HITECH) Act of the American Recovery and
Reinvestment Act of 2009, the Patient Protection and Affordable Care Act (ACA) of 2010, and
the Health Care and Education Reconciliation Act of 2010 provided extensive changes in the
healthcare system and health information, transitioning the profession to operate in a digital
environment (Hertlendy et al., 2010; Kowalski, 2015; Liaw, 2013). This data revolution reshaped
the HI professional role from paper health record librarian to electronic health data steward,
increasing the need for education and skills in information technology (Dimick, 2012; Fenton et
al., 2017).
Impact of Disruptive Technologies
Technology is one of the most significant disrupters in healthcare and health information,
as it rapidly automates health information jobs and produces substantial amounts of health data
for analysis (Environmental Scan Report, 2018). Research predicts that artificial intelligence,
17

machine learning, and robotics will eventually overtake various activities that require routine
physical and cognitive functions accomplished by individuals in the workplace (Manyika et al.,
2017a; Manyika et al., 2017b; Pew Institute, 2016). Research from the McKinsey Global
Institute (2017a, 2017b) also reported that 49% of workplace activities could be automated by
adapting currently demonstrated technology. Predictions in research indicated that 5% of
occupations, including health professions, are targeted for automation, and nearly 60% of these
occupations have 30% of activities that can be automated (Manyika et al., 2017a; Manyika et al.,
2017b; Pew Institute, 2016). As a result, increased engagement with automation will become
necessary for workers (Kolbjornsrud et al., 2016; Manyika et al., 2017a; Manyika et al., 2017b;
Pew Institute, 2016). Additionally, studies by Stanfill and Marc (2019) and Fenton et al. (2017)
showed legislative and financial pressures to use technology as factors driving the development
of artificial intelligence in healthcare, which requires HI professionals to advance their current
skills. Furthermore, the magnitude and governance of health data generated from patient visits
need skilled HI professionals who can lead these changes (Stanfill & Marc. 2019; Fenton et al.,
2017).
The Need for Advanced Education
Research signifies that the goal behind automation is not to replace workers with
technology but to add value to human capabilities (Kolbjornsrud et al., 2016). Nevertheless, HI
professional trade studies indicated that automation will increase the demand for data
governance, data analytics, and legal, ethical, and regulatory guidance for health data (Kowalski,
2015; Liaw, 2013; Stanfill & Marc, 2019). Prior literature and studies indicated that the primary
roles vulnerable to automation and artificial intelligence are those involving physical activity in
predictable environments and those middle-skill jobs like data collection and data processing
18

with everyday activities (Abrams et al., 2017; Manyika et al., 2017a; Manyika et al., 2017bb;
Stanfill& Marc, 2019). In health information, this includes data management and governance,
patient privacy and confidentiality, medical coding and capturing AI-based information, and
workforce training, education, and development (Stanfill & Marc, 2019). These are primary roles
for many HI professionals in entry-level occupations without advanced degrees. These changing
healthcare trends are related to automation and require health information practitioners to
analyze the education and skills necessary to evolve their profession (Boyleston & Collins,
2012).
Education Trends in Other Allied Health and Health-Related Professions
Several research studies revealed that other health-related and clinical professions, such
as physical therapy and pharmacy, have already adopted or are considering entry-level doctoral
degree programs to meet the challenges in healthcare (Graham et al., 2011; Menezes et al., 2015;
Ortega & Walsh, 2014; Seegmiller et al., 2015; Tekian, 2014). The current required degree in
entry-level health information remains a bachelor’s degree with additional knowledge and skills
acquired through credentials (Karl, 2021). A recent study by Madlock-Brown et al. (2021)
evaluated the AHIMA career map to determine which degrees, knowledge, and skills were
necessary for higher pay due to technology advances. Still, the study did not address the need for
advanced education to maintain relevance in healthcare. The AHIMA needs an appealing
pathway to attract academically prepared HI professionals to higher education and, consequently,
the profession’s advancement (Abrams et al., 2017; Olenik, 2019).
Previous and Existing AHIMA Strategic Plans and Educational Strategies
Prior literature indicates the AHIMA conducted research and developed two strategic
plans in 2006 and 2017 for future health information educational development (Abrams et al.,
19

2017; Brightwell, 2020; Calhoun et al., 2012; Eramo, 2017; Karl, 2021; Olenik, 2019). Both
plans focused on three items: the transformation of health information into a graduate-level
profession, the realignment of associate degrees, and the preparation of effective, qualified health
information faculty (Abrams et al., 2017; Calhoun et al., 2012). However, the 2017 strategic plan
addressed the necessity of increasing baccalaureate and master’s degree programs to transition
the current associate-degree workforce to move the profession to a higher educational level as
soon as possible (Abrams et al., 2017; Eramo, 2017; Olenik, 2019). One of the four
recommendations from this study was a call to action to obtain advanced degrees, namely,
master’s and doctorate degrees, for the profession’s advancement and sustainment. Despite this
move toward advanced degrees, there is no formal AHIMA mandate to create a future roadmap
for HI professionals (Karl, 2021; Olenik, 2019).
Clark and Estes (2008) Gap Analysis Framework
The Clark and Estes (2008) gap analysis is a practical framework to determine gaps
between the AHIMA association’s current performance and goals. This framework defines and
measures the causes of gaps between the desired goal and present performance levels (Clark &
Estes, 2008). The gap analysis facilitates analysis to implement organizational change through
the context of knowledge, motivational, and organizational influences (Clark & Estes, 2008).
According to Clark and Estes (2008), the three elements that influence performance are
individual knowledge, individual motivation, and the organizational environment. In this
research, the stakeholder groups are the AHIMA HI professionals working in various healthcare
occupations. This study’s organizational environment is the AHIMA, which governs the HI
profession.
20

The first two sections introduce the knowledge and motivational influences and
application of the gap analysis framework about the stakeholder, the HI professionals, in the
quest to obtain advanced degrees. The third section will analyze the AHIMA organizational
influences on the HI professional’s goal to obtain advanced degrees. The final section explains
the study’s conceptual framework.
Stakeholder Knowledge, Motivation, and Organizational Influences
According to Clark and Estes (2008), the three leading causes of performance gaps are
the knowledge and skill of individuals, an individual’s motivation for goal achievement, and
organizational barriers that prevent goal attainment. This study will first examine the knowledge
and skills necessary to determine if HI professionals can achieve the organizational goal. The
literature determined the need for HI professionals to obtain advanced degrees for professional
advancement and sustainment of the profession itself due to advancing healthcare, increasing
rates of practice-based doctoral degrees in allied and clinical health professions, and increasing
impacts of disruptive technologies on healthcare (Abrams et al., 2017; Seegmiller et al., 2015;
Stanfill & Marc, 2019). Therefore, the knowledge and motivation influences will determine what
experience, information, and skills are necessary for HI professionals to achieve the
organizational goal of advanced degree pursuit and attainment. The organizational influences
will discuss cultural models and settings and the necessary organizational changes and
developments required to meet the stakeholder and organizational goals.
Knowledge Influences
This section will discuss knowledge-related influences that are important in exploring the
stakeholder competency of focus to achieve the goal of attaining advanced degrees. It will
contain a literature analysis to support the knowledge influence descriptions. The knowledge
21

influences include both declarative and procedural knowledge types. Therefore, this literature
review aims to determine how declarative knowledge helps HI professionals decide to return to
school to pursue advanced degrees. This section organizes the literature by defining declarative
knowledge and then analyzing research that identifies declarative knowledge strategies to assist
adult, mature learners in selecting and returning to educational institutions.
Declarative Knowledge
HI professionals must demonstrate declarative knowledge techniques, skills, and
competencies to assist them in returning to school for advanced degrees. They must understand
how to make an informed decision to return to school, including the hours, cost, time, and
work/home/study ratio. Declarative knowledge factors play an essential part in mature adults
returning to higher education; therefore, they play an essential role in meeting the stakeholder
and organizational goal of 20% of HI professionals returning to school for advanced degrees
(Cappellari & Lucifora 2009).
HI professionals must employ processes to navigate school selection, admission,
financing, and enrollment in courses of study. Declarative knowledge is the capacity to recall
facts, understand static knowledge and events, and use that information to solve problems and
make complex decisions (Gray & Orasanu, 1987; Gupta et al. 2009; Krathwohl, 2009; Kump et
al., 2015; Wuryaningrum et al., 2020). Declarative knowledge is also the acquisition of specific
facts and definitions, which are the building blocks of higher forms of knowledge (Apt et al.,
1988; Goldman & Hasselbring, 1997, as cited in Sawar & Trumpower, 2015)
The analysis of the declarative knowledge can reveal how behavior impacts learning
effectiveness (Politzer, 1983 as cited in Hwang et al., 2019). Few studies in the literature
discussed declarative knowledge of adult, mature learners returning to school. However, some
22

studies focused on elementary and high school students’ declarative knowledge. These studies
indicated that using declarative knowledge improved student understanding of concepts,
problem-solving, and knowledge reflection when they learned through text, were given feedback,
and actively engaged in their knowledge structures (Sawar & Trumpower, 2015; Wuryaningrum
et al., 2020). One study did indicate that using declarative knowledge assisted the ability of adult
learners to bring their prior experiences and personal biographies to college environments
(Anderson, 1993; Bruer, 1993; Rummelhart & Norman, 1978, as cited in Donaldson & Graham,
1999). Donaldson and Graham (1999) also noted that declarative and procedural knowledge,
metacognitive processes, and cognitive operations are part of adult cognition. Adults with
enhanced prior knowledge experiences can connect new information to prior experiences, which
is essential for complex decision-making (Donaldson & Graham, 1999; Gupta et al., 2009).
Therefore, declarative knowledge is necessary for HI professionals to recall processes used to
select, apply, and enroll in academic institutions, and to identify relevant collegiate experiences.
Procedural Knowledge
Procedural knowledge is understanding how to do a thing (Kadijevich & Haapasalo, 2001
as cited in Sawar & Trumpower, 2015; Krathwohl. 2002; Wuryaningrum et al., 2020). Research
shows that declarative and procedural knowledge are aligned, as Berge & Hezewijk (1999)
posited that declarative knowledge is not separate from procedural knowledge. There was no
extensive research on mature adults returning to higher education using procedural knowledge
skills. Most studies involved school-aged children and undergraduates enrolled in bachelor’s
degree-producing programs using procedural knowledge for task completion. Nevertheless,
procedural knowledge is necessary for HI professionals to understand and execute the necessary
methods to enroll in advanced degree programs.
23

Table 2 summarizes the declarative and procedural knowledge influences pertinent to the
achievement of both the stakeholder goal (10% of HI professionals enrolled or attending
advanced degree programs by 2023) and the AHIMA goal (20% of their members hold a
graduate degree by 2027).

Table 2
Knowledge Influences
Assumed knowledge influence Knowledge type
HI professionals must know how to make an
informed decision to return to school (Gray &
Orasanu, 1987; Gupta et al. 2009; Krathwohl,
2009; Kump et al., 2015; Wuryaningrum et
al., 2020).
Declarative
HI professionals must know how to select,
apply, and enroll in graduate degree programs
(Berge & Hezewijk, 1999; Kratwohl. 2002;
Sawar & Trumpower, 2015; Wuryaningrum
et al., 2020).
Procedural

24

Motivational Influences
Examination of motivational influences and strategies is important to achieve
stakeholder and organizational goals. This section organizes the literature under the following
primary areas: (a) defining motivation and individualistic motivation theories of utility value and
self-efficacy, and (b) analyzing research that identifies motivation as the reason why mature
adult learners return to school.
Motivation is an individual’s energy, intent, or psychological process to complete tasks
and activities (Pintrich, 2003; Pintrich & Schunk, 1996, as cited in Clark & Estes, 1999; Ryan &
Deci, 2000). Clark and Estes (2008) stated that motivation is a driver for the knowledge,
motivation, and organization (KMO) gap analysis and involves the three facets of active choice,
persistence, and mental effort, which are necessary for growth, integration, social development,
and personal well-being (Ryan & Deci, 2000).
Expectancy-Value Theory and Task Value
Expectancy-value theory (EVT) suggests that motivational influences impact an
individual’s choice, persistence, and performance based on self-efficacy beliefs (Atkinson, 1957;
Eccles et al., 1983; Wigfield, 1994; Wigfield & Eccles, 1992, as cited in Wigfield & Eccles,
2000). Furthermore, EVT determines an individual’s achievements by the expectancies for
success and subjective task values (Eccles, 1983,1994; Wigfield & Eccles, 2000, 2002, as cited
in Georges & Chandler, 2010, p. 610). Moreover, Eccles et al.’s (1983, as cited in Wigfield &
Eccles, 2000) expectancy-value model determined that subjective task value has four
components: interest value, utility value, attainment value, and cost (Eccles et al. 1983; Eccles &
Wigfield, 2002; Wigfield & Eccles, 2001 as cited in Leaper, 2011; Eccles, 2014). The
expectancy-value model posited that expectations for success and task value are shaped by a
25

combination of factors that include individual characteristics (e.g., capabilities, previous
experience, aspirations, self-perceptions, beliefs, and expectations) and environmental influences
such as cultural environment and the socializers’ beliefs and behaviors (Leaper, 2011).
Additionally, the Eccles expectancy-value model (EEVM) included task-specific beliefs, called
social cognitive variables, influence expectancies, and values (Eccles & Wigfield, 2002). Eccles
et al.’s (2002) expectancies also reflected Bandura’s (1997 as cited in Eccles et al., 2002)
personal efficacy expectations for success, as personal expectations encompass an individual’s
beliefs on task performance. Overall, using these strategies assists in the analysis of learning
motivation and the likelihood of an HI professional returning to school if they participate in high
subjective task values they can master (Eccles, 2014; Georges & Chandler, 2010). Motivational
task value strategies also enable an expectation for personal efficacy related to the mastery of
specific task values (Bandura, 1987, as cited in Eccles & Wigfield, 2002; Eccles, 2014; Wigfield
& Eccles, 2000).
Interest (Intrinsic) and Utility (Extrinsic) Value Motivation
Individual motivation is crucial to the adult learner’s decision to return to school for an
advanced degree. Ryan and Deci’s (2000a, 2000b) work with individual motivation defined
intrinsic and extrinsic motivation. Intrinsic motivation is the completion of a task that an
individual finds exciting or enjoyable. In contrast, extrinsic motivation pertains to an individual
completing a task because it leads to a distinguishable outcome (Ryan & Deci 2000a, 2000b).
The literature regarding motivational strategies for adults returning to school often
incorporated personal and professional motivational factors. Harris & Burman (2016) analyzed
the impact of professional and personal motivation (inhibitors and job satisfaction) for nurses
returning to school for baccalaureate or advanced degrees. Of the 305 nurses surveyed for their
26

motivation to return to school, personal motivational factors included confidence, commitment,
respect, and career satisfaction. In contrast, professional factors included influence, awareness,
clear organizational roles, career progression, increased collaborative opportunities, quicker
ability to identify concerns and issues in the field, and increased promotion expectation (Harris
& Burman, 2010). The results of this study suggested that as personal motivation increased, the
intent to return to school increased, but as professional motivation increased, the likelihood of
returning to school decreased (Harris & Burman, 2010). A qualitative study by Jacot, Frenay,
and Cazan (2010) analyzed the task value and expectancy of success using attainment value,
intrinsic value, utility value, and cost. The researchers observed motivational and contextual
factors that affected the dropout rate of 17 adults returning to school, plus barriers that interfered
with the motivation of adult students for academic advancement (Jacot et al., 2010). Results
indicated that some adults returned to school for extrinsic reasons, and others developed coping
strategies to succeed and graduate. However, the authors suggested a need for more research in
this area (Eccles, 1984; Jacot et al., 2010).
Another study by Nurashima et al. (2013) evaluated 669 adult women and men over the
age of 60, and all enrolled in a public continuing education program (Nurashima et al., 2013).
The researchers’ goal was to use the theory of self-determination, intrinsic and extrinsic
motivation, and educational gerontology and psychology frameworks to assess older adult
learners’ educational activities needs. The assessment included their investment of time and
energy, the expectation of future gains, and psychological needs (Adair & Mowsesian, 1993;
Havighurst, 1964, as cited in Nurashima et al., 2013). Results indicated that gender and
perceived motivation were factors in overall participation in educational activities. Still,
27

researchers determined the need for more quantitative and qualitative research regarding
motivational benefits from a personal, situational, and structural lens (Narushima et al., 2013).
HI professionals must consider the impact of motivational factors and strategies to seek
advanced degrees. The motivation to pursue new learning experiences in higher education is
critical (Guo et al., 2015). This is a crucial factor for those who respond to the recommendation
and subsequent call to action from AHIMA to pursue and obtain advanced degrees. An HI
professional’s interest, enjoyment, personal goal-fulfillment, self-identity, knowledge of
potential consequences, and cost benefits are all task values and motivational factors related to
the attainment of advanced degrees (Bandura, 1987, as cited in Eccles & Wigfield, 2002; Eccles,
2014; Wigfield & Eccles, 2000).
Self-Efficacy
Bandura’s (2001) social cognitive theory discusses how individual agents influence their
life circumstances using “intentionality, forethought, self-regulation, and self-reflection” (p. 6).
Social cognitive theory also emphasizes the role of cognition and how behavior is motivated by
personal, behavioral, and environmental influences, all of which influence each other (Bandura,
2001, as cited in Smith et al., 2005). Individuals learn from their behaviors and the actions of
others, which allows thought regulation and beliefs while interacting with the environment and
behaviors (Bandura, 2005). The self-efficacy theory is the most applicable to the HI
professional’s motivation to return to school. According to Bandura (1989), self-efficacy is an
individual’s belief in their ability to master a certain skill or behavior and control life events
(Bandura, 1989). Furthermore, mastery experiences are the most effective method of providing a
keen sense of efficacy and human motivation, affect, and action, all which play essential roles in
28

self-regulation and motivation (Bandura, 1982, as cited in Hackett, 1995; Bandura, 1989;
Bandura, 2002).
Literature concerning the motivation of adult graduate students determined that personal
motivation is crucial for success and determines if the experience is positive or negative
(Hegarty, 2011). According to Hegarty (2011), understanding self-determination theory (SDT)
and achievement-goal theory (AGT) leads to understanding motivation at the college level.
Hegarty also determined that adult student motivation is influenced by an interest in a specific
topic (intrinsic) and by goal attainment (extrinsic).
The literature included examinations of motivational theories, definitions, and studies to
show how motivation impacts adults returning to school. When adults consider furthering their
education or meeting personal or organizational goals, individual motivation, task value, and
self-efficacy are factors. Table 3 summarizes the self-efficacy, utility value, and intrinsic value
motivational influences pertinent to the stakeholder goal of 10% of HI professionals enrolled or
attending advanced degree programs by 2023 and the AHIMA goal to achieve 20% of their
membership with a graduate degree by 2027.

29

Table 3
Motivation Influences
Assumed motivation influence Motivation type
HI professionals need to possess the interest and
motivation to respond to the AHIMA
recommendation to return to school for
advanced degrees (Eccles & Wigfield, 2002;
Eccles, 2014; Wigfield & Eccles, 2000).
Interest value (intrinsic)
HI professionals must possess the motivation to
apply, enroll and complete advanced
education degrees (Eccles & Wigfield, 2002;
Eccles, 2014; Wigfield & Eccles, 2000).
Utility value (extrinsic)
HI professionals must possess an expectation
and determination for success and goal
fulfillment by returning to school (Bandura,
1989).
Self-efficacy

Organizational Influences
In addition to gaps in knowledge and motivation, barriers formed by organizational
culture influences often cause performance gaps. These influences are determinants for
stakeholder success in goal attainment. Gallimore and Goldenberg (2001) defined organizational
influences as organizational models and settings. For this study, it is essential to determine if
organizational gaps related to stakeholder advanced degree attainment exist.
AHIMA has no current structured, top-down guidance for advanced degree pursuit. HI
professionals do not typically pursue additional education except for job advancement or to
instruct at the collegiate level. HI professionals often return to school for advanced education
only if required by their employer or for personal advancement, mainly because of the widely
held assumption that advanced degrees are not necessary to practice in the profession. Therefore,
30

there is a lack of preparation and guidance for HI professionals wishing to return to school,
despite AHIMA’s call to action. This section discussed the prominent models and settings
affecting the HI professionals’ return to school for advanced degrees.
Cultural models are defined as the normal understanding of how the world should work
and includes what is valued, settings to endorse or avoid, and rules and purpose of interaction
(Gallimore & Goldenberg, 2001; Cole, 1985, as cited in Gallimore and Goldenberg, 2001).
Gallimore and Goldenberg (2001) considered cultural models as historical representations that
evolved from shared perceptions, thoughts, and responses to challenges and conditions. These
models are often developed gradually over long periods and are so familiar that they are often
overlooked and undetectable to those within the organization (Gallimore & Goldenberg, 2001;
2010; Rueda, 2011).
Cultural Model: Credential Attainment Post-Graduation
One cultural model which impacts the stakeholder group is evident in the credentialing
process after degree completion. After graduating from a CAHIIM-accredited two- or four-year
collegiate program in health information technology or health information management, HI
professionals complete national examinations for AHIMA-specific credentials. Graduation from
an associate degree program enables students to complete the exam to become Registered Health
Information Technician (RHIT), while graduation from a 4-year health information
baccalaureate program enables students to complete the examination and receive the Registered
Health Information Administrator (RHIA) credential. Additionally, HI professionals can obtain
additional professional credentials as clinical data coders through a self-study course or a one-
year certification course through AHIMA or a collegiate program.
In addition to the RHIT and the RHIA, AHIMA also has three specialty credentials HI
31

professionals can earn and use in conjunction with the practice-based and coding credentials;
these include the Privacy and Security (CHPS) credential, the Clinical Documentation
Improvement (CDIP) credential, and the Certified Health Data Analytics (CHDA) credential. HI
professionals often obtain these credentials to indicate competence, proficiency, and expertise in
the field. This cultural model is the standard expectation for professional progression, as the
bachelor’s degree is the terminal degree for the profession (Karl, 2021; Olenik, 2019). Also,
many HI professionals opt to increase the number of credentials by testing for additional
specialty and coding credentials within AHIMA or from other professional healthcare
organizations instead of returning to school. The cultural model of obtaining credentials, though
important and necessary to practice in the profession, has signified success without furthering
educational opportunities with advanced degrees. Advanced degrees are not for everyone, which
is evident in a 2020 AHIMA partnership with a land-grant university system to provide an online
course to obtain additional micro-credentials (Kaldec, 2016). This cultural model is also apparent
in the number of online courses offered to AHIMA members for credentialing examination
preparation, specialty certifications, and continuing education units (CEUs) (Kaldec, 2016).
Training and education for AHIMA HI professionals continues to focus on skill development
within the profession, but not advanced degrees. Furthermore, peer-reviewed educational
research conducted by HI professionals since the 2017 recommendation revealed only one study
focused on efforts to establish an advanced degree educational model (Morey et al., 2017)
Cultural Model: Focus on Undergraduate Education and Career Development
The current entry-level education for a credentialed HI professional is the associate
degree, with the baccalaureate representing the terminal degree level (Kadlec, 2016). The
cultural model of education has historically been to obtain either an associate’s or bachelor’s
32

degree to work successfully in the profession. According to 2022 data from CAHIIM, there are
currently 241 accredited collegiate health information management associate degree programs,
74 accredited programs offering health information management baccalaureate degrees and
health information management certificates, and 35 accredited health informatics and health
information management master’s degree programs in the United States.
Because of the current evolution of the healthcare ecosystem, there is a greater demand
on the HI profession to function at increasingly higher skill levels, but the majority of degree
programs are at the undergraduate level and do not cover advanced skill sets and practices
(AHIMA Education Workgroup, 2012; Kadlec, 2016). Furthermore, one recommendation from
both AHIMA Vision 2016 and the HIM Reimagined call to action discussed the need for an
adequate, qualified pool of health information management faculty to teach health information
programs in colleges and universities, but for this to occur, the culture must embrace the earning
of advanced degrees (Vision 2016, 2012; Kadlec, 2016; AHIMA Educational Work Force,
2012).
As a professional association, AHIMA provides career development guidance and
continuing education to its HI professionals. Career tools, such as the AHIMA Career Map,
Career Prep Workbook, and Career Prep Webinars, help HI professionals discover individualized
pathways for career development (Enhance your career: Career Map and Tools, 2022). The
career preparation tools created by AHIMA health information experts in the field focus on goal
setting, skill development, and navigating future career goals in the HI profession. The
interactive career map shows HI professionals’ potential and emerging career opportunities at the
entry, mid-career, advanced, and master’s levels. However, the Career Map shows many of the
career paths at the entry, mid, and advanced levels, but fewer potential careers at the master’s
33

level for HI professionals. For the profession to advance to a master’s-level health information
degree and profession, it is necessary to include organizational support for potential jobs, plus
career emphasis on the advanced health information skill sets, advanced degree programs, and
career placement in positions that require advanced degrees. Also, as previously indicated in the
literature review, many healthcare and allied health professions already require post-
baccalaureate education before qualifying for entry-level positions (AHIMA Education
Workgroup, 2012; Kadlec, 2016). This shift to advancing the HI workforce to an advanced
degree profession requires a change in the profession’s educational culture to allow for the
profession’s maturation, as well as to advance HI professionals in leadership roles within the
healthcare ecosystem (Kadlec, 2016). Figure 3 shows the Career Map and its mastery levels and
depicts few current and emerging career pathways at the master’s level in the outer circle.

34

Figure 3
AHIMA Career Map

Note. Adapted from the AHIMA career map by the American Health Management Association,
2022, (https://my.ahima.org/careermap) Copyright © 2022 AHIMA.

Cultural Setting: Career Pathways, Financial Support, and Mentorship
There are similarities between cultural models and settings, but cultural settings are the
visible manifestations of cultural models (Clark & Estes, 2008; Gallimore and Goldenberg, 2001;
Schein, 2004). Cultural settings are observable, such as written policies and standard operational
35

procedures. One cultural setting is HI professional support through the AHIMA Foundation, the
501(c)3 nonprofit organization branch of the AHIMA parent organization. In addition to
conducting innovative research and workforce development opportunities for HI professionals,
the AHIMA Foundation provides financial support through donations for HI professionals
enrolled in degree-producing programs. The Foundation offers four scholarships for
professionals enrolled in associate, bachelor, master’s, and doctorate programs. The scholarship
amount begins at $1,000 for an associate degree, and increases in $500 increments for each
successive degree, with the doctoral student receiving $2,500. The AHIMA Foundation also has
scholarships for merit, veterans, and dissertation support. Several students from each category
who are enrolled in accredited health information programs receive these scholarships annually.
These scholarships range from $1,000 to $2,500.
Although the AHIMA Foundation provides scholarship support to its members, the dollar
value of the scholarships from donor support is not enough to provide for advanced degree
education. A qualitative study explored the perception of value-added to the lives of college
graduates and discovered that most students who borrowed money for education felt the outcome
was worth the costs. But the study showed the costs of repaying the loans left the students feeling
overburdened (Nukols et al., 2020). Furthermore, the study determined that the 44 million
students who borrowed loan monies had a combined total debt of $1.569 trillion (Experian 2018;
Board of Governors of the Federal Reserve System, 2019, as cited in Nukols et al., 2020). To
assist the 20% of the members who decide to answer the call to action and return to school for
advanced degrees by 2027, the AHIMA organization must consider alternative financial support
to meet the goal.
36

Adult learners face many barriers when deciding to return to school, and financial support
is often one of those barriers. According to research, adult learners juggle competing
responsibilities when returning to school and face dispositional, institutional, and situational
barriers, including financial difficulties (Osam et al., 2017). Prior qualitative and quantitative
studies showed lack of financial support, in addition to the family, work, and time demands, was
a barrier to returning to school for adult learners (Deutsch & Schmertz, 2011; Goto & Martin,
2009; Flynn et al., 2011; Saar et al., 2014, as cited in Osam et al., 2017). AHIMA must find
methods to eliminate this barrier to support those HI professionals returning to school to meet the
organizational goal by 2027.
Table 4 summarizes the organizational influences, cultural models, and cultural settings
pertinent to the AHIMA goal to achieve 20% of its membership with a graduate degree by 2027.

Table 4
Organizational Influences
Assumed organizational influence Organizational category
The AHIMA must eliminate the assumption
that undergraduate degrees and credentials
are enough, by providing leadership and
mentorship support services to guide those
pursuing advanced education.
Cultural model
The AHIMA must reduce barriers to
advanced degree completion by providing
additional financial and educational
incentives for members who return to
graduate education.
Cultural setting

37

Conceptual Framework
A conceptual framework comprises what the researcher wants to find in the study and,
through literature, determines the study’s exploration, direction, and relationship (Creswell &
Plano Clark, 2018; Grant & Osanloo, 2014; Maxwell, 2013; Merriam & Tisdell, 2018). The
problem of practice and literature design support the conceptual framework and guide the
research design (Maxwell, 2013; Merriam & Tisdell, 2018).
The theoretical framework for this study is Clark and Estes’ (2008) gap analysis, which
identifies performance gaps in the knowledge of the health information stakeholders, the
motivation of stakeholders to return to school, and existing and potential organizational barriers.
The conceptual framework guides the research process and identifies concepts, assumptions,
variables, beliefs, and methodology about the lack of advanced degrees (Merriam & Tisdell,
2018; Miles & Huberman, 1994 as cited in Grant & Osanloo, 2014).
For this study, the stakeholder is the HI professional. As the organization’s goal is for
20% of the stakeholders to obtain advanced degrees by 2027, the conceptual framework must
focus on the knowledge, motivation, and organization influences and performance gaps that may
impede goal accomplishment. To meet the goal, the stakeholders must know how to initiate and
implement the processes associated with returning to school for advanced degrees. They must
also have the motivation and the need to return to school. Additionally, the AHIMA, as the
association that implemented the initiative to return to school, must provide support for those
answering the call to action for advanced degrees.
In this conceptual framework depiction in Figure 4, the diagram denotes the three areas
of the gap analysis framework: knowledge, motivation, and organization. In this visual depiction
of influences, each circle represents an area that affects the health information stakeholder. The
38

diagram shows the declarative and procedural knowledge influences and the self-efficacy and
utility value the stakeholders must implement to meet the stakeholder goal for 10% of the
membership to apply and enroll in educational institutions to obtain advanced degrees. These
circles overlap, showing the knowledge and motivational constructs the stakeholder needs to
demonstrate to accomplish the organizational goal. The organizational circle envelopes the
knowledge and motivation circles just as the influences of cultural models and settings impact
the knowledge and motivation influences of the stakeholders’ goal attainment. All stakeholder
and organizational influences must work synergistically to meet the organizational goal of 20%
of AHIMA membership obtaining advanced degrees by 2027.

Figure 4
Conceptual Framework

Organizational Influences

Health
Information Professionals’
Knowledge
Influences

Declarative
Procedural
Health
Information Professionals’
Motivational
Influences

Interest (Intrinsic) Value
Utility (Extrinsic) Value
Self-Efficacy
Member Support Services
Financial and Educational lncentives
20 Percent of Health Information Professional with Advanced Degrees by 2027
39

Summary
Chapter Two outlined the lack of advanced degrees and KMO factors that may influence
the achievement of the stakeholder goal of 10% of HI professionals applying to or being enrolled
in advanced degree programs by 2023. The literature review in Chapter Two analyzed the KMO
influences affecting the goal of 20% of HI professionals with advanced degrees by 2027.
Additionally, the literature review emphasized the historical background, context, and decisions
that determine the health information role in the healthcare ecosystem, the impact of disruptive
technologies in the health information field, and the reason advanced degrees are necessary,
specifically for those who have the potential to have their careers replaced by technology in the
future. Furthermore, the conceptual framework showcased how KMO influences impact the HI
professionals’ understanding of the need to return to school and the processes necessary to return
to school to meet the goal. Overall, goal achievement will require HI stakeholders to have the
ability to enroll, complete, and graduate from advanced degree programs. Chapter Three
provides a detailed discussion of a mixed-methods design and methodology to explore the KMO
influences on achieving the stakeholder and organizational goals.

40

Chapter Three: Methodology
The purpose of this study is to explore the KMO influences which impact HI
professionals’ determination to return to school for advanced degrees to meet the stakeholder
goal of 10% of HI professionals enrolled or attending advanced degree programs by 2023, and
the AHIMA goal to achieve 20% of their membership with a graduate degree by 2027.
Therefore, Chapter Three will identify the research design, setting, and the researcher’s
positionality. The chapter will also discuss data sources, participants, instrumentation, data
sources, collection procedures, and analysis. Lastly, the chapter will address the study’s validity,
reliability, the researcher’s ethical responsibilities, and any limitations and delimitations.
Research Questions
The research questions for this study were as follows:
1. What knowledge, motivation, and organizational influences are necessary to achieve
the AHIMA goal of obtaining graduate degrees for their credentialed HI
professionals?
2. What are the primary reasons provided by HI professionals for not obtaining
advanced degrees?
3. What are the recommended change processes and implementation methods required
in the organization pertaining to knowledge, motivation, and organizational support
required to meet the goal?
Overview of Design
This quantitative study used a descriptive research methodology, which used a survey
with close-ended questions and a single open-ended question to collect participant information.
Descriptive studies describe responses to the study variables and can also describe and interpret
41

the status of individuals, settings, and actions with no manipulation from the researcher
(Creswell & Creswell, 2018; Mertler, 2014). The methodological design involved the collection
of quantitative data using a survey in response to the research questions to determine the
knowledge, motivation, and organizational influences of HI professionals in their pursuit of
advanced degrees. Furthermore, this study aimed to recognize gaps in knowledge, motivation,
and organization that would keep the AHIMA from meeting the goal of having 20% of their
credentialed HI professionals with advanced degrees by 2027. Questions asked during the study
included rigorous quantitative sampling for data collection. The data collection for this study
included quantitative sampling and survey data analysis (Merriam & Tisdell, 2016). This study
also used qualitative data collected from the survey using one open-ended free-text survey
question, along with the use of internal organizational documentation reviews for the quantitative
findings. Table 5 depicts the methodology for data collection and the guiding research questions.

42

Table 5
Data Sources
Research questions Method 1:
survey
Method 2:
open-ended
survey question
Method 3:
document analysis
RQ1: What knowledge,
motivation, and organizational
influences are necessary to
achieve the AHIMA goal of
obtaining graduate degrees for
their credentialed HI
professionals?
X X X
RQ2: What are the primary
reasons provided by HI
professionals for not obtaining
advanced degrees?
X X X
RQ3: What are the recommended
change processes and
implementation methods
required in the organization
pertaining to knowledge,
motivation, and organizational
support required to meet the
goal?
X X X

Research Setting
A research setting is a physical, social, and cultural site where the researcher conducts the
study (Given, 2008). The setting can also refer to a geographic location or a specific group of
participants (Given, 2008). For this study, the geographic research setting was within the
AHIMA organization, the fifty United States, the District of Columbia, and Puerto Rico. The
study did not include AHIMA international affiliates. The AHIMA has over 103,000
professional association members located throughout the United States, including Puerto Rico
43

and the District of Columbia. The setting for the survey was online, as it allowed access to active
AHIMA HI professional members across the United States, the District of Columbia, and Puerto
Rico. The participants for the study were graduates of certificate programs, CAHIIM-accredited
associate, and bachelor’s degree programs, and have active AHIMA professional or specialty
credentials. This population was appropriate for the research questions, as it is the population
targeted by the AHIMA HIM Reimagined white paper recommendation to obtain advanced
degrees.
The Researcher
There are several issues related to my positionality. First, my positionality for this study
is formed by social factors, previous experiences as an HI professional within the military and
academia, and my identity as a minority, cisgender woman with expertise in health information
as a professional member with two graduate degrees. Secondly, like the stakeholders, I am an
active, credentialed member of the AHIMA, so the stakeholders in this study are not my
employees or subordinates. Instead, they are my colleagues in the profession of health
information. As an active AHIMA member, I have served on committees at the state and national
levels for the last five years. I also have experience as a state association director of education,
state association president for the District of Columbia, and state delegate within the AHIMA
House of Delegates for four years.
As the call to action recommended, I am an HI professional currently enrolled in a
doctoral program. I understand the knowledge, motivational, and organizational factors which
led to the decision to answer the call to action and return to school. I also appreciate the
difficulty of deciding to return to school and the barriers to school choice, application, and
44

enrollment. As a parent and educator, I also understand the impact such a decision has on family
obligations, employment, and finances.
My tenure in leadership positions in AHIMA, my state association, and the military, plus
my graduate education studies in information systems and technology, may introduce
preconceived biases against the stakeholders, potentially affecting the research study. The
stakeholders do not have graduate degrees, may not have served in the military, and may not be
educators in this field of study. However, according to Merriam and Tisdell (2016) and Probst
and Bereson (2014), applying the strategy of reflexivity to understand the influence it will have
on the stakeholder can not only aid in the elimination of personal biases and assumptions but add
clarity to the study.
Data Sources
The University of Southern California (USC) Qualtrics online software program collected
the survey data. The survey questions informed the research questions, conceptual framework,
and theoretical framework concerning the KMO influences affecting HI professionals’ pursuit of
advanced degrees to meet the goal for 20% of the AHIMA membership (credentialed HI
professionals) to obtain advanced degrees by 2027.
Participant anonymity and confidentiality maintenance for this study occurred by
retaining all information within the password-protected USC Qualtrics system. Furthermore,
maintenance of all quantitative data security occurred by limiting access to survey data to the
researcher and the dissertation chair. Any participant’ breach of anonymity or revelation of
confidentiality would have resulted in the immediate destruction of that participant’s information
upon error identification. All necessary academic and professional expertise and support utilized
for this study came from the researcher, the dissertation committee members, the AHIMA
45

Director of Academic and Workforce Development, and the AHIMA Academic Research
Workgroup of the Council for Excellence in Education (CEE), who reviewed and approved the
researcher’s academic research request forms and approved the distribution of the data collection
instrument within the AHIMA Access online community and the AHIMA Component State
Associations, None of these individuals and organizations had access to the identities of the
study participants at any time. The participating organization, AHIMA, gave permission to use
the organizational name in the research in lieu of a pseudonym.
The survey design diminished the collection of data that contained identifiable
information. Participant names were not collected during the survey; however, demographic data
were collected during the survey. Any survey responses that named individuals in the final open-
ended question were immediately redacted prior to data analysis and destroyed at the study’s
completion. The researcher maintained the security of all survey data, which included all data
from the online survey and survey reports, researcher notes, draft dissertation copies, data from
conversations with the AHIMA Director of Academic and Workforce Development, and data
from discussions with the researcher’s dissertation committee chair and members.
Method 1: Surveys
The survey measured the AHIMA goal for 20% of the membership to obtain advanced
degrees by 2027. The survey design supported and investigated the KMO influences which
impact the AHIMA members’ return to school to pursue advanced degrees to meet the AHIMA
goal. The survey used 41 demographic, Likert scale, closed-ended questions and one final open-
ended question to determine declarative and procedural knowledge influences, intrinsic value,
extrinsic value, self-efficacy for motivational influences, and cultural models and settings for
organizational influences. The purpose of the open-ended survey was to allow participant
46

discussion on any topic related to the survey questions and to collect additional information to
support recommendations to address the goal. These responses had the potential to address the
research questions about knowledge, motivational, and organizational influences HI
professionals have related to responding to the AHIMA call to action to return to school for
advanced degrees. These questions reflected participant experiences, behaviors, opinions, values,
and feelings (Patton, 2002). Participant responses were used to provide recommendations to meet
the goal of 20% with advanced degrees by 2027.
Method 2: Open-Ended Survey Question
The only open-ended survey question allowed respondents to offer additional information
concerning their responses to the survey questions, thoughts or feelings about returning to
school, or other information that could be pertinent to the research questions that may not have
been covered in the research questions. The responses to the open-ended question correlated to
the knowledge, motivation, and organizational influences on returning to school for advanced
degrees by 2027.
Method 3: Document Analysis
Document analysis provided secondary data to compare to the survey data and assist in
identifying organizational gaps. Documents analyzed included AHIMA mission and vision
statements, organizational standards, and training documents that outline, investigated, and
informed the KMO influences impacting AHIMA members’ return to school for advanced
degrees to meet the 2027 goal. Document analysis provided additional detailed information and
data on the AHIMA members’ knowledge, motivation, and organizational influences on
returning to school for advanced degrees and were analyzed in conjunction with survey data.
Document analysis was used to triangulate and illuminate existing gaps that impacted the pursuit
47

and attainment of advanced degrees in the HI profession. Document excerpts used in data
analysis are in Appendix B.
Participants
The use of purposeful sampling assists with the discovery of specific information to
inform this study (Maxwell, 2013; Patton, 2015, as cited in Merriam & Tisdell, 2016). Therefore,
the researcher used a typical, criterion-based purposeful sampling of the AHIMA membership
with the following three criteria:
1. Prospective participants needed to be credentialed, active, HI professional AHIMA
members within the United States of America, including the District of Columbia and
Puerto Rico, with certifications obtained from workforce development programs or
one-year certification programs in colleges and universities.
2. Prospective participants needed to be credentialed, active, HI professional AHIMA
members within the United States of America, including the District of Columbia and
Puerto Rico, with associate degrees in health information or other fields who had not
yet obtained a bachelor’s degree. This criterion included HI professional members
currently enrolled in a bachelor’s degree program.
3. Prospective participants needed to be credentialed, active, HI professional AHIMA
members within the United States of America, including the District of Columbia and
Puerto Rico, with bachelor’s degrees in health information or other fields, who did
not have an advanced degree and were not currently enrolled in an advanced degree
producing program.
These participants were the primary stakeholders who were HI professionals and active
members of AHIMA, who had an associate degree, bachelor’s degree, or certificate, may have
48

had entry-level, rudimentary, task-oriented positions, and were at risk for potential replacement
by emerging technologies like artificial intelligence (LeCompte & Schensul, 2010, as cited in
Merriam & Tisdell, 2016; Olenik, 2019). These participants were vital in determining whether
AHIMA met the stakeholder goal of 10% enrollment in advanced degree programs and if
AHIMA will meet their goal of 20% with advanced degrees by 2027. Therefore, the study will
not utilize a large, random, representative sample.
The projected target sample size for the survey was 250–300 stakeholders. The Academic
Research Workgroup of the Council for Excellence in Education (CEE) permitted the
recruitment of participants who met the stated criteria within the AHIMA Access online digital
community platform. Recruiting within the membership allowed access to over 103,000
credentialed AHIMA members, 55% of whom do not hold advanced degrees. This method
increased the probability of meeting the target sample size of HI professionals without advanced
degrees. Within AHIMA Access, the recruitment message gave an overview of the study,
identified the criteria for survey participation, explained the study protocol and consent form,
and provided an embedded link to the Qualtrics survey.
Instrumentation
The survey instrument was the primary tool for this study. The goal was to determine if
the survey respondents had the knowledge and motivation to return to school to pursue advanced
degrees and to identify organizational influences on goal attainment. The survey’s target
population was composed of credentialed HI professionals who were active members of
AHIMA, did not hold advanced degrees, and were not currently enrolled in advanced degree
programs. This population was appropriate for the survey questions. These HI professionals are
at the greatest risk of having their positions diminished or replaced by disruptive technologies
49

(LeCompte & Schensul, 2010, as cited in Merriam & Tisdell, 2016; Olenik, 2019). Additionally,
using a survey to target this specific population of HI professionals allowed the collection of
quantitative data to analyze the knowledge, motivation, and organizational influences on
attaining advanced degrees.
The survey contained six sections and a total of forty-two questions. The initial survey
question asked for the participant’s informed consent to complete the survey. The first section
contained seven closed-ended demographic questions. The second section had five closed-ended
questions to collect information about the respondent’s current background in the HI profession
and the AHIMA. These questions included their current certifications and degrees, AHIMA
health information active credentials, length of time in the trade, and general knowledge about
the AHIMA call to action to obtain advanced degrees. The following three sections echoed the
concepts reflected in the research questions of Clark and Estes’ (2008) KMO influences and
theories of declarative and procedural knowledge, intrinsic and extrinsic value, self-efficacy, and
cultural setting and models of the organization based on the conceptual framework. These
sections contained seven Likert scale questions about knowledge influences, five Likert scale
and two rank order questions about motivational influences, and eight Likert scale questions that
reflect organizational influences. The closing section contained one open-ended question to
solicit survey feedback and allow the respondent to add additional information at the end of the
survey.
Two University of Southern California (USC) faculty and two HI professionals who did
not meet the criteria for participation reviewed the survey questions to ensure validity.
Additionally, five USC Rossier School of Education doctoral students field-tested a pilot sample
of these survey questions. The survey questions are in Appendix C.
50

Data Collection Procedures
Quantitative data collection for this study occurred using a survey created in the Qualtrics
online survey tool. Qualtrics was the most feasible tool for use, as it is available through the
University of Southern California (USC) and accessible for student use. The survey was
necessary to collect information about respondent knowledge, motivation, and organizational
influences on respondents’ return to school to pursue advanced degrees.
Before survey distribution, the researcher submitted the completed AHIMA Student
Research Request Form and specific IRB documentation to the AHIMA Research Workgroup
for review in January 2022 for permission to post the survey in the AHIMA Access Online
Community. IRB documentation submitted included the Informed Consent sheet, the
Information Sheet for Exempt Studies, and the study’s survey questions. The AHIMA Research
Workgroup approved the survey for posting in the Access Online Community on January 17,
2022, with a disclaimer that AHIMA was not sponsoring the research.
Before starting the online survey in Qualtrics, participants received a detailed information
sheet that described the study’s purpose and why their participation was necessary and
encouraged. Participants also received information discussing the confidentiality of their
collected data and how their anonymity would be protected. Next, participants were informed
that their consent was necessary to begin the survey. After consenting, the participants were able
to complete the survey questions. The survey exited those who declined to give informed consent
or did not meet the criteria. Survey completion took 10 to 15 minutes. Upon completion,
participants were thanked for their participation. The Qualtrics survey software recorded and
maintained all survey data. The Informed Consent form and Qualtrics information form can be
found in Appendices H and I.
51

The survey link was first placed in the AHIMA Access online digital community
platform. Specifically, the link was posted in the Career Mobility, Trending Topics, Faculty
Forum, and Coding and Classification communities within AHIMA Access. The researcher
chose these communities as these communities were the most likely to have the most HI
professionals who met the study criteria or had access to those who met the criteria, as in the
Faculty Forum community. The posting in each community included the explanation of the
research and reason for recruitment, the link to the Qualtrics survey, and the AHIMA disclaimer
from the Research Workgroup that indicated that AHIMA was not sponsoring the survey. The
survey remained in the AHIMA Access communities from January to March 2022. Reminders
inviting participation were posted every few weeks.
Additionally, between January 25 and February 7, 2022, due to low participation in the
Access online community, the researcher sent the study information and the survey link to the
Executive Boards of all 52 AHIMA-affiliated Component State Associations (CSA). This
information was disseminated via the website landing page forms or using email addresses
provided on the websites to increase participation. The researcher also provided reminder emails
to encourage survey completion in the Access online platform. At the end of February, the
researcher removed the survey link from the AHIMA Access digital community platform
communities and closed access to the survey in Qualtrics to prevent further CSAs from accessing
the survey. Nevertheless, one CSA who overlooked the initial email request for survey
participants requested access on April 5, 2022. After communication with the CSA requestor, the
researcher reopened the survey for 14 days to allow the CSA members who met the criteria to
participate. The survey officially closed for the second time on April 28, 2022. Afterward, the
52

researcher began compiling and analyzing all data and findings from the survey to report in the
dissertation.
Data Analysis
This descriptive study required methods to analyze quantitative data. The survey
questions for the study were primarily Likert scale closed-ended questions; therefore, using
descriptive statistics and coding for the open-ended question was necessary to analyze data.
Method 1: Survey Data
The Qualtrics online survey tool was the source of data analysis, as Qualtrics allowed the
researcher to complete an initial analysis by filtering, classification, merging, cleaning, and
statistically analyzing response data (Qualtrics, 2021). This feature allowed the researcher to
begin to convert the raw data into a form useful for data analysis, which included scoring the
data by assigning numeric values to each participant response, cleaning data entry errors from
the Qualtrics database, and creating any necessary special variables (Creswell & Plano Clark,
2018). The data analysis was completed using the Qualtrics software and Microsoft Excel
spreadsheets. Using Qualtrics, the researcher conducted a descriptive analysis that included the
frequency and central tendency of responses to each item on instruments or checklists to
determine the general trends in the data for all significant independent and dependent variables in
the study. The researcher explored the database for normal or non-normal distribution and
examined the quality of the scores from the survey assessed with data reliability and validity.
The survey questions were categorized by KMO influence, and the responses provided data on
KMO gaps. This data was then used to identify solutions to close the identified gaps.

53

Method 2: Singular Open-Ended Survey Question
The researcher used Quirkos software to assist with the coding process for the single
open-ended question. After the researcher read participant responses, she identified primary
coding categories for qualitative analysis and data visualization using the Quirkos software
application. The researcher coded the respondent’s initial excerpts to detect trends, and then
conducted a second round of coding, which led to three primary responses from respondents that
included information related to the KMO influences. These three primary responses were
included as supplemental information in the data analysis.
Method 3: Document Analysis
The researcher analyzed public AHIMA documents and documents available for
members only within the AHIMA Body of Knowledge. The purpose of the analysis was to
determine if there was specific AHIMA policy or specific guidance provided to the HI
professional membership to assist them in the pursuit of advanced degrees, or if there was any
existing plan or training program to assist AHIMA HI professional members with advanced
degree attainment. This information was necessary to identify gaps in the organizational goal of
20% of the membership with advanced degrees and to correlate with survey findings. The
document analysis included an examination of methodology, curriculum, and provision of
training to assist HI professional members, specifically with the knowledge involved in the
preliminary preparation tasks and specific steps to search for, apply, and enroll in advanced
degree programs.
Validity and Reliability
This study’s trustworthiness, validity, and reliability were strengthened by the fact that
there were a variety of respondents. Nominal levels of measurement assisted with variability and
54

the selection of respondents with certificates, associate degrees, and bachelor’s degrees, all with
AHIMA credentials. The researcher ensured question and instruction standardization by
eliminating unclear questions, strengthening study validity. The researcher asked appropriate
information from the respondents, with well-defined constructs, which strengthened content
validity (Robinson & Leonard, 2019; Salkind, 2014). Additionally, the quantitative survey
instrument included 40 questions based on the identified KMO influences to increase validity.
The researcher created questions that did not contain industry or non-industry-related acronyms
or any ambiguous information that could confuse the participants.
According to Salkind (2014), the increased likelihood of authenticity from respondents
can contribute to survey validity. The initial version of the survey questions was peer-reviewed
within the USC doctoral program cohort to eliminate superfluous language that could cause
confusion. Feedback from the peer-review led to a redesign of the survey questions, thereby
improving internal validity. Furthermore, dissertation committee member feedback led to further
revisions and modifications prior to the survey release. The Qualtrics XM survey software
provided the platform for the survey’s development and administration. Qualtrics captured
response data from the study’s anonymous respondents; respondent information remained
confidential throughout the survey and post-survey data analysis.
Ethical Implications
Creswell and Creswell (2018) and Creswell and Plano Clark (2011, 2018) noted that in
research, ethical considerations are critical throughout the entire study. Researchers who conduct
studies must anticipate and address the importance of ethical considerations, which include the
obligation to protect participant rights, needs, and values (Locke et al., 1982; Marshall &
Rossman, 1989; Merriam, 1988; Spradley, 1980, as cited in Creswell & Creswell, 2018).
55

Therefore, in this descriptive quantitative study, participants’ rights were protected by ensuring
they understood and comprehended all information about the research study and by obtaining
their voluntary agreement to take part in the study.
The researcher took initial steps to ensure an ethical study by completing the Responsible
Conduct of Research (RCR) course certification within the Collaborative Institutional Training
Initiative (CITI) Program. The study was approved by the University of Southern California
(USC) Institutional Review Board (IRB) because the study involved human subjects. Securing
the informed consent of all participants before conducting surveys formed an additional step in
an ethical study. This informed consent included the acknowledgment of participant rights,
interests, and desires regarding data reporting and their right to anonymity. According to Miller
(1992, as cited in Creswell & Creswell, 2018), it is vital to employ safeguards for participant
protection that include: (a) informing participants of the research objectives both verbally and in
writing for their understanding, (b) ensuring participants understand how the collected data are
used, (c) obtaining written permission from participants to proceed with the research as
specifically dictated on the informed consent form, (d) informing participants of the data
collection methodology and potential activities and devices to be used to collect the data, and (e)
providing written or electronic transcripts of the interview and subsequent reports to participants
if requested. Therefore, the informed consent form ensured participants understood the study’s
purpose, their role in the study, and how their contribution would assist in the collection of data
to inform recommendations and solutions of the pursuit of advanced degree completion. This
included a description of the research study, knowledge of the survey questions, potential risks,
participation benefits, and the acknowledgment of anonymity and confidentiality on behalf of the
researcher. Additionally, participants were informed of any potential risks, and participants also
56

received contact information for the USC Rossier School of Education, the dissertation chair,
and the researcher if they had any questions or concerns.
Limitations and Delimitations
The design of this study focused on data collected from samples of HI professional
stakeholders using surveys. According to Creswell & Creswell (2018), limitations may include
researcher bias or inarticulate and perceptive respondents. Limitations that may have affected the
study include the possibility that the information and data obtained from the stakeholders and the
AHIMA may have been inaccurate. There was also the possibility that participants may have
provided responses in the survey that were dishonest or inaccurate, so the truthfulness of
collected data could not be predicted. Furthermore, the limitations in this research may include
the number of regions in the United States that had AHIMA CSAs that did not participate or
complete the survey. Consequently, not all regions in the United States or all 52 CSAs who are
AHIMA Affiliates are represented in the survey data. Additionally, the corruption of data from
one of the survey questions and the impact of the COVID-19 pandemic on the workplace,
educational institutions, and traditional schooling during data collection may also have been a
limiting factor.
Study delimitations include the researcher’s choice of study participants without
advanced degrees within the AHIMA. The study consisted of AHIMA-credentialed stakeholder
participants who were HI professionals and members of the AHIMA. Still, it did not include
those with certifications and credentials from other health information clinical data coding
professional organizations. Other delimitations that may have impacted this study’s data
collection include the researcher’s choice of survey questions.
57

Chapter Four: Results and Findings
The purpose of this study was to conduct a gap analysis of the knowledge, motivation,
and organizational influences affecting the return of HI professionals pursuing advanced degrees
to meet the goal for 20% of the AHIMA membership to obtain advanced degrees by 2027. The
Clark and Estes (2008) gap analysis approach provided the framework to study the assumed
knowledge, skills, motivation, and organizational influences. This framework will help
determine the causes of these challenges, identify solutions for them, and assist with the
implementation of solutions that AHIMA may use to assist the HI professional stakeholders
within AHIMA to return to school for advanced degrees. The research questions for this study
were as follows:
1. What knowledge, motivation, and organizational influences are necessary to achieve
the AHIMA goal of obtaining graduate degrees for their credentialed HI
professionals?
2. What are the primary reasons provided by HI professionals for not obtaining
advanced degrees?
3. What are the recommended change processes and implementation methods required
in the organization pertaining to knowledge, motivation, and organizational support
required to meet the goal?
Based on the literature review in Chapter Two, a list of seven assumed influences was
created to determine if HI professionals had the propensity to return to school for advanced
degrees. The influences were identified in the literature review and used Krathwohl’s (2009)
knowledge framework for declarative and procedural knowledge. The seven influences were
placed into knowledge, motivation, and organizational categories. Based on a review of the
58

literature in Chapter 2, a list of KMO influences described potential barriers to HI professionals’
returning to school for advanced degrees. As discussed in Chapter 3, quantitative data were
collected using a 42-question survey to validate the assumed influences. The survey and
document analysis data were collected to comprehend the potential knowledge, motivation, and
organizational barriers HI professionals may experience when making their decision to return to
school for advanced degrees. The survey was placed in the AHIMA Access online platform for
members and emailed to each of the 52 Component State Association affiliates of AHIMA.
Document analysis was conducted after survey completion. The rationale was that the survey
data would inform the document analysis pertaining to each of the KMO influences. Chapter
Two housed the literature review on each of the assumed KMO influences. Chapter Four
describes the survey and document analysis results to support the KMO needs assessment.
Participating Stakeholders
The stakeholders for this study were active, credentialed HI professionals without
advanced degrees and who were not currently enrolled in an advanced degree producing
program. All respondents were credentialed members of AHIMA. Based on previous data in
Chapter Two, approximately 55% of the over 103,000 AHIMA members did not have advanced
degrees. In total, 294 HI professionals participated in the survey. Of the 294 respondents, 61
(20%) did not meet the criteria as they already held advanced degrees, were currently enrolled in
an advanced degree program, or responded “no” to the Informed Consent question to complete
the survey. These responses were omitted. Of the 232 remaining respondents, 63 (27%)
completed less than 26% of the survey. The omission of these respondents resulted in the final
number of 170 remaining respondents who met the survey criteria requirements and completed at
least 72–100% of the survey. The survey was anonymous, but Questions 4–11 of the survey
59

collected demographic details for analysis of gender, ethnicity, age, income, employment,
geographic region, degree, and credentials. Respondents were able to opt out of answering
demographic questions or could respond with “prefer not to answer.”
Gender, Ethnicity, and Age of Survey Respondents
The survey asked participants to respond to the choices for gender identity, ethnicity, and
age in questions four through six. Of those who responded to gender (N = 169), 163 (96.45%)
identified as female and six (3.55%) identified as male. There were no responses for any other
gender category. For those who responded to ethnicity, 119 (70.41%) respondents identified as
White/European origin, and 18 (10.65%) identified as Black/African American. These were the
two largest response groups. Additionally, nine respondents (5.33%) identified as two or more
ethnicities, eight (4.73%) identified Latinx or Hispanic, six (3.55%) identified as Asian, five
(2.96%) preferred not to respond to the question, three (1.83%) identified as Native American or
Native Alaskan, and one respondent (0.59%) identified as African. There were no respondents
who identified as Native Hawaiian or Pacific Islander, or the category of “other/unknown.”
Lastly, the survey requested participants to report their age. The results showed that 51–
to 60-year-olds (35.5%) represented the largest age group with 60 respondents. There were four
(2.37%) 21–30-year-old respondents, 30 (17.75%) 31–40-year-old respondents, 46 (27.22%) 41–
50-year-old respondents, 27 (15.98%) respondents over 60 years old, and two (1.18%)
respondents who preferred not to say. Table 6 shows the survey demographic results for gender,
ethnicity, and age.

60

Table 6
Gender, Ethnicity, and Age Demographic Data
Gender Count (N = 169) Percent
Male 6 3.55
Female 163 96.45
Non-binary 0 0
Transgender female 0 0
Transgender male 0 0
Other 0 0
Prefer not to say 0 0
Ethnicity Count (N = 169) Percent
Asian 6 3.55
African 1 0.59
Black or African American 18 10.65
Latinx or Hispanic 8 4.73
Native American or Native Alaskan 3 1.78
Native Hawaiian or Pacific Islander 0 0
White/European Origin 119 70.41
Two or more 9 5.33
Other 0 0
Prefer not to say 5 2.96
Age Count (N = 169) Percent
Less than 20 years old 0 0.00
21–30 years old 4 2.37
31–40 years old 30 17.75
41–50 years old 46 27.22
51–60 years old 60 35.50
61+ years old 27 15.98
Prefer not to say 2 1.18

Employment, Income, and Geographic Region of Survey Respondents
Questions 7–9 of the survey collected demographic details for analysis of employment,
income, and their geographic region within the United States and its territories. 168 respondents
indicated their employment status, with 147 (87.50%) respondents employed full-time, five
61

(2.98%) employed part-time, 13 (7.74%) seeking employment, and three (1/79%) who preferred
not to say.
Next, of the 169 who answered the question concerning their annual income, 87 (51.48%)
respondents indicated that their annual income was between $50,000 and $100,000, 32 (18.93%)
had an annual income between $100,000 and $200,000, and 28 (16.57%) reported their annual
income was between $25,000 and $50,000. Nine (5.33%) respondents reported an annual income
of less than $25,000, and one (0.59%) respondent reported an annual income of over $200,000.
Twelve (7.10%) respondents preferred not to say.
Lastly, pertaining to geographic regions in the United States and its territories, 44
(26.04%) respondents were geographically located in the Midwest region, specifically the West-
North-Central states (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South
Dakota). This region had the highest response rate. Twenty-nine (17.16%) respondents were
from the West-Pacific region states (Alaska, California, Hawaii, Oregon, Washington). The
Southern-West-South-Central region (Arkansas, Louisiana, Oklahoma, and Texas) had 26
(15.38%) respondents, and the West-Mountain region states (Arizona, Colorado, Idaho,
Montana, Nevada, New Mexico, Utah, and Wyoming) had 22 (13.02%) respondents. There were
19 (11.24%) respondents from the Southern-South Atlantic region states (Delaware, Florida,
Georgia, Maryland, North and South Carolina, Virginia, District of Columbia, and West
Virginia), and 16 (9.47%) from the East-North-Central area of the Midwest region (Illinois,
Indiana, Michigan, Ohio, and Wisconsin). The Northeast Mid-Atlantic region (New York, New
Jersey, and Pennsylvania) had eight (4.73%) respondents, the Southern-East-South-Central
region (Alabama, Kentucky, Mississippi, and Tennessee) had three (1.78%) respondents, and
Northeast-New England region (Connecticut, Maine, Massachusetts, New Hampshire, Rhode
62

Island, and Vermont) had one (0.59%) participant. There were no respondents from the
territories of the United States, no respondents listed “other” as their location, and one (0.59%)
respondent preferred not to answer the question. Table 7 lists the results for employment,
income, and geographic regional demographic information.

Table 7
Employment, Income, and Geographic Region Demographic Data
Employment Count (N = 168) Percent
I am employed full-time. 147 87.50
I am employed part-time. 5 2.98
I am seeking opportunities. 13 7.74
Prefer not to say 3 1.79
Current annual income Count (N = 169) Percent
Less than $25,000 9 5.33
$25,000–$50,000 28 16.57
$50,000–$100,000 87 51.48
$100,000–$200,000 32 18.93
More than $200,000 1 0.59
Prefer not to say 12 7.10
Geographic region Count (N = 169) Percent
Northeast/New England 1 0.59
Northeast/Mid Atlantic 6 4.73
Midwest/East-North Central 16 9.47
Midwest/West-North Central 44 26.04
South/South Atlantic 19 11.24
South/East-South Central 3 1.78
South/West-South Central 26 15.38
West/Mountain 22 13.02
West/Pacific 29 17.16
US Territories 0 0.00
Other 0 0.00
Prefer not to say 1 0.59

63

Certificates, College Degrees, and AHIMA Credentials
Questions 10 and 11 of the survey collected demographic details for analysis of
respondent degrees and the number of AHIMA-specific certifications and credentials attained as
shown in Table 8. Most respondents had bachelor’s degrees, followed by associate degrees and
certifications. There were 97 (58.08%) respondents with bachelor’s degrees, 53 (31.74%) with an
associate degree, nine (5.39%) with coding certifications, three (1.80%) with medical coding and
billing certifications, and three (1.80%) with health information technology certificates. One
(0.60%) respondent answered with certificate–other as their certification, and one (0.60%)
indicated that they had a non-health related master’s degree. This respondent was the one
exception to the survey criteria as the AHIMA goal discussed in Chapter One is for HI
professionals to obtain health-related master’s degrees.
For the AHIMA-specific credentials obtained by HI professionals, respondents were able
to select multiple credentials, as HI professionals may have one professional credential as either
a Registered Health Information Technician (RHIT) or Registered Health Information
Administrator (RHIA), and multiple coding or specialty credentials, as discussed in Chapter 2.
Eighty-two (37.51%) respondents held the RHIA certification, with 64 (29.36%) respondents
indicating they were RHIT credentialed. Of the coding credentials, 44 (20.18%) respondents had
the Certified Coding Specialist (CCS) credential, 10 (4.59%) held the Certified Coding
Specialist-Physician (CCS-P) credential, and six (2.75%) held the Certified Coding Associate
(CCA) credential. Six (2.75%) respondents held the Clinical Documentation Improvement
Practitioner (CDIP) specialty credential, three (1.38%) held the Certified Health Data Analyst
(CHDA) specialty credential, and three (1.38%) had the specialty credential for being Certified
in Healthcare Privacy and Security (CHPS).
64

Table 8
Certificates, Degrees, and Credentials Demographic Data
Certificates and degrees Count (N = 167) Percent
Certificate: coding 9 5.30
Certificate: medical coding and billing 3 1.80
Certificate: health information technology 3 1.80
Certificate: other 1 0.60
Associate degree 53 31.74
Bachelor degree 97 58.08
Non-health related master’s degree 1 0.60
AHIMA credentials Count (N = 218) Percent
CCA 6 2.75
CCS 44 20.18
CCS-P 10 4.59
RHIT 64 29.36
RHIA 82 37.61
CDIP 6 2.75
CHDA 3 1.38
CHPS 3 1.38

Determination of Assets and Needs
The study used a survey as the sole source for analysis to validate whether the KMO
influences are assets or needs. Chapter Three contained a detailed description of the survey, and
the survey is in Appendix C. The resulting quantitative data collected from the survey helped the
researcher determine and validate the knowledge, motivation, and organizational influences on
the pursuit of advanced degrees. The criteria used for survey data validation on the assumed
causes of knowledge, motivation, and organizational influences for the return of HI professionals
to school for advanced degrees were as follows: respondent results with greater than 75%
agreement indicated an asset; respondent results with less than 75% agreement indicated a need.
65

75% was chosen as the limit due to the potential behaviors of some respondents to the questions.
The criteria are explained in the tables accompanying the paragraphs.
Results and Findings for Knowledge Influences
The results and findings for the HI professionals’ knowledge causes were measured
through the survey. The results are reported in the following sections per assumed influence in
the categories of declarative knowledge and procedural knowledge. The knowledge causes are
also divided by survey results and document analysis.
Declarative Knowledge
One of the areas of knowledge includes declarative knowledge. For HI professionals,
declarative knowledge includes recalling facts and concepts, specifically, the knowledge of facts
or the basic elements that must be known to be acquainted with a discipline or solve problems
(Krathwohl, 2002; Pintrich, 2002). This section discusses the survey results and document
analysis pertaining to the declarative knowledge influence, which is that HI professionals must
know how to recall information to make an informed decision to return to school.
Declarative Knowledge About Making an Informed Decision for School
For survey Question 12, HI professionals were asked three declarative knowledge
questions to determine if they had a high level of confidence to make an informed decision to
return to school, if they could recall how to complete a college application, and if they
understood how to use the college administrators and advisors to assist with the college selection
process. The Likert scale listed five choices to select for each question: strongly agree, somewhat
agree, neither agree nor disagree, somewhat disagree, and strongly disagree. Table 9
demonstrates that of those who responded to this question, 65.09% of HI professionals either
agreed or strongly agreed that their confidence level was high to make an informed decision for
66

school. Additionally, results showed that 18.34% indicated that they neither agreed nor disagreed
pertaining to their level of confidence. Furthermore, a total of 16.57% either somewhat or
strongly disagreed that they had a high level of confidence to make an informed decision. As this
influence did not meet the 75% threshold, the result of the survey showed that this influence is a
need.
Declarative Knowledge: Recall Usage in College Application Completion
For Question 16 in the survey, HI professionals were asked if they could recall how to
complete a college application using a Likert scale with five choices. Results showed that
88.75% either agreed or strongly agreed that they could recall how to complete a college
application whereas 3.55% neither agreed nor disagreed they could recall how to do this task.
Just 7.69% somewhat disagreed or strongly disagreed they could recall how to complete an
application for college. As this influence met the 75% threshold, the result of the survey showed
that this influence is not a need.
Declarative Knowledge: Utilizing Collegiate Staff for College Selection Assistance
HI professionals who responded to Question 22 in the survey were asked if they
understood how to utilize the college admissions staff, administrators, and/or advisors to assist
then in the college selection process. 70.41% of respondents strongly agreed or agreed that they
knew how to use the appropriate collegiate administrative personnel to assist with the college
selection process. 7.69% neither agreed nor disagreed, and 21.9% disagreed somewhat or
strongly that they understood this process to assist with college selection. This influence is a
need, as it did not meet the 75% threshold to be an asset.

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Table 9
Assumed Declarative Knowledge Influences of HI Professionals
Survey question Number of
respondents who
completed question
(N)
Total percentage
who strongly agree
or agree

Count
Q12: My level of confidence
to make an informed
decision to return to
school is high.

169

65.09

110
Q16: I can recall how to
complete a college
application.

169

88.75

150
Q22: I understand how to
utilize the college
admissions staff,
administrators, and/or
advisors to assist me in the
college selection process.

169

70.41

119

Document Analysis for Declarative Knowledge. A search conducted within the
AHIMA website, the AHIMA Access Online community for members, the AHIMA Body of
Knowledge, and the online AHIMA Career Prep Resources did not reveal any documents for this
influence related to the HI professional’s declarative knowledge influences on returning to
school. The AHIMA Career Prep Workbook provided a workbook activity under the section
titled Changing Careers and Moving Forward: How Do I Start Over in HIM? This activity was
based on a journal article that discussed the need for HI professionals considering a master’s
degree to consider three items: (a) degree-program competition, (b) if the program attracted
qualified students and faculty, and (c) financial assistance as an obstacle. The workbook activity
and journal article did not provide information pertaining to specific declarative knowledge
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principles as addressed in the survey but instead addressed the reasoning for obtaining advanced
degrees and detailed the types of different advanced degree skills necessary to return to school.
Declarative Knowledge Summary. The assumed declarative knowledge influence that
HI professionals must know how to make an informed decision to return to school for an
advanced degree was determined to be a need. The declarative knowledge influence for
completing a college application was met, and therefore is an asset. However, this assumption is
based on two of the three questions where only 65.09% and 70.41% of respondents agreed, either
somewhat or strongly, that they had the confidence to make an informed decision to return to
school, or that they understood how to use the college admissions staff to assist with the college
selection process. These two questions did not meet the 75% standard, which indicates this
influence as a need.
Procedural Knowledge
Procedural knowledge is understanding how to accomplish a certain task using methods
of inquiry about tasks and establishing certain criteria for skills (de Jong & Ferguson-Hessler,
1996; Krathwohl, 2002). HI professionals must be able to use procedural knowledge skills and
tasks in their pursuit of advanced degrees. This section discusses the survey results and
document analysis pertaining to the procedural knowledge influence, which is that HI
professionals must know how to select, apply, and enroll in graduate degree programs. Table 10
depicts the results from each procedural influence.
Procedural Knowledge: College Selection That Supports Education Goals, Career Goals, and
Current Lifestyle
Survey Questions 13, 14, and 15 asked HI professionals if they understood how to select
a college or university that supports their educational goals, career goals, and current lifestyle
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using a Likert scale with five choices for each question. Of those who responded to Question 13
(N = 168), 88.17% either agreed or strongly agreed that they understood how to select a school
that supported their educational goals, whereas 6.51% neither agreed nor disagreed, and 5.32%
somewhat disagreed or strongly disagreed they could complete this task. Additionally, in
response to Question 14 (N = 168), 84.53% strongly or somewhat agreed they understood how to
select a school that supported their career goals, with 10.12% neither agreeing nor disagreeing,
and 5.36% somewhat or strongly disagreeing about their ability to complete the task. Lastly, in
response to Question 15 (N = 169), 86.40% either agreed or strongly agreed that they understood
how to select a school that supported their current lifestyle, while 8.88% neither agreed nor
disagreed, and 4.73% somewhat disagreed or strongly disagreed they could complete the school
selection. Table 10 provides a depiction of the survey results.

Table 10
Assumed Procedural Knowledge Influences of HI Professionals: School Selection
Survey question Number of
respondents who
completed question
(N)
Total
percentage who
strongly agree
or agree
Count
Q13: I understand how to select
a college or university that
supports my educational
goals.
169 88.17 149
Q14: I understand how to select
a college or university that
supports my career goals.
168 84.53 142
Q15: I understand how to select
a college or university that
supports my current
lifestyle.
169 86.40 146

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Procedural Knowledge: School Application Task Completion for Registration,
Recommendations, Transcripts, and Funding
Survey Questions 17 through 21 asked HI professionals if they understood how to select
a college or university that supports their educational goals, career goals, and current lifestyle
using a Likert scale with five choices for each question. Results showed that for Question 17,
47.70% of respondents (N = 169) either somewhat agreed or strongly agreed that they knew how
to complete the registration process for a standardized examination for graduate school, whereas
6.51% neither agreed nor disagreed, and 5.32% somewhat disagreed or strongly disagreed they
could complete this process. Additionally, for Question 18 (N = 169), 62.50% of respondents
strongly or somewhat agreed, with 10.12% neither agreeing nor disagreeing, and 5.36%
somewhat or strongly disagreeing about their knowledge of how to obtain letters of
recommendation for a graduate school application. Responses to Question 19 (N = 167) showed
that 90.41% of respondents either agreed or strongly agreed that they knew how to request
transcripts from previously attended schools, while 8.88% neither agreed nor disagreed, and
4.73% somewhat disagreed or strongly disagreed they could complete the school selection.
Question 20 asked respondents (N = 167) if they knew how to secure school funding by
completing financial aid applications, and 67.27% somewhat and strongly agreed they could
complete this process. Of the remainder of responses to this question, 8.88% neither agreed nor
disagreed, and 4.73% somewhat disagreed or strongly disagreed they could complete the
application. Lastly, for Question 21, responses (N = 168) show that 66.86% somewhat and
strongly agreed they knew how to secure funding by completing scholarship applications,
11.24% neither agreed nor disagreed, and 21.89% somewhat and strongly disagreed they could
complete the scholarship application process.
71

Based on the survey results, the only question that met the 75% threshold was Question
19, as over 75% felt they were able to request a college transcript from a previous academic
institution. The responses to all other questions were under 75%. As the other responses were
under the 75% threshold, the results of the survey showed that this influence for procedural
knowledge is a need and not an asset. Table 11 provides the results of these survey questions.

Table 11
Assumed Procedural Knowledge Influences of HI Professionals: College Task Completion
Survey question Number of
respondents who
completed the
question (N)
Total percentage who
strongly agree or
agree
Count
Q17: I know how to complete
the registration process for a
standardized examination
for graduate school.
169 47.70 83
Q18: I know how to obtain
letters of recommendation
for my graduate school
application.
168 62.50 105
Q19: I know how to request
transcripts from schools I
previously attended.
167 90.41 151
Q20: I know how to secure
funding to return to school
by completing financial aid
applications.
168 67.27 113
Q21: I know how to secure
funding to return to school
by completing scholarship
applications.
169 66.86 113

72

Document Analysis for Procedural Knowledge. A search conducted within the
AHIMA website, the AHIMA Access Online community, the AHIMA Body of Knowledge, and
the AHIMA Career Prep Resources did not reveal any documents for this influence related to the
HI professional’s procedural knowledge influences on returning to school. The AHIMA Career
Prep Workbook activity titled Changing Careers and Moving Forward: How Do I Start Over in
HIM? had an embedded 2016 AHIMA practice brief titled Climbing Higher, Bridging the Gap to
Advanced Degrees. This practice brief provided practical tools and guidance to HI professionals
and educators to move themselves and HI educational programs to a master’s level. Additionally,
the practice brief discussed the need to prepare and recruit HI Professionals to fill the teaching
positions in accredited associate and baccalaureate degree HI collegiate programs. Although the
practice brief discussed how graduate education requires admissions testing or other criteria
(bachelor’s degree, a minimum grade-point average, satisfactory undergraduate training), it did
not elaborate on how HI professionals should prepare for graduate education based on prior
knowledge and task completion. Lastly, the practice brief noted the personal financial impact of
pursuing graduate education, and it mentioned scholarships and grants available and offered by
the AHIMA Foundation and many component state associations. The practice brief did not
provide information to assist HI professionals in the recall of procedural tasks involved applying
for scholarships or additional types of financial aid procurement.
Procedural Knowledge Summary. Overall, the assumed procedural knowledge
influence that HI professionals must know how to select, apply, and enroll in graduate degree
programs was determined to be a need. The procedural knowledge influence for completing a
college application was met, and therefore is an asset. However, the assumption of this influence
as a need is based on the remaining four of the five procedural knowledge influence survey
73

questions that did not meet the 75% threshold where respondents agreed, either somewhat or
strongly, that they knew how to select, apply, and enroll in graduate degree programs. Since all
assumed procedural influences did not meet 75% threshold based on the survey questions, the
results of the survey show that this influence is a need.
Results and Findings for Motivational Influences
The results and findings for the HI professionals’ motivation causes were measured
through the survey, using the categories discussed in Chapter Three. The results are reported in
the following sections per assumed motivational influences in the categories of interest value,
utility value, and self-efficacy. Survey results and document analysis for each motivational cause
is included.
Interest (Intrinsic) Value: HI Professionals Returning to School and Supporting the 2017
HIM Reimagined Call to Action for Advanced Degrees
An individual’s interest, enjoyment, personal goal-fulfillment, self-identity, knowledge of
potential consequences, and cost benefits are all task values and motivational factors of a goal
(Bandura, 1987; Eccles & Wigfield, 2000, 2002, 2014). This section discusses the survey results
and document analysis pertaining to the interest value, or intrinsic value motivational influence,
which is that HI professionals need to possess the interest and motivation to return to school for
advanced degrees, in response to the HIM Reimagined initiative.
Questions 23 and 26 in the survey asked HI professionals about their interest in obtaining
a master’s or doctorate degree and asked if their interest in returning to school for an advanced
degrees by 2027 was based on the call to action from the HIM Reimagined white paper initiative.
Both questions used a Likert scale with five choices for each question. Additionally, for this
influence, Question 24 asked respondents to rank from highest (1) to lowest (5) five factors of
74

their motivation for returning to school for an advanced degree. These factors included increase
earning potential, job promotion, start a new career path in my profession, further education and
skills, and finish an incomplete advanced degree.
In the question involving respondent interest in obtaining an advanced degree, survey
results showed that only 33.55% of the respondents who answered the question strongly agreed
or somewhat agreed that they were interested in obtaining an advanced degree, while 44.74%
somewhat or strongly disagreed. The remaining 21.71% of respondents neither agreed nor
disagreed they were interested in returning to school for an advanced degree. Responses relating
to HI professionals’ interest for returning to school based on the AHIMA call to action showed
that 11.26% somewhat or strongly agreed that their interest in returning to school would be based
on the AHIMA call to action. However, 62.92% somewhat or strongly disagreed that their
interest in returning to school to obtain an advanced degree was based on the AHIMA call to
action, while 25.83% of respondents that neither agreed nor disagreed. As this influence did not
meet the 75% threshold, this motivational influence for interest (intrinsic) value is a need. Table
12 shows the data results from this assumed motivational influence.

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Table 12
Assumed Motivation (Interest Value/Intrinsic) Influence of HI Professionals
Survey Question Number of
respondents
who completed
question (N)
Total percentage who
strongly agree or
agree

Count
Q23: I am interested in obtaining an
advanced degree (master’s or
doctorate).
152 33.55 68
Q26: My interest in returning to
school is based on the AHIMA
HIM Reimagined (HIMR) call to
action for health information
professionals to return to school
for advanced degrees by 2027.
151 11.26 17

Rank Order Question for Motivational Priorities for Obtaining Advanced Degrees
Question 29, which ranked respondents’ (N = 132) motivational priorities for obtaining
an advanced degree showed that for job promotion, 40% of respondents ranked “increased
earning potential” as the most important motivational factor for returning to school. Starting a
new career path ranked second (27%), while “starting a new career path in health information”
ranked third as a motivational factor (18%). The fourth-ranked factor was furthering education
and skills (13%), and finishing an incomplete degree ranked fifth (5%). As this influence used a
rank order question which asked respondents to prioritize factors for their returning to school to
obtain an advanced degree, it will not be an asset or a need, as the 75% threshold does not apply.
However, Chapter Five recommendations will use these results. Figure 5 depicts the results from
the rank order question for motivational priorities.

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Figure 5
Motivation for Returning to School for an Advanced Degree Survey Results

Document Analysis for Interest Value
Document analysis within the AHIMA Access Online community platform, the AHIMA
Body of Knowledge, and the AHIMA Career Prep Workbook and Tools did not reveal any
documents for this influence that were related to HI professionals’ motivation for returning to
school. The AHIMA Body of Knowledge produced a 2017 study that discussed intrinsic
motivation in relation to the main topic but was unrelated to intrinsic motivation involving HIM
Reimagined or HI professionals returning to school for advanced degrees. The AHIMA Career
Prep Workbook Changing Careers and Moving Forward: How Do I Start Over in HIM? activity
and its corresponding 2016 AHIMA practice brief titled Climbing Higher, Bridging the Gap to
Advanced Degrees needed to complete the workbook activity discussed the pursuit of higher
education as a significant investment of time and energy and the need to overcome obstacles to
pursue graduate education but these resources did not discuss any topics related to interest value

77

or have any tool for those completing the workbook to assess their level of interest in returning
to school for advanced degrees.
Summary for Interest Value
Overall, the assumed influence that HI professionals must possess the interest and
motivation to return to school, and the assumed influence to support the 2017 HIM Reimagined
call to action for advanced degrees were both determined to be needs. The rank order
motivational priorities for returning to school to obtain an advanced degree was not an asset or a
need, as the 75% threshold did not apply, but results will be used for Chapter Five
recommendations. As all assumed interest (intrinsic) value influences did not meet the 75%
threshold based on the survey questions, the results of the survey show that this influence is a
need.
Utility Value: HI Professionals Returning for Advanced Degrees for Personal and
Professional Goal Fulfillment
Extrinsic motivation, or utility value, defines a person completing a task, regardless of
whether it is enjoyed, because it leads to a distinguishable outcome and may be integral to the
individual’s future vision or goal, and fulfills a psychological need (Eccles, 2006; Ryan & Deci
2000a, 2000b; Wigfield, 1994). HI professionals must have the ability to have extrinsic
motivation, or utility value related to their pursuit of advanced degrees. This section discussed
the survey results for utility value, as well as the document analysis pertaining to this assumed
influence, which is that HI professionals must possess the motivation to apply, enroll, and
complete advanced education degrees
Survey questions 29 and 30 asked HI professionals if returning to school for advanced
degrees would fulfill either a personal or professional goal. Table 13 depicts the results of these
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survey questions. Both questions used a Likert scale with five choices for each question, ranging
from strongly disagree to strongly agree. In the question concerning respondents’ belief that
attending graduate school and obtaining an advanced degree would fulfill a personal goal, 51%
of the respondents both somewhat and strongly agreed attending graduate school and obtaining
an advanced degree school would complete a personal goal. In contrast, 23.49% somewhat
agreed and strongly disagreed pertaining to their interest. The remaining 25.5% of respondents
neither agreed nor disagreed that attending graduate school and obtaining an advanced degree
would fulfill a personal goal. Responses relating to HI professionals’ belief that attending
graduate school and obtaining an advanced degree to fulfill a professional goal revealed that
55.04% somewhat or strongly agreed that a graduate degree would fulfill a professional goal,
while 24.83% somewhat disagreed or strongly disagreed. Additionally, 20.13% of respondents
neither agreed not disagreed about professional goal fulfillment by completing graduate school
and obtaining an advanced degree. As this motivational influence for utility (extrinsic) value did
not meet the 75% threshold, the results of the survey show that this influence is a need.

79

Table 13
Assumed Motivation (Utility Value) Influence of HI Professionals
Survey question Number of respondents
who completed question
(N)
Total percentage who
strongly agree or
agree
Count
Q29: I believe that attending
graduate school and
obtaining an advanced
degree will fulfill a personal
goal.
149 51.00 76
Q30: I believe that attending
graduate school and
obtaining an advanced
degree will fulfill a
professional goal.
149 54.04 82

Document Analysis for Utility Value
Document analysis within the AHIMA Access Online community platform, the AHIMA
Body of Knowledge, and the AHIMA Career Prep Workbook and Tools did not reveal any
documents for this influence that were related to HI professionals’ utility value or extrinsic
motivation to returning to school for advanced degrees. The AHIMA Body of Knowledge
produced a 2017 study that discussed extrinsic motivation in relation to the main topic but was
unrelated to extrinsic motivation involving HIM Reimagined or HI professionals returning to
school for advanced degrees. The AHIMA Career Prep Workbook Changing Careers and
Moving Forward: How Do I Start Over in HIM? activity and its corresponding 2016 AHIMA
practice brief titled Climbing Higher, Bridging the Gap to Advanced Degrees discussed how
earning advanced degrees can secure credentials for personal and professional goals that open
doors for new opportunities. Furthermore, the practice brief indicated that earning advanced
degrees can offer a higher level of professionalism, prestige, and lead to earning designation of
80

Fellow of the American Health Information Management Association (FAHIMA), as a master’s
degree or higher is required to become an AHIMA Fellow. The documents did not specifically
discuss any topics or have any tools for use that could be related to utility value that would assist
HI professionals who are completing the workbook to assess their level of utility value related to
returning to school for advanced degrees.
Utility Value Summary
Overall, the assumed influence that HI professionals must possess the motivation to
apply, enroll, and complete advanced education degrees for either personal or professional
reasons were both determined to be needs. As both assumed utility value influences did not meet
75% threshold based on the survey questions, the results of the survey show that this influence is
a need.
HI Professionals’ Self-Efficacy to Return to School for Advanced Degrees
Self-efficacy is an individual’s belief in their ability to master a certain skill or behavior
and control life events, plus mastering these experiences can provide a keen sense of efficacy
which is essential in self-regulation and motivation (Bandura, 1982 as cited in Hackett, 1995;
Bandura, 1989, p. 1175; Bandura, 2002). Therefore, the following showcases the survey results
related to HI professionals’ need to believe they can success in returning to school to complete
their advanced education degrees.
To reach the 2027 goal, it is important to determine if HI professionals have the self-
efficacy to return to school. Furthermore, their self-efficacy should support the HIM Reimagined
initiative. Questions 25, 27, 28, and 31 evaluated HI professionals’ self-efficacy in returning to
school for advanced degrees that would fulfill either a personal or professional goal. Three
questions used a 5-point Likert scale, with the remaining question using rank order to rate
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potential barriers to returning to school for an advanced degree in the next five years. Data from
the first Likert scale question for the self-efficacy influence showed that 47.02% respondents
somewhat or strongly agreed that feel confident they have the ability to apply to an advanced
degree program within the next five years, and 26.49% somewhat or strongly disagreed that they
felt confident that they had the ability to apply. 26.49% of respondents fell into the category of
neither agree nor disagree. Therefore, less than half of respondents felt confident enough to apply
for school in the next five years. As this motivational influence for self-efficacy did not meet the
75% threshold, the results of the survey showed that this influence is a need.
The next two Likert scale questions asked respondents if they felt their previous
experience as a college student, or if their experience working as an HI professional, would help
them successfully complete an advanced degree program. For the question concerning their
previous college experience, 70.66% somewhat and strongly agreed, while 14% somewhat and
strongly disagreed, and 15.33% neither agreed nor disagreed. The results for previous HI
professional experience showed that 81.88% felt their experience would help them complete an
advanced degree program. Only 7.38% somewhat and strongly disagreed their experience would
help them successfully complete an advanced degree, while 10.74% neither agreed nor
disagreed. For this motivational influence for self-efficacy, only one of the two questions met the
75% threshold. Therefore, the results of the survey showed that HI professionals’ belief that
previous college experience would help them successfully complete an advanced degree program
is a need, but professional experience is an asset. Table 14 describes the survey results for the
motivational influences for the self-efficacy of HI professionals.

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Table 14
Assumed Motivation (Self-Efficacy) Influence of HI Professionals
Survey question Number of
respondents who
completed question
(N)
Total percentage
who strongly agree
or agree

Count
Q25: I am confident I have the
ability to apply to an
advanced degree program
within the next five years.
151 47.02 71
Q27: I believe that my previous
experience as a college
student will help me
successfully complete an
advanced degree program.
150 70.66 106
Q28: I believe that my experience
working as a health
information professional will
help me successfully complete
an advanced degree program.
149 81.88 122

Rank Order Question for Motivation for Potential Barriers
Question 31 ranked respondents’ (N = 132) potential barriers that may delay their
enrolling in an advanced degree program in the next five years. Results showed that most
respondents (30%) ranked family obligation as their primary barrier. Additionally, 26% of
respondents selected time restrictions, 16% selected financial costs, and 12% chose work
obligation as a barrier. The last three factors selected were program/degree selection at 8%,
school selection process and school application process, where responses were both 5%. As this
influence used a rank order question which asked respondents to prioritize factors that were
potential barriers to beginning an advanced degree program in the next five years, the outcome
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will not be an asset or a need, as the 75% threshold does not apply. Chapter Five will use these
results for recommendations. Figure 6 depicts the results for the potential barrier rankings.

Figure 6
Results for Potential Barriers Which May Delay Pursuit of Advanced Degrees in the Next 5
Years

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Document Analysis for Self-Efficacy
Document analysis within the AHIMA Access Online community platform, the AHIMA
website Online Career Tools, and the AHIMA Body of Knowledge did not reveal any documents
for this influence that were related to the HI professionals’ self-efficacy to return to school for
advanced degrees. The AHIMA Body of Knowledge included studies from 2007 and 2017
discussing topics involving self-efficacy, but none related to self-efficacy involving HIM
Reimagined or discussing HI professionals returning to school for advanced degrees. The
AHIMA Career Prep Workbook activity called Changing Careers and Moving Forward: How
Do I Start Over in HIM? and its corresponding 2016 AHIMA practice brief titled Climbing
Higher, Bridging the Gap to Advanced Degrees discussed how earning advanced degrees and
mastery of HI-related skills can lead to new employment opportunities, increased
professionalism, and prestige. These resources also note that earning an advanced degree can
result in becoming a Fellow of the American Health Information Management Association
(FAHIMA). However, these documents did not specifically discuss any topics or have any tools
that could increase HI professional self-efficacy of returning to school for advanced degrees.
Self-Efficacy Summary
Overall, the assumed influence that HI professionals must possess an expectation and
determination for success and goal-fulfillment by returning to school to complete advanced
education degrees was determined to be a need. As only one of the three self-efficacy questions
met the 75% threshold for the assumed self-efficacy, the results of the survey showed that
overall, this influence is a need.
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Results and Findings for Organizational Influences
The results and findings for the HI professionals’ organizational influences and causes
were measured through the survey. The following sections report results per assumed influence
in the categories of organizational cultural models and cultural settings. The survey results and
document analysis will clarify the organizational causes.
Cultural Models
The results and findings for the organizational models and settings were measured
through the survey, using the categories discussed in Chapter Three. The reported results are per
the assumed organizational influences in the categories of cultural models and cultural settings,
as discussed by Schein (2010) and Clark and Estes (2008). The organizational influences are
divided by survey results and document analysis.
Cultural Models Describing Certification, Credential, and Degree Sufficiency and
Equivalency in the Organization
Survey questions 32–34 specifically asked respondents to determine if the organization’s
cultural models existed for obtaining credentials and certifications versus advanced degrees, and
if the bachelor’s degree should remain as the profession’s terminal degree. For each cultural
model question, there were five choices to select: strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, and strongly disagree. 58.22% of HI professionals either
agreed or strongly agreed that their current certifications and degrees were sufficient for
advancement and promotion without an advanced degree. Only 17.81% indicated that they
neither agreed nor disagreed, while 23.97% either somewhat or strongly disagreed that their
certifications and degrees were sufficient. Similarly, for Question 33, which asked if the
respondents’ specific credentials from AHIMA were sufficient for advancement and promotion,
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over half of the respondents (58.22%) somewhat and strongly agreed that their credentials were
sufficient. At least 20.54% somewhat and strongly disagreed that their credentials were enough,
while 21.23% neither agreed or disagreed with the sufficiency of their credentials for promotion
and advancement. Question 34 asked respondents if they believed that obtaining additional
credentials and certifications in their profession would be the equivalent of obtaining an
advanced degree. While 51.03% felt additional credentials would be the equivalent of an
advanced degree, 22.76% neither agreed nor disagreed, and 26.21% somewhat and strongly
disagreed that credentials were the equivalent of an advanced degree. As none of these
influences meet the 75% threshold, the results of the survey showed that this organizational
influence is a need.
Cultural Models for Attainment of Credentials and Terminal Degrees Within the Organization
Survey questions 35–37 specifically asked respondents to determine if the organizational
cultural model existed pertaining to obtaining credentials and certifications versus advanced
degrees, and if the bachelor’s degree should remain as the profession’s terminal degree.
However, data from Question 37 was corrupted within Qualtrics and was not used in the final
results. When asked if the organizational culture (AHIMA) promoted credential attainment over
advanced degree pursuit, only 46.58% agreed. Many respondents (38.36%) neither agreed nor
disagree with the question, and 15.06% somewhat and strongly disagreed. In question 36,
respondents were asked if they believed the bachelor’s degree should remain as the terminal
degree for the profession. Those respondents who somewhat and strongly agreed totaled 47.94%,
and 24.66% somewhat and strongly disagreed with the question. Furthermore, a total of 27.40%
of respondents neither agreed nor disagreed that the bachelor’s degree should remain as the
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terminal degree. Because this influence did not meet the 75% threshold, this influence was
determined to be a need. Table 15 highlights the results of all five cultural model questions.

Table 15
Assumed Cultural Model Influences Within the Professional Organization
Survey question Number of
respondents who
completed question
(N)
Total percentage
who strongly
agree or agree

Count
Q32: I believe that my current
certifications and/or
degree(s) are sufficient for
advancement and promotion
in this profession without an
advanced degree.
146 65.09 110
Q33: I believe that my specific
credentials from AHIMA are
sufficient for advancement
and promotion in this
profession without an
advanced degree.
146 88.75 150
Q34: I believe that obtaining
additional credentials and
certifications in my
profession is the equivalent
of obtaining an advanced
degree.
145 70.41 119
Q35: I believe the culture of the
AHIMA organization
promotes credential
attainment over the pursuit
of advanced degrees in this
profession.
146 46.58 68
Q36: I believe the bachelor’s
degree should remain the
terminal degree for this
health information
profession.
146 47.94 70

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Document Analysis. A search conducted in the AHIMA website, the AHIMA Access
Online community for members, the AHIMA Body of Knowledge, the AHIMA Career Prep
Workbook or Career Tools did not reveal any documents for this influence related to the HI
professionals’ organizational model influences related to HI professionals returning to school.
Cultural Model Summary. The assumed cultural model influence that the organization
must eliminate the assumption that the undergraduate degrees and credentials are sufficient was
determined to be a need. One question pertaining to the belief that credentials were sufficient for
advancement was above the 75% threshold, as respondents felt credentials were enough, but the
remaining data showed that less than 75% felt their credentials and undergraduate degrees were
sufficient, that credential attainment equaled advanced degrees, that the bachelor’s degree should
remain the terminal degree, or that AHIMA valued credentials over degrees. As the AHIMA
organization is attempting to become a graduate-level profession, and to meet the HIM
Reimagined goal of 20% with graduate degrees by 2027, the results showed this cultural
influence as a need.
Cultural Settings
According to Rueda (2011) and Gallimore and Goldberg (2001), cultural settings are
visible indicators and describe realities of the organizational cultural models. This section
discusses the survey results and document analysis pertaining to the assumed organizational
influence for cultural settings, which is that the AHIMA organization must reduce barriers to
advanced degree completion through the provision of incentives. Therefore, this section
discusses the AHIMA organization’s cultural setting influences.
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Cultural Settings for Educational Pathways and Mentorship Support Within the Organization
Survey questions 38–39 specifically asked respondents to determine if there were
AHIMA organizational cultural models that existed for advanced degree attainment for the HI
professional membership. For each cultural setting question, there were five choices to select for
each question: strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree,
and strongly disagree. Question 38 asked respondents if they believed that AHIMA should create
an advanced education pathway, or map to assist those who return to school, and 75.35%
somewhat or strongly agreed. Only 6.16% of respondents somewhat and strongly disagreed,
while 18.49% neither agreed nor disagreed with the development of an educational
pathway/map. Question 37 contained information asking respondents whether they believed
AHIMA viewed advanced degrees as relevant for future sustainment of the profession, but the
data were not used as the question became corrupted after the release of the survey. The next
cultural setting question asked respondents if they believed there should be a mentorship match
program with AHIMA members with advanced degrees, to assist those who return to school.
Most respondents (70.84%) somewhat and strongly agreed that there should be a mentorship
match program, while 8.33% disagreed that there should be a mentorship match program. In
addition, 20.83% neither agreed nor disagreed about the mentorship match program. Survey
results demonstrated that 65.09% of HI professionals either agreed or strongly agreed that their
confidence level was high to make an informed decision for school. Only 18.34% indicated that
they neither agreed nor disagreed pertaining to their level of confidence. Furthermore, a total of
16.57% either somewhat or strongly disagreed that they had a high level of confidence to make
an informed decision. For these cultural setting influences, the responses for the mentorship
program were over 75% agreement, so this influence is an asset. The remaining influences did
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not meet the 75% threshold; therefore, these influences were determined to be needs. Table 16
shows the results of all cultural settings questions.
Cultural Settings for Financial Support Within the Organization
Survey questions 40–41 asked respondents about AHIMA organizational cultural models
regarding scholarships and financial support for the HI professional members who return to
school for advanced degrees. For each cultural setting question, there were five choices to select:
strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, and strongly
disagree. 52.08% somewhat and strongly agreed they were aware of the AHIMA Foundation
scholarship availability. There were 36.81% who somewhat and strongly disagreed about their
awareness of the AHIMA Foundation scholarships, and 11.11% neither agreed nor disagreed.
Results pertaining to AHIMA providing financial assistance to their membership to return to
school for advanced degrees showed that 67.81% somewhat and strongly agreed there should be
financial support. Just 10.95% of respondents somewhat and strongly disagreed about AHIMA
help with financial support for school, and 21.23% neither agreed nor disagreed. As neither
influence met the 75% threshold, it was determined that this influence is a need. Table 16 depicts
the results of all four questions for cultural settings.

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Table 16
Assumed Cultural Settings Influences Within the Professional Organization
Survey question Number of
respondents who
completed question
(N)
Total percentage
who strongly
agree or agree

Count
Q38: I believe the AHIMA should create
an advanced education pathway/map
to assist members who decide to
return to school for advanced degrees.
146 75.35 110
Q39: I believe a mentorship match
program with AHIMA members who
already have advanced degrees would
assist members who decide to return
to school for an advanced degree.
144 70.84 102
Q40: I am aware of the AHIMA
Foundation academic scholarships
available for active members who
pursue advanced degree education.
144 52.08 75
Q41: I believe AHIMA should help their
membership with financial assistance
to return to school for advanced
degrees.
146 67.81 99

Document Analysis. A search conducted in the AHIMA website and the AHIMA Access
Online community for members did not reveal any specific documents for this influence related
to the HI professionals’ organizational cultural model influences. The AHIMA Career Prep
Workbook provided a workbook activity under the section titled Changing Careers and Moving
Forward: How Do I Start Over in HIM? The practice brief Climbing Higher: Bridging the Gap
to Advanced Degrees in HIM (2016 update), which was required to complete the workbook
activity, suggested that finances were significant, substantial, and a lack of funding could cause
interference with degree completion. The practice brief further discussed the availability of
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scholarships and grants available through both the AHIMA Foundation and state CSAs for HI
professional graduate students and mentioned potential employer tuition reimbursement. Also,
the AHIMA Foundation website described each scholarship in detail, complete with
requirements and amounts rendered. Within the AHIMA Body of Knowledge, a pre-HIM
Reimagined AHIMA journal article from 2012 provided links for HI professionals who wanted
to continue their education. Some of the links included in this document were for finding and
researching accredited HI degree programs, accessing financial aid, and accessing a now inactive
checklist for continuing education. Furthermore, the AHIMA Career Map provided current and
emerging positions in the profession with detailed information and salary about each position;
however, the interactive Career Map under the Career Tools on the AHIMA website provided
more career related information for undergraduate degrees and fewer for graduate degrees.
Lastly, the AHIMA website revealed that the mentorship program is not currently active.
Cultural Setting Summary. The assumed cultural setting influence that the organization
must reduce barriers related to advanced degree attainment was determined to be a need. One
question was above the 75% threshold, as most respondents felt the AHIMA should create an
advanced education pathway or map to assist members who decide to return to school for
advanced degrees. However, the remaining data showed that less than 75% were aware of
scholarships, felt AHIMA should assist with finances for returning to school or felt the need for a
mentorship match program for graduate students. Although these responses were less than 75%,
the results confirm this cultural influence as a need.
Final Open-Ended Question Results and Findings
For the singular, open-ended final survey question, respondents provided any additional
feedback they felt would be helpful to support the questions and topics within the survey. 53
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respondents completed this question and provided additional feedback. These respondents
provided more understanding of the survey question results in the areas of knowledge,
motivation, and organizational influences. After coding the responses using the Quirkos XM
coding software, the top four themes derived from the closing question primarily noted four
motivation and organizational themes: (a) AHIMA’s need to market and retain current skills,
certifications, and credentials for the HI profession, (b) disagreement with returning to school for
advanced degrees, (c) HI professionals’ reluctance to return to school, and (d) barriers to
returning to school.
AHIMA Should Retain and Market HI Professionals’ Current Skills and Credentials
One theme that emerged from the closing question was regarding current skills and
credentials maintained by the HI profession. These HI professionals’ responses regarding their
credentials and advanced degrees depicted their knowledge and motivation influences, their
attitudes toward the AHIMA organization’s setting and culture, all focused on their returning to
school for advanced degrees. Respondents indicated that the AHIMA should maintain the current
skills and credentials HI professionals possess. Most respondents felt that the AHIMA
credentials “CCS, RHIT, RHIA can all be obtained and maintained easily and provide a
sustainable living wage and allow family and social flexibility.” Others felt that degrees were
helpful, but certifications helped as well, as one respondent said, “my RHIT and CTR (certified
tumor registrar) credentials have kept me employed for 41 years.” One respondent stated,
I fear that a degree focus career path will only cause more unemployment for those
already in the field. I would like AHIMA to really focus on marketing what incredible
skills we have as I am not sure healthcare organizations and others that use EHRs could
benefit.
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Another respondent wrote,
I work with many RHITs that have exceeded in their careers as directors and managers;
plus know of two HIM managers without an RHIT or RHIA with the same salary.
Knowing this, I wouldn’t want to spend an X-amount of funds to obtain a master’s degree
that wouldn’t be beneficial in the end. Employed in the rural areas, promotions are due to
job performance and not linked to education.
One last comment from a respondent indicated that the AHIMA’s focus on advanced degrees
was not terrible, but they felt that AHIMA was “overlooking the primary population of skilled
workers–those at the certificate or associate-degree level” as the respondent felt that advanced
degree graduates did not want to code records, which is still a primary function of some AHIMA
certification specialists. In addition, these respondents felt that AHIMA should improve
marketing of these skills and credentials so that the healthcare ecosystem understood their value
despite the degree held. One comment inferred that “certifications rather than an entire more
general MS or PhD provide more focused and relevant education for the areas of the field where
advanced skills and knowledge are required.”
Overall, for this theme, the respondents’ feedback noted that advanced certifications were
more beneficial than an advanced degree, that AHIMA should continue to maintain and protect
current credentials for their HI professionals, and that “AHIMA needs to reach out to post-acute
organizations such as AHCA and Leading Age to promote the importance of hiring credential
HIM professionals in post-acute [care].”
Disagreement With the Need for Advanced Degrees in the Profession
Many respondents reported extensively about their disagreement with the AHIMA call to
action for HI professionals to have advanced degrees. These responses reflected the lack of
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motivation for HI professionals possessing the interest to return to school, and their value of
advanced degree completion. These responses also indicated the lack of HI professionals’
motivation to earn advanced degrees or to value degree completion. There were mixed emotions
about AHIMA and advanced degree push, but there were several respondents who inferred that
there were many HI professionals at the top of the profession without additional education. Some
asserted that “degrees don’t necessarily make you smarter or more qualified than someone who
has experience,” and others said, “I do not think AHIMA should take the stance that ALL HIM
professionals need advance (sic) education beyond the bachelor’s degree.” Another respondent
wrote:
Furthermore, if MS or PhD become required for management and higher roles, wages
will likely fall for the rest of the HIM workforce since the perceived “gap” between
frontline staff and degree-holders would mean the skilled but non-degreed staffers would
look “uneducated” when education level doesn’t equate to professional skill level in this
field. There are MS and PhD holders in other soft-science and humanities fields
(education & library science fields for instance) where degrees add debt and make
newcomers look “overqualified” or “too expensive” and top wages are not as high as they
would be for hard science, technology, law, etc. fields. The investment vs. likely payoff
just isn’t there for advanced HIM degrees, and encouraging employers to demand MS or
higher for HS/GED or BS only level wages is not a benefit to the workforce or to how the
profession is viewed by outsiders.
Another respondent wrote this statement in response to the open-ended question:

On the subject of AHIMA’s HIM Reimagined, I think it is actually crazy that they thing
[sic] that HIM professionals should go beyond a bachelor’s degree program and that it
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should be the standard for the industry. I can see getting into a managerial or executive
role it might be helpful, but honestly, the courses I have been taking at the associate’s
degree level have not been very educational and helpful in my career. I am in coding and
compliance. I think that them pushing for higher education is actually just a money grab
for them because they will require their textbooks to be purchased and used for the
curriculum for these programs. As an employee and current student in their programs, I
honestly do NOT feel like I am getting my money worth of education and will not be
pursuing a degree higher than an associate’s in one of their credentialed programs. If I
were to go further, I would pursue a degree in business or non-accredited health
management program.
In general, this theme indicated that there were respondents who believed that advanced degrees
may not be beneficial for all HI professionals, that associate and bachelor’s degrees were
sufficient education, and that advanced degrees may make some HI professionals overqualified
for industry-specific employment opportunities, which could be a detriment to the profession.
This trend is also indicated in the next prominent theme of HI professionals’ reluctance to return
to school.
HI Professionals’ Lack of Interest in Returning to School
Several respondents discussed their reluctance about returning to school and completing
an advanced degree program. These responses indicated the lack of motivation for earning
advanced degrees and for valuing degree completion. Some respondents indicated they were too
old or too advanced in their careers to return to school, while others did not want to obtain a
degree and incur debt. Some commented that an advanced degree offered no return on
investment when compared to the money spent to pursue advanced education. Many respondents
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implied that they were too old to return to school or were close to retirement and “had no need
for further education.” Others stated that they were not interested and did not desire an advanced
degree. One respondent said,
I’m not really interested in obtaining a higher degree. Personally, I believe degrees are
overrated. I am from the experience is more important era. I have no interest in going
back to school and would resign my position if the organization I work for insist that I do,
which may happen in today’s world.
Another respondent said they had “no desire to go back to school.” They stated,
I was Director of HIM at our local hospital for a short time and realized I have no desire
to be management. I enjoy not having the added stress of administration and want to
continue to just ‘do my job and go home.’
In order to meet the advanced degree goal of 20% by 2027, HI professionals must possess the
motivation to return to school. However, as this was one of the larger themes in the open
question, many HI professionals do not desire to return to school.
Barriers to Returning to School
The coding for this theme reflected the rank order questions from the survey which asked
about potential barriers that would keep HI professionals from returning to school in the next
five years. The rank order questions were relative to motivational barriers inhibiting returning to
school and included school selection, applying to school, program/degree selection, financial
costs, family obligation, time restriction, and work obligation. Many who responded to the open-
ended question who were reluctant to return to school stated the reasons as age, work, family,
and finances. Of all the listed barriers, financial cost was the prominent reason the respondents
listed, with age and proximity to retirement frequently listed as barriers as well. Financial
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reasons included current student debt, the possibility of incurring more debt, and being rejected
multiple times for AHIMA scholarships “due to the numerous applications.” Time resources,
work, and family constraints were additional barriers. One respondent listed the school system as
a barrier by stating,
I’m nearly finished with my bachelor’s and I haven’t learned anything helpful that I
didn’t already know from working in healthcare, and much of the knowledge is textbook-
based rather than actual practice in the healthcare setting. I have no faith in the university
setting for any type of advancement, and to be quite honest after seeing what people with
advanced degrees deal with as managers, I have no desire to work those roles.
These respondents believed that these barriers were too substantial to be overcome. Figure 7
illustrates the results of the Quirkos XM coding from the singular open-ended question and
reflects the dominant themes that appeared and reflected KMO influences on advanced degree
attainment.

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Figure 7
Themes From Singular Open-Ended Final Question

Summary
Although the top four themes indicated a preference for not returning to school, there
were other themes present in the open-ended responses. For instance, there were a few
respondents currently enrolled in associate and bachelor’s degree programs who were
considering advanced schooling after completing their current degree programs. One respondent
was completing an associate degree “because I fell behind as the technology changed so
quickly.” Another respondent stated that the survey “made me rethink my future goals.”
Organizational responses included statements for AHIMA to engage in employment, mentorship,
and funding assistance for those HI professionals who pursue advanced degree programs.
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Synthesis and Findings
This study utilized surveys and document analysis to identify the knowledge, motivation,
and organizational (KMO) gaps between current performance and the AHIMA goal for returning
to school for advanced degrees. The data from this study illustrated that recognizing and
highlighting the KMO influences, factors, and barriers identified in this study are critical to
ensuring that HI professionals will return to school to meet the AHIMA organizational goal: that
20% of HI professional members will have advanced degrees by 2027. Overall data analysis
indicated that there were gaps in knowledge, motivation, and organizational influences that may
prevent this goal from being met. Addressing the barriers may assist the organization in meeting
its goal by 2027.
The analysis of the data from the study supported the assertion that declarative and
procedural knowledge gaps existed in the ability of the stakeholders to meet the goal. HI
professionals exhibited an understanding of two of three declarative knowledge skills. The data
suggested that the HI professionals could recall how to complete a college application, but there
were declarative knowledge gaps in their understanding of how to return to school. Likewise,
there were declarative knowledge gaps in their understanding of how to use the college
admissions staff, administrators, and advisors to assist with the college selection process. These
processes are integral to the goal for advanced degrees, as HI professionals must recall both
processes to make an informed decision to return to school. The data also identified procedural
knowledge gaps. HI professionals understood how to select schools that supported their
educational goals, career goals, and current lifestyle, and knew how to secure transcripts from
previous schools. The procedural knowledge gaps occurred in their ability to complete the
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registration process for standardized examinations, to obtain letters of recommendation for
graduate school, and to secure financial aid and scholarship funding for graduate school.
The data analysis for motivational influences identified gaps in HI professionals’ interest
value, utility value, and self-efficacy in obtaining advanced degrees. The data suggested that
most respondents did not possess the motivation to return to school to pursue advanced degrees
to meet the HIMR goal. HI professionals reported low interest value for obtaining an advanced
degree and returning to school based on the HIM Reimagined 2017 call to action. HI
professionals also reported low utility value; few participants held belief that returning to
graduate school to obtain an advanced degree would fulfill either a personal or professional goal.
In addition, they reported low self-efficacy; few participants held the belief that their previous
experiences as college students would assist them in completing an advanced degree and
reported that they were not confident in their ability to apply to an advanced degree program in
the next five years. However, their self-efficacy based on their experience working as HI
professionals would help them successfully complete an advanced degree program was high.
Additional data analysis from two rank order questions, one for interest value and the
other for self-efficacy, prioritized interest value. Respondents ranked five motivational priorities
for advanced degree completion from highest to lowest as increased earning potential (1),
starting a new career path (2), job promotion (3), to further education and skills (4), and to finish
an incomplete advanced degree (5). For self-efficacy in advanced degree completion, HI
professionals ranked seven potential barriers to degree completion, from highest to lowest as
family obligation (1), time restriction (2), financial costs (3), work obligation (4), and
program/degree selection (5). The school selection and school application barriers tied for last
place. Lastly, prominent themes related to motivation from the open-ended question suggested
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that HI professionals did not possess the motivation and interest to return to school for advanced
degrees, and other data suggested similar barriers to returning to school as well.
Data analysis identified organizational gaps in the AHIMA organizational models and
settings with respect to HI professionals. The data for the organizations’ cultural model of
undergraduate degrees and credential attainment imply that HI professionals do believe that their
AHIMA-specific credentials (RHIT, RHIA, CCA, CCS, CCS-P) were sufficient for advancement
and promotion within the HI profession without an advanced degree. The open-ended question
also reflected these data as one of the main themes was that AHIMA should retain and market HI
professionals’ current skills and credentials. However, many respondents did not believe that the
culture of the AHIMA organization promoted credential attainment over advanced degree
pursuit.
Conversely, also pertaining to AHIMA credential (and degree) culture, data suggest that
many HI professionals responded that they did not believe that their current certifications
(coding, billing) and degrees (associate and bachelors) were sufficient for advancement without
an advanced degree. In addition, HI professionals did not believe that obtaining additional
credentials and certifications in the profession were the equivalent of obtaining an advanced
degree. Lastly, HI professionals disagreed that that the bachelor’s degree should remain the
terminal degree for the profession. However, the open-ended question theme that mirrored this
cultural model for credential attainment was incongruous with the need for advanced degrees.
These data suggest that HI professionals did not feel the organizational culture promoted
credential attainment over advanced degrees, and their belief is that their AHIMA credentials are
sufficient for advancement and promotion without an advanced degree. However, their other
responses to the questions indicated that they did not believe that the bachelor’s degree should
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remain the terminal degree, and that current certification and pursuing additional credentials will
not be sufficient for advancement, promotion, or are the equivalent of having an advanced
degree. These data have some alignment with the HIMR initiative for advanced degree pursuit
but are contrary to motivational data for HI professionals to return to school.
For the organization cultural settings pertaining to gaps in mentorship and financial
assistance, data suggested that HI professionals believed that a mentorship match program with
AHIMA members with advanced degrees would assist those who want to return to school. The
data also implied that HI professionals felt that AHIMA should help their members with
financial assistance to return to school. However, there was a significant gap with HI
professionals’ awareness of the AHIMA Foundation scholarships to assist with advanced degree
education.
Summary
This chapter presented the results of the quantitative survey and the document analysis as
they related to the research questions. The discussion included assumed knowledge, motivation,
and organizational influences found in the literature review and the conceptual framework. The
subsequent findings presented information that HI professionals did exhibit some knowledge and
motivation influences, plus an understanding of organizational influences on returning to school
for advanced degrees. But the findings also showed evidence that indicated many assumed
influences as needs rather than assets. These needs must be addressed for the AHIMA
organization to meet the 2027 goal of having 20% of their credentialed HI professionals earn
advanced degrees in the next five years. There are several needs that emerge from these data.
First, there is a need to prepare those who have been out of school for a long time to know how
to complete the basic tasks toward college application and enrollment; these are declarative and
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procedural knowledge. Second, there is a need to provide information about the tech takeover
and build a new or expanded career mapping to show how advanced degrees will advance the
profession overall and in the healthcare ecosystem; this need is related to interest value, utility
value, and self-efficacy. Lastly, there is an organizational need to create an understanding of how
advanced degrees will sustain the profession in the future, in addition to specific skills and
credentials. The data revealed the need for a deeper understanding of the effect of AI and ML on
entry-level positions, the move in healthcare toward advanced degrees in other professionals,
both administrative and clinical, and a re-imagining of the current AHIMA decentralized
mentorship model and financial assistance provided by the foundation.

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Chapter Five: Recommendations
Chapter Four presented the results and findings from the survey and the document
analysis to answer the two research questions:
1. What knowledge, motivation, and organizational influences are necessary to achieve the
AHIMA goal of obtaining graduate degrees for their credentialed HI professionals?
2. What are the primary reasons HI professionals provide for not obtaining advanced
degrees?
The results identified the knowledge, motivation, and organizational needs pertaining to the
AHIMA goal to have 20% of their credentialed HI professional members with advanced degrees
by 2027.
Chapter Five analyzes the final research question: What are the recommended change
processes and implementation methods required in the organization pertaining to knowledge,
motivation, and organizational support required to meet the goal? This chapter presents these
solutions to the validated needs identified in Chapter Four within the context of the organization.
The chapter discusses needs and assets for each KMO assumed influence, examines
recommendations for those assumed influences, and concludes with a recommended Kirkpatrick
and Kirkpatrick (2016) implementation and evaluation plan.
Discussion of Findings
The task to transition the HI profession from an associate and bachelor’s degree
profession to one with advanced degrees has been in progress for several years. This transition is
necessary for the profession’s sustainment as it is predicted that AI and ML may replace the
entry-level HI positions in the next 10 years. Other health related professions like physical
therapy and pharmacy have successfully transitioned to having practice-based doctorates, but for
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HI to make this transition as well, the nature of the HI professional career track must shift. HI
professionals must understand the need for the advanced degree and it potential use in the
profession. Most importantly, to meet the AHIMA organizational goal by 2027, HI professionals
must possess the necessary knowledge and motivation to pursue advanced degree education and
have organizational support to return to school.
This study found HI professionals throughout the United States that were credentialed
members of the AHIMA to participate in the survey. Study outcomes discovered and validated
that HI professionals did possess some declarative and procedural knowledge skills that will
assist them in their quest to find and apply to advanced degree programs in colleges and
universities. There were gaps in declarative and procedural knowledge influences related to
recall and completion of certain tasks to enable and facilitate school enrollment and funding,
which overall, may affect their ability to return to school. There were also motivation gaps in
their interest and utility value, plus self-efficacy gaps. These gaps included reasons pertaining to
interest in earning advanced degrees, personal and professional goal attainment, potential
barriers to returning to school, and confidence in completing advanced degree programs. The
study also found that there were organizational barriers pertaining to AHIMA-specific
credentials’ importance in the profession and in healthcare in relation to advanced degrees. Also,
there were gaps pertaining to having adequate financial support from the AHIMA and the
AHIMA Foundation for HI professionals who want to return to school. The study validated the
need for organizational change and the importance of AHIMA goal alignment for advanced
degree attainment as outlined in HIM Reimagined: there is a need for strategy and structure at
the national level to explain career development, mentorship, and an understanding of the future
employment opportunities available with advanced degrees and credentials for implementation
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and execution at the state-level as well. Overall, to meet the goal, the AHIMA organization must
prepare the HI professional to return to school and ensure they fully understand the importance
of advanced degrees for the future sustainment of the profession.
As mentioned in the literature review, the research identified the concept of how the
seven assumed KMO influences affect adults who desire to return to school. The literature
specifically discussed the importance of the recall and performance of certain tasks, which the
study identified in the HI professionals’ ability to recall how to complete tasks to make informed
decisions return to school, as well as knowing how to select, apply, and enroll in graduate-degree
producing programs using Krathwohl’s (2009) framework for declarative and procedural
knowledge. It is important that HI professionals know these tasks to return to school and to assist
AHIMA in reaching the 2027 goal.
Solutions and Recommendations for Practice to Address KMO Influences
This study’s goal was to recognize gaps in knowledge, motivation, and organization that
would keep the AHIMA from meeting the goal of having 20% of their credentialed HI
professionals with advanced degrees by 2027. The literature review discussed the AHIMA
organization’s origins, history, and trends over its 94-year existence, focused on the future of
health information pertaining to artificial intelligence and machine learning, explored the
movement toward doctoral degrees in other clinical and health information professions, and
identified several assumed KMO influences and potential barriers to goal attainment of advanced
degrees. The identified assumed influences were placed into specific KMO categories based on
the Clark and Estes (2008) gap analysis framework. Results of the study in Chapter Four
validated the KMO influences impacting the stakeholder focus and organizational goals of
achieving 20% of the AHIMA membership with advanced degrees by 2027.
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Addressing potential barriers identified in the study using the KMO framework assists
with the identification and elimination of organizational deficits, which will assist the AHIMA in
meeting their organizational goal. Using the framework will also increase HI professionals’
determination to earn advanced degrees to meet the organizational goal as well. If these barriers
are addressed appropriately, then there is an increased likelihood of combating the gaps to
prepare the HI professionals and the organization for the future sustainment of the profession
where the bachelors’ degree will no longer be the terminal degree. The following section will
outline the recommendations for all assumed influences and barriers in accordance with the
KMO framework. This chapter discusses the recommendations for each identified KMO
assumed influence as either an asset or a need.
Knowledge Recommendations
The assumed knowledge influences were declarative and procedural knowledge, which
refer to what and how individuals learn specific tasks, processes, and concepts (Krathwohl, 2002,
2009). The study found gaps in declarative and procedural knowledge that HI professionals need
to know to prepare to return to school for advanced degrees. The study determined that although
there are some declarative and procedural knowledge the HI professionals currently possess,
which were identified as assets, most of the knowledge needed to return to school were identified
as needs. Due to this finding, the recommendation is that AHIMA prioritize these knowledge
gaps to prepare HI professionals to return to school so the AHIMA can meet their organizational
goal. Table 17 outlines each of the assumed knowledge influences for declarative and procedural
knowledge, identifies whether the influence was categorized as a need or asset, and lists the
commensurate theoretical principle and citation that informs the recommendation for that
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influence. Additionally, the table outlines context-specific recommendations based on the
principles to improve the HI professionals’ performance to meet the organizational goal.

Table 17
Summary of Knowledge Influences and Recommendations
Assumed
knowledge
influence
Need
or asset
Principle and citation Context-specific recommendation
Declarative
HI professionals
need to
know how to
make an
informed
decision to
return to
graduate
school,
which
includes
school
selection,
admission,
enrollment,
and
financing.
Need Declarative knowledge
factors must play an
essential part in
mature adults
returning to higher
education (Cappellari
& Lucifora 2009).
Adults with enhanced
prior knowledge
experiences can
connect new
information to prior
experiences, essential
for complex decision-
making (Donaldson &
Graham, 1999; Gupta
et al., 2009).
Provide information and job aids
that will incorporate relevant
past knowledge experiences
attained from their prior degrees
and certificates and summarize
the procedures to tackle needed
skills to assist HI professionals
with tasks to help them make
decisions to return to school for
advanced degrees.
Provide HI professionals with
access to self-directed online
training webinars and videos
which will reintroduce and
reinforce knowledge skills and
tasks related to graduate school
selection, admission,
enrollment, and financing
procedures.
Procedural
HI professionals
must know
how to
select, apply,
and enroll
into graduate
degree
programs.
Need Procedural knowledge is
the type of knowledge
required for an
individual to know the
“how” or “when” to
perform specific skills
and tasks (Aguinis &
Kraiger, 2009;
Krathwohl, 2002;
Launspach, 2008).
Continued practice of
procedural knowledge
Provide HI professionals with
information and job aids that
will incorporate relevant past
knowledge experiences and
summarize the procedures to
tackle needed skills to assist HI
professionals with tasks to help
them make decisions to return to
school for advanced degrees.
Provide HI professionals with
continued access to self-directed
online training webinars and
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Assumed
knowledge
influence
Need
or asset
Principle and citation Context-specific recommendation
promotes automaticity
and takes less capacity
in working memory
(Schraw &
McCrudden, 2006).
videos to reinforce knowledge
skills and tasks related to
graduate school selection,
admission, enrollment, and
financing procedures, which
may offer continuing education
units for completion.

Declarative Knowledge Solutions
Declarative knowledge is the ability to recall and understand facts and concepts, which
includes knowledge associated with basic elements in a specific discipline necessary to solve
problems within an organization, structure, or policy (Krathwohl, 2002; Pintrich, 2002). This
knowledge is a combination of both factual knowledge, which is the awareness of primary and
essential elements to be understood within a certain discipline, and conceptual knowledge, which
is the knowledge of how these elements are related to each other within a larger system that
permits them to function (Krathwohl, 2002). Based on the study’s findings, HI professionals
must have declarative knowledge to make informed decisions to return to school.
The results of the study for declarative knowledge discovered show that over 75% of
participants felt they could recall how to complete a college application. However, less than 75%
of respondents felt they could make an informed decision to return to school, or recall how to
utilize college admissions staff, administrators, and advisors to assist with the college selection
process. These gaps require closure to meet the organizational goal. Therefore, it is
recommended that the organization create a job aid that descriptively outlines necessary steps
and pathways to college preparation, selection, and financial aid information. This job aid would
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assist seasoned HI professionals recall the skills and steps to making informed decisions to return
to school. The job aid must be available to all HI professionals either through the AHIMA Body
of Knowledge or the website for easy accessibility. This job aid and information could become
part of the Career Prep Workbook available to members of the AHIMA. According to Schraw
and McCrudden (2006), if learning is connected to individual interests, it will make learning
more meaningful. Therefore, this addition to the Career Prep Workbook would support the
interests of those HI professionals who have a desire to return to school and help them recall how
they completed these tasks and skills when they obtained prior degrees and certificates. The
information in the Career Prep workbook would mirror the current outline of workbook tasks by
providing outlines, reading material, exercises, and activities to master.
Procedural Knowledge Solutions
Procedural knowledge is the knowledge of understanding of how to do something and
knowing when to use procedures, and can include inquiry, skill usage criteria, algorithms,
techniques, required steps, and methods (Krathwohl, 2002). In addition to having the declarative
knowledge to complete tasks to make informed decisions to return to school, HI professionals
must also understand procedural knowledge as it pertains to returning to school for advanced
degrees, as this understanding will lead to organizational goal achievement.
The results and findings of this study indicated that over 75% of HI professional
respondents knew the process to select a college or university that supports educational, career
goals, plus their current lifestyle, plus knew how to obtain transcripts from previous schools.
However, responses to survey questions indicated that less than 75% of respondents understood
how to complete tasks related to GRE registration, letters of recommendation, or financial aid
and scholarships. Therefore, there were gaps in procedural knowledge of certain processes
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involved in returning to school that are critical to successful advanced degree enrollment and
completion. This indicated a significant need for development to ensure organizational goal
attainment.
According to Clark and Estes (2008), knowledge and skill enhancement are necessary
when people do not know how to accomplish a goal and are needed for the anticipation of future
goal attainment challenges. Providing HI professionals with the ability to complete tasks related
to applying to school for advanced degrees will show them how to perform these tasks, thereby
enabling them to use their knowledge and skills to increase the number of HI professionals with
advanced degrees. Therefore, the recommendation is for the AHIMA organization to provide
information, job aids, and training to ensure HI professionals can complete these tasks. Clark and
Estes (2008) also indicated that training is effective for communicating procedural knowledge,
so in addition to the information and job aids, training is necessary for this recommendation.
Since the AHIMA already has the Career Prep Workbook for information and has a job aid that
provides self-help information for HI professionals, including training to supplement the Prep
Book adds an additional benefit to augment the procedural knowledge necessary to apply, select
and enroll in advanced degree programs. The training could be titled Educational Development
and Tools, similar to the existing AHIMA Career Tools, and will provide opportunities to
practice, with corrective feedback to achieve the AHIMA HIMR goal. Training should occur as
it is normally conveyed to the AHIMA HI professional membership. This training can occur
through onsite workshops at conferences and conventions, or online as webinars or virtual
training courses where participants can acquire CEUs. According to Schraw and McCrudden
(2006), this kind of procedural knowledge training eventually facilitates mastery of the material.
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Motivation Recommendations
Motivation is the inner desire propelling individuals to accomplish personal and
organizational goals and energizes and guides behavior that leads to successful performance
outcomes (Linder, 2019; Sansone & Harackiewicz, 2000). According to Clark and Estes (2008),
motivation can be beneficial to organizations, even if no gaps exist between goals and
performance. Additionally, Clark and Estes determined there are three motivational indices:
active choice, persistence, and mental effort, where active choice is the intent to pursue a goal,
persistence is the continued effort toward the goal, and mental effort is the determination to learn
to work smarter toward the development of novel solutions. Therefore, motivational effort
combined with knowledge supports increased performance (Clark & Estes, 2008).
This study did show motivational gaps in each area relating to interest (intrinsic) value,
utility (extrinsic) value, and self-efficacy. Table 18 outlines the motivational influences on the
achievement of the stakeholder and organizational goals as needs, along with the evidence-based
principles and recommendations.

Table 18
Summary of Motivation Influences and Recommendations
Assumed
knowledge
influence
Need
or
asset
Principle and citation Context-specific
recommendation
Interest (intrinsic) value
HI professionals
need to
possess the
interest to
return to
school for
advanced
degrees.
Need Learning and motivation are
enhanced when learners have
positive expectancies for
success (Pajares, 2006).
People will easily and quickly
choose to do what interests them
the most, such as mastering a
new skill or adding to current
Include meaningful
personal aspects into
educational career and
professional
development training
that will be of interest to
HI professionals and
keep them engaged.
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Assumed
knowledge
influence
Need
or
asset
Principle and citation Context-specific
recommendation
expertise (Clark & Estes, 2008;
Eccles & Wigfield, 1999).
The ability to understand self-
determination theory (SDT) and
achievement-goal theory (AGT)
helps with understanding
motivation at the collegiate level
(Hegarty, 2011). Motivation
influences in adult students can
include interest in a specific
topic (intrinsic) or goal
fulfillment (extrinsic) (Hegarty,
2011).
Provide opportunities for
HI professionals to
choose training that
they have not completed
previously, which will
allow them to master a
new skill or experience
to return to school for
an advanced degree.
Utility (extrinsic) value
HI professionals
need to value
completing
advanced
education
degrees.
Need Individuals are more likely to take
part in an activity if that activity
provides personal value (Eccles,
2009). Discussing the
importance and utility value of
work or the importance and
utility of learning can help
learners develop positive values
(Eccles, 2006; Pintrich, 2003).
Enhanced learning and motivation
occur if the learner values the
task if the learner is aware of the
benefits (Clark & Estes, 2008;
Eccles, 2006).
Understanding self-determination
and achievement-goal theories
assists with understanding
collegiate-level motivation
(Hegarty, 2011). Motivation
influences in adult students can
include interest in a specific
topic (intrinsic) or goal
fulfillment (extrinsic) (Hegarty,
2011).
Provide training to HI
professionals that
stresses the value and
importance of advanced
degree completion,
while developing the
skills and tasks
necessary to
successfully apply,
start, and complete
advanced degree
programs.
Include rationales and
incentives for advanced
degree completion in
the information, job
aids, and training for HI
professionals.
Self-efficacy
HI professionals
need to
believe they
can succeed in
Need Positive people who believe in their
capability will achieve more than
those who have the same
capabilities but possess self-
Provide opportunities for
teamwork and
collaboration during
training to allow HI
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Assumed
knowledge
influence
Need
or
asset
Principle and citation Context-specific
recommendation
returning to
school to
complete their
advanced
degrees.
doubt about their own abilities
(Bandura, 1977, 1997 as cited in
Clark & Estes, 2008, p. 82).

professionals to learn
from each other and
from peers with
advanced degrees.

Task Value Recommendations and Solutions
There are two types of values HI professionals need to meet the goal of achieving 20% of
the AHIMA membership with advanced degrees by 2027. These values are interest (intrinsic)
value, and utility (extrinsic) value. Interest value is perceived as the internal reward of
completing a task for satisfaction, enjoyment, or reward (Eccles, 2006; Ryan & Deci, 2000;
Stanford Encyclopedia of Philosophy, 2019). Conversely, utility value is described as the
perceived usefulness of completing a skill or task (Eccles, 2006). The section discusses these two
values and proposed recommendations as identified in Table 18.
Interest (Intrinsic) Value. HI professionals must have intrinsic motivation to return to
school for advanced degrees. In this study, participants reported that they did not have a high
degree of interest in returning to school for advanced degrees. Respondents showed a lack of
intrinsic motivation to return to school for their own self-interest, as well as in response to the
HIMR call to action to return to school for advanced degrees. However, participants did rank
their interest motivation for returning to school, and the results showed that increasing earning
potential, starting a new career path, and job promotion were the top three reasons of five total
response selections. The two bottom-ranking responses were furthering education and skills and
finishing incomplete advanced degrees.
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Overall, survey results showed that interest value is a need to complete the AHIMA goal,
so it is important to consider these reasons in the development of a recommendation that will
propel HI professionals toward advanced degree enrollment and completion to meet the
stakeholder and AHIMA goal. According to Clark and Estes (2008), people easily and quickly
choose to accomplish what interests them the most, as well as acquiring interest in mastering a
new task or skill to add to their expertise. Therefore, the recommendation is for AHIMA to
redevelop the current AHIMA Career Prep Workbook to add more information on the need for
advanced degree attainment. Also, AHIMA should consider the creation of an educational
professional development program that is not based on the development of skills to become
proficient in the profession or for credential maintenance, but rather one that is based on
equipping and motivating HI professionals to understand the need for advanced degrees. Clark &
Estes stated that there should be connections between performance goals and a person’s interest
when possible, so the goals should represent an opportunity to do something of interest.
Consequently, the professional development should include clear goals and objectives on how to
prepare for advanced degree enrollment and attainment, plus detailed explanations, milestones,
and incentives for task and skill completion. According to Eccles (2006) and Schraw and
Lehman (2001), motivation increases when individuals feel control and choices in processes, so
these changes and enhancements should assist HI professionals with the skills necessary to apply
for advanced degree schooling while ensuring they feel the decision to returning to school is
their choice.
Utility (Extrinsic) Value. HI professionals must possess extrinsic motivation to return to
school for advanced degrees to meet the AHIMA goal. Utility value, or extrinsic motivation, is
determined if the individual values the given task, and the task aligns with the individual’s
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person goal (Eccles, 2006). This study found that HI professionals did not have a high degree of
extrinsic motivation to return to school for advanced degrees. Most survey respondents did not
show any extrinsic motivation to returning to school for either personal or professional goals.
However, as previously indicated from the ranking data question, HI professionals were
motivated to return to school for increased earnings, a new career path, and job promotion.
Eccles noted that individuals are more likely to engage in tasks that provide value; HI
professionals’ value increased earning potential, career advancement, and promotion
opportunities, and an advanced degree can lead to these things.
Survey results showed that utility value is a need to achieve the organizational goal.
Therefore, it is important to consider appropriate recommendations to assist HI professionals in
obtaining advanced degrees to meet the stakeholder and AHIMA goals. According to Eccles
(2006) and Pintrich (2003), rationales that include a discussion of the importance and utility
value of the work or learning can help learners develop positive values. Therefore, the
recommendation is for the redevelopment of the current AHIMA Career Prep Workbook and
AHIMA Career Map to add more information and exercises that focus on the value of
completing tasks leading to degree completion for increased earnings, a new career trajectory,
and job promotions, all pertaining to the need for advanced degree attainment in the profession.
Also, AHIMA should still consider the creation of an educational professional development
program that is based on the development of tasks and skills to gain additional education through
advanced degrees by applying and returning to school. This development program must give HI
professionals an understanding of the need for advanced degrees and how those degrees are used
for professional advancement to supplement their current credentials as an enhancement.
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This professional development must discuss the value-added benefit of advanced degrees
and provide motivation for HI professionals through active choice, persistence, and mental
effort. Clark & Estes (2008) stated that active choice begins at the beginning of the pursuit of a
goal when there is an intention to pursue the goal, and the pursuit is replaced by action.
Additionally, Clark and Estes stated the importance of persistence, which is a continuation of the
goal regardless of distractions, plus mental effort with novel challenges and solutions. So, the
professional development training along with workbook exercises must include direction,
persistence, and energy to complete the necessary tasks to prepare to return to school for
advanced degrees. HI professionals need education that stresses the value and importance of
advanced degree completion, while developing the skills and tasks necessary to successfully
apply, start, and complete advanced degree programs. The results should assist HI professionals
with building the motivation to apply for an advanced degree program, while ensuring these
professionals are motivated to perform and can see the value of the end result, which is the
degree.
Self-Efficacy Recommendations and Solutions
Efficacy is the belief that an individual has the capacity and agency to complete a task.
The results of this study found that HI professionals did not have high self-efficacy in returning
to school to pursue advanced degrees. The survey data indicated that most respondents did not
display any self-efficacy in the belief that their previous experience as a student or their
professional work experience would help them successfully complete an advanced degree
program. Additionally, when asked to rank barriers they believed would prevent them from
returning to school for advanced degrees in the next five years, 84% of respondents ranked
family obligations, time restrictions, financial costs, and work obligations as the top four barriers
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that would affect their return to school. The remaining 16% of survey question responses for
barriers that ranked in the bottom related to school selection and application and program/degree
selection. Therefore, based on the survey results, the lack of self-efficacy of HI professionals is a
need in order to meet the goal.
According to Bandura (1977, 1997, as cited in Clark & Estes, 2008), if an individual is
positive and believes they are capable and effective, they will achieve more than those who are
just as capable but doubt their abilities. Engaging HI professionals in educational development in
goal attainment will increase their commitment and impact performance of returning to school to
complete advanced degrees. People with self-efficacy characteristics must understand the
purpose of using and selecting accurate strategies to cope with situations and believing that they
can master skills, behaviors, and life-events (Bandura, 1982, as cited in Hackett, 1995; Bandura,
1989, Bandura, 2002; Zimmerman, 1995). Adult graduate student motivation literature
determined that personal motivation is crucial for graduate-level success, and that motivation can
determine the positivity or negativity of the experience (Hegarty, 2011). It is recommended that
the AHIMA provide educational professional development training so HI professionals will have
the opportunity to increase personal motivation by mastering tasks and skills related to returning
to school. This training should also include ways to increase motivation and self-efficacy by
building personal confidence in skills for degree selections, enrollment, and completion by
assigning specific, short-term, and challenging but achievable goals, removing perceived
organizational barriers standing in the way of goal achievement, creating a positive emotional
environment, and suggesting reasons and values for performance goals (Clark & Estes, 2008).
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Organizational Recommendations
In addition to stakeholder motivation, organizational influences are an important part of
organizational goal attainment. Clark and Estes (2008) stated that even though individuals may
have the best motivation, knowledge, and skills, inadequate processes may prevent performance
goal achievement. Additionally, organizational theory suggests there are cultural models and
cultural settings in organizations (Clark & Estes, 2008; Gillmore & Goldenberg, 2001). Internal
cultural practices, beliefs, observable values, and mental schema are cultural models (Gillmore &
Goldenberg, 2001). Cultural settings are tangible factors, which include personnel, tasks, social
structures (Gillmore & Goldenberg, 2001).
The data from this study suggests that there are significant needs at the organizational
level. Table 19 outlines the cultural models and cultural settings that influence the stakeholder
goal and provides the guiding theoretical principle to inform organizational recommendations.
The influences include organizational recommendations for meeting the organizational goal.

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Table 19
Summary of Organizational Influences and Recommendations
Assumed org
influence
Need
or asset
Principle and citation Context-specific
recommendation
Cultural model
The AHIMA
needs to
have a
culture that
emphasizes
the
importance
of advanced
education in
addition to
credential
attainment.
Need Organizational culture is an
important work process, as it
determines how we work
together to get the job done
(Clark & Estes, 2008).
When beliefs and values within
the organization are shared,
organizational changes occur
(Schneider, Brief & Guzzo,
1996).
Stable organizational culture and
work processes that are
compatible with work culture
must be balanced with a need
for flexibility to accommodate
rapid and complex market
shifts (Clark & Estes, 2008).
Use training and motivation
programs as methods to
convey new organizational
culture and to change personal
behaviors (Clark & Estes,
2008).
Provide continuous, candid,
clear communication and
marketing to change the
culture surrounding
advanced degree
completion, its relevance
to stakeholder
professional growth in
addition to credentials,
and degree importance
for the sustainment of the
health information
profession.
Consider method to
reestablish and widen
understanding of the
HIMR vision and goals,
and methods to measure
progress toward the 2027
goal.
Recognize or acknowledge
HI professionals who
complete advanced
degrees.
Cultural Settings
The AHIMA
needs to
provide
leadership-
mentorship
to guide
those
pursuing
advanced
degrees.

Need

When organizations create
collaborative processes,
performance increases (Clark
& Estes, 2008).
Mentors should coach, empower,
engage, and collaborate.
Students should receive
coaching from mentors to
keep them focused, to ensure
direct engagement, and for
empowerment to build
confidence. Students should
also collaborate with their
mentors to strengthen research
Establish mentorship
program to connect HI
professionals with other
AHIMA members who
completed advanced degree
programs to establish goals
for enrollment and
completion of graduate
programs.
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Assumed org
influence
Need
or asset
Principle and citation Context-specific
recommendation
skills and receive assistance
toward becoming published
authors (Brodnik, Valerius, &
Watzlaf, 2013).
The AHIMA
needs to
provide
financial
assistance,
educational
incentives,
and career
mapping
for
members
who return
to graduate
education.
Need Adult learners juggle competing
responsibilities when
returning to school and face
dispositional, institutional, and
situational barriers, including
financial support (Osam et al.,
2017).
Financial support, in addition to
family, work, and time
demands, are barriers to
returning to school for adult
learners (Deutsch & Schmertz,
2011; Goto & Martin, 2009;
Flynn et al., 2011; Saar et al.,
2014 as cited in Osam et al.,
2017).
Promote AHIMA
Foundation scholarship
awareness to the
membership.
Provide HI professionals
with information for
financial aid resources to
fund advanced degree
programs, to include
scholarships, grants,
employer assistance
programs, loans, and
other resources.
Repurpose the AHIMA
Career Map to showcase
advanced education
pathways to highlight
career opportunities for
those who return to
school for advanced
degrees.

Cultural Model Solutions
According to Clark and Estes (2008), employees jobs change when organizations change
their work processes. The development of HIM Reimagined is the equivalent of a work process,
value chain, and value stream change within the AHIMA. This must occur to shift the culture of
a credentials-based profession with a terminal bachelor’s degree to a profession with members
who hold advanced degrees. Work processes require knowledge, skills, and motivation to be
successful, while value chains and streams analyze organizational process, identify processes
that are most influential in achieving business goals, plus identify critical client-focused
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objectives and processes to achieve more limited goals. If organizational policies fail to support
processes, even with adequate knowledge, skills, and motivation, the organization will not have
the ability to close performance gaps (Clark & Estes, 2008). Although the AHIMA is not a
traditional organization, because it is a professional association with a membership, it still has a
developed organizational culture, which is an important work process that determines how the
organization achieves its business objectives.
Establish a Culture of Advanced Education Degree Attainment. According to the
survey data, there is an organizational gap in the culture of credentialing and the pursuit of
advanced degrees. The results and findings indicated that 65% of survey participants responded
that their certificates and degrees were equivalent to an advanced degree, and 58% felt that their
current AHIMA credentials were sufficient for advancement. Additionally, 51% stated that
addition credential obtainment was the equivalent of an advanced degree. 47% felt AHIMA
promoted credential attainment over advanced degrees, while 48% felt that the bachelor’s degree
should remain the terminal degree for the profession. However, there were many participants
who neither agreed nor disagreed with the questions, as 38% were neutral when considering
these questions. And at least 16% felt that AHIMA did not promote credential attainment over
advanced degrees. However, one of the four primary trends in the open-ended question
suggested that respondents were opposed to obtaining advanced degrees and felt that their
credentials were sufficient for their positions. These combined results indicated there is a need to
change the organizational culture if the AHIMA wants to meet the goal for 20% of membership
to have earned an advanced degree by 2027.
Change Organizational Identity Through Degree Attainment. The history of
credentials for HI stems from paper-based medical record technical and administrative expertise,
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and expertise in the clinical data coding of diagnoses and procedures. The credentials are
required for HI professionals to practice and are a collective identity within the organization.
(Schein, 2004). As HI professionals’ cultural identity and environment includes undergraduate-
level education and credentials, the collective identity and environment must shift to become a
profession with members who have graduate-level education. Additionally, technology advances
are pushing HI professionals toward advanced degrees. According to Bolman and Deal (2013),
there must be a shift in the understanding of the professions organizational identity and brand to
avoid retention and continuity issues. The recommendation is for the AHIMA organization to
reiterate the importance of the HIMR initiative and their recommendation for advanced degrees
to the entire membership by developing organization-wide plans to enhance exposure to their
message. This message should be that in order to sustain the profession, there is a need for
advanced degrees, and a lack of advanced degrees may have a potential negative impact on the
profession’s future. Clark and Estes (2008) stated that training and motivation programs are
attempts to transmit new organizational culture to change cultural behaviors at work (p. 110).
Consequently, for this organizational cultural model, the gap occurred when AHIMAs
development and release of the HIMR did not specifically discuss the best way to transition and
adapt to a cultural identity of a profession of advanced degrees.
Therefore, despite HIMR initiative, the professional membership of AHIMAs historical
culture remains focused on associate degree education, certificates, and credentials. The AHIMA
should develop a plan of action to develop, enhance, or change the narrative to showcase the
importance and need for advanced degree attainment. The HIMR began in 2017, but currently, at
slightly past the halfway point toward the goal of 20% with advanced degrees by 2027, HI
professionals need this renewed exposure from the AHIMA organization concerning the HIMR
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recommendations to advance the profession. This exposure should not only highlight advanced
degree attainment but should also discuss how advanced degrees supplement AHIMA credentials
and increase potential for career advancement. This exposure should also begin at the certificate
and associate levels with students enrolled in HI-producing programs. To influence HI
professionals’ behaviors and identity from credentials, undergraduate degrees, and certificates
and increase interest in obtaining advanced degrees, the AHIMA should reassess and revisit the
HIMR initiative by reestablishing the goals and recommendations for advanced degrees.
Similarly, this occurred after the creation and release of Vision 2016: A Blueprint for
Quality Education in Health Information Management by the AHIMA HIM Education Strategy
Committee in 2007. Subsequently, the 2012 release of Reality 2016 helped identify progress
toward the Vision 2016 goals and reiterate the purpose of Vision 2016. Reality 2016 restated the
importance of culture of credentials but shifted the focus to obtaining advanced degrees as the
pathway to leadership positions and how advanced degrees impact on the future of the profession
and organization and paved the way to the current HIM Reimagined initiative in 2017 (Calhoun
et al., 2014; Education: the pathway to leadership, 2013; Mancilla & Fenton, 2014). The key
factor is to communicate constantly and candidly to HI professional members about the HIMRs
purpose, the need for advanced degrees, and the potential of future job loss due to disruptive
technologies. Therefore, AHIMA must remain involved in the process of meeting the goal of
advanced degree attainment for their professional membership (Clark & Estes, 2008).
Cultural Setting Solutions
According to Sarson (1972, as cited in Gallimore & Goldenberg, 2001), cultural settings
occur when two or more people come together over time to accomplish a task. Cultural models
differ from cultural settings, as settings are visible, observable, tangible factors and outcomes
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within an organization which can include employees, tasks, and social context (Gallimore &
Goldenberg, 2001; Nestell, 2022; Rueda, 2011). Cultural settings are familiar and can be positive
or negative factors including incentives, training, resources, and communications, as well as
conflicting goals, restrictive policies and practices, and bureaucracy (Clark & Estes, 2008;
Gallimore & Goldenberg, Rueda, 2011; Tharp & Gallimore, 1988). This section outlines
recommended strategies for the AHIMA to assist their HI professional members in attaining
advanced degrees.
To achieve its organizational goal to have 20% of HI professionals with advanced
degrees by 2027, AHIMA must consider its current cultural settings pertaining to advanced
degree career pathways, mentorship, and financial support. The results indicated that 68% of
respondents believed the AHIMA should provide financial support for those returning to school
for advanced degrees, while 52% were aware of the AHIMA Foundation scholarships.
Additionally, 71% agreed with the mentorship match program development with others who
already obtained advanced degrees, and 75% agreed that the AHIMA should create an advanced
education pathway for those who decide to return to school. Although one response in this
influence was over 75% and was considered an asset, the overall result for this cultural setting
influence was categorized as a need.
Structured Advanced Degree Mentorship Match Program. According to Singe et al.
(2021) and Brodnik et al. (2013), the need for mentorship and mentor relationships is a critical
aspect in the professional development of doctoral students, and mentorship from HI
professionals with advanced degrees, specifically doctoral degrees, can provide the necessary
support, encouragement, and understanding for HI professionals considering or pursuing
advanced degrees. AHIMA previously had a semi-structured AHIMA Mentorship Match
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program through its Academic Affairs office, and according to the website, this program is
currently inactive but expected to relaunch later this year (AHIMA Academic Center: AHIMA
Mentor Match, 2022).
The study’s results and findings showed that 71% of participants agreed with the
mentorship match program development with others who already obtained advanced degrees.
Therefore, since this program is under redevelopment, but the process is unknown to the
membership, the recommendation is that the redeveloped program be designed as a structured
mentorship program, which matches potential graduate school members/HI professionals with
members who have conferred graduate degrees. Mentorship fosters professional and
psychological relationships and offers social benefits for those involved which is important for
graduate program enrollment and completion (American Psychological Association, 2006, as
cited in Orsini et al., 2019). In addition, mentorship supports both the mentor and mentee as it
builds and supports the development of trusting relationships (Martin et al., 2016). In higher
education institutions, mentors and mentees reported that mentoring helps with teaching,
research, and career planning and that visible support for mentoring is critical to participation
(Fountain & Newcomer, 2016 as cited in Orsini et al., 2019). Furthermore, Brodnik et al. (2013)
stated that a mentoring institute with HIM professionals with conferred doctorate degrees is
necessary for aspiring doctoral students as they progress through doctoral programs. Therefore,
quality mentorship is vital for long-term success in the world of academics and for job
satisfaction (Ocobock et al., 2022).
Reassess Financial Support for Membership. According to Nuckols et al. (2020),
participants felt that the ability to take on student loans to fund their education was worth it, but
on the other hand felt overburdened with the cost of loan repayment. However, receiving
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scholarships benefitted students financially, and lowered stress, increased goal attainment, and
increased focus on school and program opportunities (DeWitty et al., as cited in Macdiarmid et
al., 2021). Over 68% of survey participants indicated that AHIMA should provide financial
assistance if they were to pursue advanced degrees. Member donations and external donations
are the core of how the AHIMA Foundation secures financial support for scholarships and
awards. In addition, the CSAs also provide their own scholarships for HI professional members
within their state associations in accordance with their bylaws. Therefore, how can AHIMA
encourage and support the ROI do members want to finance advanced degrees?
In the study, 52% of respondents were aware of the AHIMA Foundation scholarships.
These scholarships provide veteran and merit scholarships that are not exclusive to advanced
degrees students. These awards are for their members who have achieved a 3.5 GPA and
enrolled in a CAHIIM-accredited HI program. Lastly, there is also one dissertation support
scholarship for AHIMA members enrolled in doctoral programs and are all-but-dissertation
candidates pursuing a doctoral degree in health information or health informatics-related fields.
The AHIMA Foundation awards and scholarships do not provide full tuition scholarships, but
instead provide smaller financial aid packages that serve as part of a student’s degree funding. HI
professionals who decide to return to school must still consider alternative methods to fund their
advanced degree education. Nevertheless, historically with the foundation, each of their awards
and scholarships is specifically designated for those pursuing health information management or
health informatics (HIM/HI) degrees. Member and external donations are the core of how the
AHIMA Foundation secures financial support for scholarships and awards. According to the
HIMR, the recommendation stated the need for pursuing relevant advanced degree programs,
which included fields of study other than HIM/HI. This enables HI professionals to pursue
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degrees in business, education, information systems and technology, healthcare administration,
public health, and other non-HIM/HI fields of study. In addition to this, however, AHIMA needs
to determine whether the current number of annual scholarships and awards will support the
number of HI professionals who decide to return to school to meet the goal of 20% by 2027.
Career Mapping for Advanced Degrees. Career pathways systems can provide the
structure vital for career progression and help with the development of competencies to increase
employability of organizational personnel (Hedge & Rineer, 2017). Additionally, these career
pathways also help organizations develop their personnel strategically, while building
engagement and improving employee retention (Hedge & Rineer, 2017). For AHIMA to achieve
its goal, it needs to build a career pathway model specifically for those pursuing advanced
degrees. According to Hedge & Rineer (2017), businesses face the same evolving landscape as
their employees in dealing with organizational, societal, and global environments, which
increases the difficulty of anticipating employee needs, desires, and career directions, growth,
and success. In the study, 75% of respondents agreed that AHIMA should create an advanced
education pathway or map to assist members who decide to return to school, so this is an asset
and not a need. Since AHIMA already has an interactive career map where HI professionals can
see potential positions, salaries, and required education for HI positions, the advanced job
positions on the map only show a preference for master’s degrees, but not requirements.
Therefore, to meet the advanced degree goal, AHIMA should add additional career employment
positions which require masters and doctoral degrees for career progression. This advanced
degree addition to the career map can contribute to these advanced degree goals. The next
section provides an implementation plan and an evaluation system.
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Integrated Implementation and Evaluation Plan
Organizational Purpose, Needs, and Expectations
The purpose of the AHIMA as a global non-profit professional association is to be the
primary voice and authority in health information by working at the intersection of healthcare,
technology, and business to empower people to impact health. Although it is one of the premier
associations in the HI profession, research discovered a lack of advanced degrees, specifically
masters and doctoral degrees within its professional membership ranks. The AHIMA sought to
address this problem by developing the HIM Reimagined initiative and white paper in 2017 with
four recommendations for the profession’s sustainment. This study focused on one
recommendation pertaining to members completing advanced degrees. The ultimate
organizational expectation is to have qualified, prepared professionals meaningfully contribute to
the association, the healthcare population, and the ecosystem for the sustainment of the HI
profession. The goal is that by 2027, 20% of the total membership would have earned relevant
advanced degrees. There is another goal for stakeholders, who are the HI professionals without
advanced degrees who are AHIMA members; this goal is that by 2023, 10% of HI professional
members will apply to and enroll in advanced degree programs.
The study examined the assumed knowledge, motivation, and organizational influences
and barriers to HI professionals’ ability to pursue advanced degree attainment. The desired
outcome for this study is to improve the ability for HI professionals to make informed decisions
to return to school, improve their motivation to earn and complete an advanced degree, and
remove any organizational barriers to advanced degree enrollment and completion. The proposed
solution involving the provision of knowledge, motivation, and organizational tools and learning
experiences will benefit the AHIMA and its HI professional membership.
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Expectations and Desired Outcomes
The AHIMA executive leadership and their commitment to their members are essential to
accomplish both goals prior to 2027. The anticipated result is for the AHIMA leadership to assist
their members to meet the 2023 goal of advanced degree enrollment, and the 2027 goal of
advanced degree attainment. AHIMA can accomplish this through organizational provision of
leadership, mentorship, and reduction of barriers to advanced degree pursuit by providing
continued and diversified solutions for financial support, awareness, and incentives to their HI
professional membership stakeholders. In addition, the development and provision of a back-to-
school curriculum and training program can provide skills, tools, and resources to support those
members who desire to select, apply, and enroll in advanced degree programs.
Implementation and Evaluation Framework
The implementation plan for this study will use the Kirkpatrick and Kirkpatrick (2016)
new world model. In this model, the trainers must begin with desired results, then determine the
necessary behaviors, attitudes, knowledge, and skills needed to produce the desired behavior
(Kirkpatrick & Kirkpatrick 2015; 2016). The training program presentation must enable the
participant to learn what is necessary and generate a favorable response. The four descriptive
levels of the Kirkpatrick implementation and evaluation framework model provided a solution,
as this model used evaluation, outcomes, and accountability over training (Kirkpatrick &
Kirkpatrick, 2016). These levels work to evaluate the training for favorability (Level 1: reaction),
as well as determining the degrees of knowledge acquisition (Level 2: learning), knowledge
application (Level 3: behavior), and the training, support, and accountability outcomes (Level 4:
results) (Kirkpatrick & Kirkpatrick, 2016). Implementation of the four levels occurs in reverse,
as the model first evaluates results, the evaluation of the targeted outcomes, and follows with
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behavior, learning, and reaction. The Kirkpatrick model serves as an accountability mechanism,
garnering stakeholder investment and goal attainment. Levels 3 and 4 both accomplish this task
through consistent monitoring, and these levels provide continued observation of learned tasks
and behavior changes to ensure ongoing accountability assessment (Kirkpatrick & Kirkpatrick,
2015; 2016). Using this model for the implementation and evaluation of a back-to-school
program for HI professionals will increase the likelihood that the organizational goal will be
achieved.
Level 4: Results and Leading Indicators
According to Kirkpatrick and Kirkpatrick (2016), participants in learning and
performance methods must be able to demonstrate the value of any training received after
completion. Therefore, in level 4, the predicted targeted outcomes are portrayed and represented
(Kirkpatrick & Kirkpatrick, 2016). In addition, Kirkpatrick and Kirkpatrick determined that
short-term observations, leading indicators, and measurements in Level 4 indicate that
stakeholder behaviors are progressing toward the desired outcome attainment. To reiterate, the
stakeholders for this study are the HI professionals who are members of the AHIMA, their
national professional organization.
To meet the desired outcome and goals, which is for 20% of the AHIMAs HI
professional membership stakeholders to have advanced degrees by 2027, the organizational
support would include proposed external and internal outcomes, metrics, and methods in
accordance with Kirkpatrick and Kirkpatrick (2015, 2016). As a minimum, these outcomes,
metrics, and methods should include financial knowledge and incentives for advanced degree
completion, along with the development of a back-to-school training program and curriculum to
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provide skills, aids, and resources to support those who desire to earn advanced degrees. Table
20 provides a listing of proposed external and internal AHIMA organizational outcomes.

Table 20
Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)
External outcomes
Increased number of HI
professionals with
advanced degrees
within the AHIMA
membership and across
the healthcare
ecosystem

Percentage of annual enrollment
and degrees conferred in
accredited masters and doctoral
degree programs in colleges and
universities
Track and collect member
data through surveys to
determine annual HI
membership enrolled in,
or with advanced
degrees conferred from
colleges and universities
Increased financial
resources available to
the HI professional
membership
Amount of funding available for the
provision of academic support
for advanced degree completion
through the AHIMA Foundation
Number of scholarship applications
received, and monies awarded
from AHIMA Foundation
Number of monetary incentives
obtained and awarded from other
organizations and professional
associations

Complete annual
assessment and
reporting of funding
from individuals and
organizations for
advanced degree
completion
Monitor, collect, and
report data annually
Survey HI professionals’
membership annually
through AHIMA or
CSA surveys
Internal outcomes
Increased HI
professionals’ member
enrollment in advanced
degree producing
programs
Monitor enrollment in both
accredited health information,
health-related and other relevant
masters and doctoral degree
programs

Aggregate data from
annual surveys of the
HI professional
membership for
enrollment statistics

Increased job placement
and promotions for HI
professional members
Monitor post-graduate employment
placements or promotions
Aggregate data from
annual surveys of the
HI professional
membership for
enrollment statistics

Development of back-to-
school curriculum to
Amount of training curricula
development, which includes
Aggregate data from
annual surveys of the
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Outcome Metric(s) Method(s)
increase HI
professionals’ desire
and capability to return
to school for advanced
degrees
asynchronous and synchronous
webinars, workbooks, and tools
that include the process for
application, selection,
enrollment, and successful
completion of advanced degree
programs

HI professional
membership for
enrollment statistics

Increased leadership and
mentorship support to
HI professional in
pursuit of advanced
degrees
Number of HI professional member
who volunteer to mentorship HI
professional members who plan to
enroll or are enrolled in advanced
degree programs

Aggregate data from
AHIMA Membership
statistics

Level 3: Behavior
Level 3 is the level where continuous performance monitoring and improvement occurs
(Kirkpatrick & Kirkpatrick, 2016). Level 3 includes critical behaviors, defined as specific,
required actions for the organization to meet the objectives to ensure success (Kirkpatrick &
Kirkpatrick, 2016). HI professional member stakeholders must engage in these specific actions
consistently to achieve the desired result to obtain advanced degrees. The HI professionals’
behavior will then generate drivers, resulting in the reward of the critical behaviors. These
critical behaviors may include HI professionals determining the viability, practicality, and
motivation for returning to school for advanced degrees, completing the selection, application,
enrollment and completion of advanced degree programs, and the methodology to subsidize their
advanced education pursuit. Table 21 outlines the behaviors, metrics, methods, and timing for
evaluation.

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Table 21

Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical
behavior
Metric(s) Method(s) Timing
1. Make
informed
decision
return to
school for
advanced
degrees
Number of previously
conferred
undergraduate or
graduate degrees and
AHIMA credentials
Conduct research to
determine if current
degrees and credentials
warrant need to return to
school
Ongoing
throughout the
year until
decision is made
to apply for an
advanced degree
program

Research impact of advanced
degree pursuit on
home/work/study balance
Ongoing
throughout the
year until school
acceptance

2. Select,
apply, and
enroll
college or
university
with
relevant
advanced
degree
programs

Number of available
college or university
advanced degree
programs (national or
international) with
degrees of interest
Review the CAHIIM website
for accredited HIIM
graduate programs
Ongoing until
acceptance into
advanced degree
program

Review collegiate
accreditation bodies for
colleges and universities
that have accredited
advanced degree programs

Ongoing until
acceptance into
advanced degree
program

Determine program
instruction methodology
(face-to-face, online,
hybrid)

Ongoing until
acceptance into
advanced degree
program

3. Apply and
secure
financial
support
for
education
Number of available
scholarships and
availability/eligibility
for financial aid
Research and apply for
funding and financial
support through multiple
sources, organizations the
AHIMA Foundation,
employee tuition assistance
programs, and the Free
Application for Federal
Ongoing until
acceptance into
advanced degree
program

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Critical
behavior
Metric(s) Method(s) Timing
Student Aid (FAFSA)
form

Required Drivers
Organizations must provide critical behavior support, which are the required drivers, or
the system of processes that reinforce, monitor, encourage, and reward job-based critical
behavior performance (Kirkpatrick & Kirkpatrick, 2016). Required drivers are reinforcing,
encouraging, rewarding, and monitoring, and help accomplish the application of learned training
material (Kirkpatrick & Kirkpatrick, 2016). This decreases the likelihood of losing interest in
required behavior performance (Kirkpatrick & Kirkpatrick, 2016). Organizations that reinforce
the knowledge and skills learned from training and see the active execution and monitoring of
required drivers should expect a high percentage of application, which may be the biggest
indicator of program success for any initiative (Brinkerhoff, 2006; Kirkpatrick & Kirkpatrick,
2016). With HI professionals, required drivers can establish a culture where they become
responsible for their performance maintenance in the acquisition and achievement of knowledge,
skills, and motivation to complete advanced degrees. According to Kirkpatrick and Kirkpatrick
(2016), this should enhance their own performance in pursuit of advanced degrees, which in turn
will encourage an expectancy of individual accountability and empowerment within the AHIMA
organization. As AHIMA is a professional association with an active, credentialed membership,
a few examples of required drivers for HI professionals for advanced degree attainment may
include training aids (such as webinars, educational pathways and maps, and advanced degree
educational preparatory workbooks), coaching and mentoring, and recognition for the pursuit
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and attainment of advanced degrees. Table 22 illustrates the knowledge, motivation and
organizational (KMO) influences that are necessary to drive outcome achievement based on the
KMO recommendations in the previous sections.

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Table 22
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical
behaviors
supported
Reinforcing (knowledge-related)

Create back-to-school program curriculum for those HI
professionals who desire to return to school for
advanced degrees.

Ongoing with
annual review
until 2027
1, 2, 3
Provide back-to-school programmatic information for
advanced degree roadmap/pathways
distribution/infographics.

Ongoing with
annual review
until 2027
1, 2, 3
Establish new collaborative AHIMA Access online
community platform solely for HI professionals who
return to school for advanced degrees.

Ongoing
1, 2, 3
Encouraging (motivation-related)

Create collaborative community for motivation and
support for HI professionals who are considering or
are enrolled in advanced degree programs on AHIMA
Access online platform.

Ongoing
1, 2, 3
Reestablish and reimagine the AHIMA Mentorship
program to match HI professional members
considering or completing advanced degrees with
those in the membership who have obtained advanced
degrees.

Ongoing
1, 2, 3
Rewarding (motivation-related)

Provide financial support for HI professionals returning
to school for advanced degrees from AHIMA
Foundation Scholarships and additional sources.

Ongoing until
degree
conferment
3
Recognize HI professionals who answered the call to
action to return to school for advanced degrees at the
annual AHIMA Global Conference.

Annually until
2027 1, 2
Monitoring (organization-related)

Identify HI professionals who need assistance with
pursuing advanced degree programs.

Monthly until
2027
1, 2, 3
Identify requirements, training methods, and financial
resources necessary to prepare HI professionals for
advanced degree completion.

Ongoing 1, 2, 3

Establish requirement to track and monitor HI
professionals’ advanced degree applications, financial
aid rendered, and graduation data from their CSAs.
Ongoing
1, 2, 3

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Organizational Support
The AHIMA organization maintains governance and advisory councils as the governing
bodies, which contain elected officials and volunteers. Within this structure is the AHIMA
Council for Excellence in Education (CEE), whose mandate is to enhance the HI profession by
planning for the profession’s future via education (AHIMA Council for Excellence in Education,
2022). The CEE advises AHIMA on education and workforce matters and their collective
expertise strengthens the organizations vision, mission, and strategies set by the AHIMA Board
of Directors (BOD). The AHIMA CEE also guides various AHIMA educational workgroups and
the Professional Certificate Approval Program (AHIMA Council for Excellence in Education,
2022). The AHIMA CEE should support stakeholder critical behaviors by reinforcing
information, knowledge, and skills HI professionals must learn and execute in their pursuit of
advanced degree attainment.
In addition, the AHIMA Executive BOD plays a key role in guiding AHIMAs strategic
direction and the organizational vision and mission, while encompassing corporate authority and
fiduciary duties (AHIMA, 2022e). With the guidance and support of the AHIMA BOD and the
support of the AHIMA Foundation, the AHIMA CEE should be accountable for the monitoring
and development of procedures, guidance, and support for those pursuing advanced degrees.
Additionally, the AHIMA Executive BOD and CEE leadership must ensure the listed drivers are
continuous, and pertinent for the desired outcomes of advanced degrees for their members.
Consistent monitoring of these behaviors and drivers will inform both the organization and its
members of progress toward the goal and ensure the detection of any necessary changes to
achieve the goal of 20% of the membership obtaining advanced degrees by 2027.

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Level 2: Learning
Level 2 determines to what degree participants acquire the knowledge, skills, attitude,
confidence, and commitment to the goal, based on their participation in the learning event
(Kirkpatrick & Kirkpatrick, 2016). According to the Kirkpatrick and Kirkpatrick (2016) new
world model, the addition of confidence and commitment to Level 2 closes the learning and
behavior gap and prevents repeated training for personnel who have the required knowledge and
skills but have work-related performance failures.
Learning Goals
As previously indicated, the AHIMA organizational goal is to increase the number of
members with relevant health-related degrees to 20% of the total membership by 2027. In order
for this to be achieved, the stakeholders need to know and must be able to perform the following
tasks.
1. Recall methodology to determine how to apply and enroll in advanced degree
programs.
2. Practice and demonstrate understanding of how to select, apply, and enroll in colleges
and universities to obtain relevant advanced degrees.
3. Value the importance of the necessity of advanced degrees for the sustainment of the
profession.
4. Possess the interest to return to school for advanced degrees.
5. Describe and explain why advanced degree enrollment and completion is necessary.
6. Engage with fellow HI professionals who desire advanced degrees.
7. Generate and value support and encouragement from employers, family, and friends.
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8. Identify strategies to maintain personal motivation, solicit motivational support and
maintain commitment to completion during advanced degree school enrollment.
9. Determine the best methods to secure financial aid and scholarships by completing
FAFSA and scholarship applications accurately.
10. Develop private, student-led online communities of knowledge for HI professionals
who are considering returning to school, and for those enrolled in degree-producing
programs.
11. Determine the best methods to secure financial aid, grants, and scholarships by
completing FAFSA, grant, and scholarship applications accurately.
12. Create mentorship matches with HI professionals who completed advanced degree
programs.
In addition, the establishment and implementation of a learning program for HI professionals
who desire to return to school for advanced degrees will help the performance of the critical
behaviors, using the Kirkpatrick and Kirkpatrick (2016) new world model guidelines. Following
completion of the recommended solutions, the creation of these learning goals was based on the
identified recommendations in this chapter.
Program
As the AHIMA is a professional association with an active, credentialed membership of
HI professionals, the learning goals listed above to support their stakeholders must be achieved
through a structured synchronous and asynchronous continuing education professional learning
program. This advanced degree education transition assistance program will be specifically for
HI professionals to want to obtain advanced degrees. This program supports the goal of 10% of
HI professional stakeholders either applying or enrolled in advanced degree programs by 2023,
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and 20% of the AHIMA membership with advanced degrees by 2027. Also, the program
supports HI professionals in achieving the stated learning goals by preparing them to pursue and
attain advanced degrees. Additionally, the program helps HI professionals develop the
knowledge and motivation to return to school, value the need for advanced degrees, and receive
organizational support to help them reach the goal. Furthermore, the program enables inclusion
in support networks and mentorship throughout while they earn their advanced degree.
Based on their current AHIMA mission, the recommendation to lead this initiative is the
AHIMA CEE. Throughout this process, the AHIMA CEE will develop and provide career prep
informational aids, videos, pamphlets, and webinars to support its members with the required
knowledge and skills to prepare for graduate school enrollment. The training in this program will
consist of synchronous training with a series of one-hour webinars with HI professional speakers
within the membership with master’s and doctoral degrees. These speakers will provide
informational resources and skills to assist members who desire to return to school. Each
webinar or video will address one area (select, apply, enroll, sustain, motivation, mentorship).
The webinar series will do the following things:
1. Justify the necessity for advanced education in a STEM-based health profession
within the allied health professions and the healthcare ecosystem.
2. Explain the movement of entry-level data-input healthcare roles toward artificial
intelligence and machine learning.
3. Develop educational pathways for advanced degree goal attainment.
4. Determine appropriate and relevant advanced degree pursuit, including college
selection, application completion, and enrollment necessities.
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5. Review methodologies to obtain financial assistance, including seeking and
completing grant and scholarship applications and FAFSA forms.
6. Provide motivational support and educational commitment strategies for adult
learners returning to school.
7. Seek virtual or in-person networking and mentorship assistance in Access online
professional communities and other sources.
To further support the learning and training, under the direction and management of the
AHIMA CEE, volunteer member-instructors will assess the participants and perform knowledge
checks. Furthermore, the creation of a content-specific community of interest on AHIMA Access
online will provide a community for members to engage and communicate with each other while
matriculating into an advanced degree program. The programs synchronous webinars will occur
simultaneously with asynchronous completion of the revised AHIMA Career Prep Workbook
Chapter titled Changing Careers and Moving Forward. Section Five of the current AHIMA
Career Prep Workbook provides prospective HI professional members with a physical guide to
initiate their progress toward advanced degrees. However, the revision of the Career Prep
Workbook will provide definitive information so HI professionals can make informed decisions
about advanced degrees and teach them how to apply, select, and enroll in advanced degree
programs. The revised version will supplement the webinars and provide a means for the
members to reinforce lessons learned from the webinars, create roadmaps for degree preparation,
and establish pathways to accentuate career progression after advanced degree completion. The
information contained within the revised Career Prep Workbook includes goal refinement,
motivational strategies, and the opportunity to list strengths, weaknesses, and qualification
checklists for degree attainment. Each section in the revised Career Prep Workbook will be a
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supplement to the webinars and will contain information and activities to strengthen and support
the webinar information. Therefore, HI professionals must bring the revised Career Prep
Workbook to the webinars. Asynchronous completion of videos, webinars, materials, and aids
will become available on the AHIMA website under Educational and Events: Student
Resources: Enhance Your Career: Career Prep and Tools, an online resource restricted to
AHIMA members via the AHIMA Body of Knowledge (Education and Events, 2022).
Overall, the creation of the new webinars and the Career Prep Workbook revisions will
assist those HI professional members who are moving toward advanced degree completion,
specifically for career-adult-HI professional learners. The training will target the drivers of
motivation, collaboration, mentorship support, and monitoring of their professional endeavors
toward advanced degrees, Furthermore, the training will achieve the critical behaviors for
members need to return to school to complete advanced degree schooling and apply for
admission and funding for education (AHIMA HIM Reimagined Whitepaper, 2017).
Evaluation of the Components of Learning
Level 2 evaluation of the components of learning must include methods and tools and is
designed to include techniques which include the evaluation of knowledge, skills, attitudes,
confidence, and commitment (Kirkpatrick & Kirkpatrick, 2016). To ensure this occurs, the HI
professionals who participate in the back-to-school program webinars and complete the revised
workbook must exhibit proficiency in each method and activity to ensure achievement of the
goal of increasing advanced degrees in the profession. Table 23 lists the programs learning
components and the planned timing of evaluation.

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Table 23
Evaluation of the Components of Learning for the Program
Methods or activities Timing
Declarative knowledge (“I know it”)
Pre-test and post-test assessments Before/at the end of training
Performance of individual/group knowledge
checks, scenario-based exercises, and
interactive activities to support educational
tasks and behaviors
During training
(asynchronous/synchronous)
Performance of individual/group knowledge
checks throughout webinar discussions,
exercises, activities, and group sharing to
demonstrate understanding of materials
During and at the end of training
(synchronous)
Completion of a pre-test and post-test for
synchronous and asynchronous training to
determine knowledge obtained and retained
regarding advanced degree attainment
Before training (asynchronous/
synchronous)
Procedural skills (“I can do it right now”)
Pre-test and post-test assessments Before/at the end of training
Performance of value-based discussion to
determine if HI professional participants
commitment to return to school for advanced
degree attainment
During training (asynchronous/
synchronous)
Participants demonstration of competencies
using individual/group teach-backs for
webinars and revised Career Prep Workbook
(CPW)
During and at the end of training
(asynchronous/synchronous)
Application of concepts learned to prepare for
return to college for advanced education
At the end of training
(asynchronous/synchronous)
Completion of Likert scale Survey
questionnaire by HI professional participants
for the assessment of webinars and the
revised CPW

At the end of training
(asynchronous/synchronous)
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Methods or activities Timing
Attitude (“I believe this is worthwhile”)
Pre-test and post-test assessments Before/at the end of training
Facilitator observation of HI professionals’
engagement and motivation during webinar
speaker(s) presentations and review of
professional development revised CPW
activities
During asynchronous (revised) Career Prep
Workbook completion and synchronous
webinars
Facilitator-led discussion highlighting the
necessity and value of returning to school for
the longevity of the HI profession and for the
allied health and healthcare ecosystems
During synchronous webinars only
Likert scale survey questionnaire completed by
HI professional participants to determine if
participants gained a greater level of
proficiency in their ability to complete
necessary tasks to return to school
At the end of the asynchronous (revised)
CPW completion and synchronous
webinars
Confidence (“I think I can do it”)
Pre-test and post-test assessments Before/at the end of training
Likert scale Survey questionnaire completed by
HI professional participants that annotates
level of commitment to return to school and
goal definition
During and after synchronous and
asynchronous training
Facilitator-led discussion with HI professional
participants during webinars
During and after synchronous training only
Successful completion of all revised CPW
exercises and activities
During and after asynchronous training
only
Commitment (“I will do it”)
Pre-test and post-test assessments Before/at the end of training
HI professional participants completion of self-
reporting knowledge and motivation
retention through follow-up Likert scale
survey questionnaires

At the end of training
(asynchronous/synchronous)
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Methods or activities Timing
Completion of Likert scale survey
questionnaire by HI professional participants
of items regarding their level of confidence
in advanced degree preparation and eventual
completion
At the end of training
(asynchronous/synchronous)
Continuous monitoring of HI professional
participants who completed either
asynchronous/synchronous training for
statistical data about degree completion
Ongoing after training
Continuous mentoring of HI professional
participants who completed either
asynchronous/synchronous training for
statistical data on cultural models and
settings
Ongoing after training

Level 1: Reaction Evaluation Tools
Level 1 is participant reaction and satisfaction with the learning experience, and if
participants found the training relevant, engaging, favorable, and/or relevant to its purpose
(Kirkpatrick & Kirkpatrick, 2016). In addition, Level 1 has the three components of relevance,
engagement, and customer satisfaction (Kirkpatrick & Kirkpatrick, 2016). For the proposed
asynchronous and synchronous training for HI professionals, Level 1 is necessary to determine
the effectiveness of both the instructor and the training, as well as the participants training
expectations, questions, and reactions to the learning experience. This information is critical to
the determination of the value and delivery of the training experiences (Kirkpatrick &
Kirkpatrick, 2010, 2016). Table 24 lists the usage methods, in addition to the timing to determine
the participants reaction, and includes specific engagement, relevance, and customer satisfaction
methods and tool components.
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Table 24
Components to Measure Reactions to the Program
Method(s) or tool(s) Timing
Engagement
Synchronous webinar attendance During training
Observed active listing, participation, interaction, questions,
and sharing during synchronous training webinars
During training
Number of downloads of the CPW from the AHIMA website
data analytics
Ongoing
Completion of revised Career and Prep Workbook (CPW)
based on survey data
Ongoing
Relevance
HI professional participants knowledge checks during the
synchronous training
During training
End of module question competition in revised CPW End of training
Post-training survey evaluation with questions pertaining to
relevance of subject matter
End of training
Completion of revised AHIMA Career Map for
educational/post-educational goals
End of training
Customer Satisfaction
Instructor-Facilitator observation of HI professional participants
within the webinar training to view participant reactions and
dialogue, and comments in the chat area
During training
Participant course-evaluation survey, post-training (for
synchronous and asynchronous training)
End of training
Formal/official or informal/unofficial discourse from HI
professional participants pertaining to their training
experience
During and end of
training; ongoing

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According to Kirkpatrick and Kirkpatrick (2016), evaluation should occur both
immediately after the conclusion of program implementation and after a designated period to
determine its impact on participants. Furthermore, Kirkpatrick and Kirkpatrick also
recommended the dual evaluation approach. This approach uses both immediate and delayed
evaluation tools to assess program effectiveness. Using this approach for the back-to-school
training program, participants will be given an immediate post-course evaluation and a delayed
evaluation after a certain amount of time has elapsed. These evaluations will determine the back-
to-school programs effect and influence on participant knowledge and motivation.
Immediately Following the Program Implementation
Kirkpatrick and Kirkpatrick (2016) indicated that program evaluation is necessary for
improvement, learning behavior transference, and to prove the organizational training value.
Therefore, since the proposed back-to-school program includes both synchronous and
asynchronous webinars and the revised CPW as learning methods, Likert scale surveys will be
the primary evaluation tool to assess the HI professional participants learning experience. More
specifically, the revised CPW (asynchronous) will have a written evaluation at the end of each
module under Section Five and the webinars (synchronous) will have an online, post-training
evaluation Likert scale survey for data collection and analytics.
Level 1: Reaction. The Level 1 evaluation tool will use a Likert scale assessment to
focus on participant satisfaction with the overall synchronous and asynchronous training. It will
also determine if participants found the training methodology favorable, engaging, and relevant
to their pursuit and attainment of advanced degrees (Kirkpatrick & Kirkpatrick, 2016). Examples
of survey questions for Level 1 are in Appendix F.
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Level 2: Learning. The Level 2 evaluation tool will also utilize a Likert scale assessment
to determine if participants who completed the training acquired the knowledge, skills, attitude,
and confidence to return to school for advanced degrees. It will also determine any desire or
commitment needed to facilitate their return to school for advanced degrees (Kirkpatrick &
Kirkpatrick, 2016). An example of the Level 2 survey questions is in Appendix G.
Delayed for a Period After the Program Implementation
Upon completion of formal training programs, Kirkpatrick and Kirkpatrick (2016)
indicated that the implementation of drivers, on-the-job performance, plus the status
identification of leading indicators are required after formal training. The evaluation must
connect Levels 2 and 3 to safeguard reliability between the organization and stakeholder, during
which Level 4 must track critical stakeholder behaviors for a length of time (Kirkpatrick &
Kirkpatrick, 2016). This task is accomplished by the incorporation of certain measurements and
organizational short-term observations (Kirkpatrick & Kirkpatrick, 2016). Therefore, the
AHIMA CEE workgroup committee and/or instructor-volunteers must ensure that the HI
professional stakeholders who participated in the training receive their Levels 1 and 2
survey/questionnaires four weeks after training completion, and again at eight weeks. These
surveys will measure participant reactions to the training at Level 1, and for Level 2, measure
participants mindset, dedication, and self-confidence in their application of knowledge, skills,
and motivation learned during the training. For Level 3, the surveys will determine if the training
effectively helped HI professional participants return to school. Level 3 surveys will also collect
and monitor any reinforcement, encouragement, and rewarding of participant behavior data
related to advanced degree attainment. Surveys created and used for Level 4 will evaluate any
participant improvement in the AHIMA organizational indicators and desired outcomes. Again,
151

the AHIMA goal is to achieve 20% of their professional membership completing advanced
degrees by 2027. Therefore, the Level 3 and 4 survey distribution will continue annually for the
next five to six years post-training. These surveys will determine if the HI professionals who
completed either the asynchronous or synchronous training successfully applied to and/or
completed advanced degree programs. An example of Level 3 and 4 potential survey questions is
in Appendix H.
Data Analysis and Reporting
Kirkpatrick and Kirkpatrick (2016) stated that the primary focus for data analysis sources
is Level 3 and Level 4, rather than Levels 1 and 2. The data collected and analyzed from
completed Level 3 and 4 surveys will generate data and provide feedback for the AHIMA BOD,
AHIMA CEE, any additional AHIMA leadership stakeholders, and the HI professional
membership. These data, based on Level 4 indicators and Level 3 behaviors, will determine the
progress toward the achievement of the AHIMA organizational goal. The data analysis must
determine if expectations were achieved. If not, then the data will help determine potential
solutions to improve the back-to-school training programs for the HI professional membership
stakeholders.
Summary of the Implementation and Evaluation Plan
The new world Kirkpatrick model assisted in the planning, implementation, and
evaluation of the achievement of potential training outcomes and recommendations for the
attainment of the AHIMA organizational goal, which is 20% of its membership with advanced
degrees by 2027. The new world Kirkpatrick model and the Kirkpatrick models four levels of
evaluation is a proven framework that supports the achievement of organizational and
stakeholder goals, as the models assist the AHIMA organization with using the establishment of
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outcomes, metrics and methods, and with the evaluation of their stakeholder results, behaviors,
learning, and reactions during pre- and post-training. Additionally, the data analysis collection
processes for Levels 1–4 are vital for monitoring AHIMA membership preparation and training
in pursuit of advanced degrees. Furthermore, the four evaluation levels will reveal potential
performance gaps and barriers with the back-to-school training program implementation and
distribution and assist with the creation of solutions to support goal achievement for the AHIMA
organization. Lastly, the Kirkpatrick and Kirkpatrick (2016) new world model aligns with the
Clark and Estes (2008) gap analysis framework, as it incorporates knowledge, motivation, and
organizational influences and assists in identifying performance gaps and facilitating
organizational performance improvement.
The Clark and Estes (2008) gap analysis framework provided the foundation for the
development of the implementation and evaluation plan. Research using the gap analysis
framework pinpointed existing gaps relating to the KMO influences on the organizational
(AHIMA) and stakeholder (HI professionals) performance goals and potential solutions. The use
of a Likert scale survey, a singular open-ended question, and thorough document analysis
revealed gaps in HI professionals’ declarative and procedural knowledge, interest and utility
value, and self-efficacy, in addition to the influences of cultural models and cultural settings in
the AHIMA organization. Therefore, the identified KMO influences and barriers were the
framework for the recommendations and the implementation and evaluation plan.
Use of the Kirkpatrick and Kirkpatrick (2016) new world model to design the
implementation and evaluation plan will allow AHIMA to evaluate the implementation and
impact of the back-to-school training program. Likewise, Kirkpatrick and Kirkpatrick (2016)
recommended using the exploration of departmental, functional, or organizational effectiveness
153

metrics to modify, impact, and attain the desired outcomes. The Kirkpatrick and Kirkpatrick
(2016) new world model usage is central to the implementation and assessment of an AHIMA
organizational training program that can close the identified gaps, resolve stakeholder influences
pertaining to the pursuit and attainment of advanced degrees by 2027, and provide continued
maintenance of the ontological accountability between AHIMAs executive leadership, BOD, and
councils, and its HI professional membership.
Recommendations for Future Research
An initial recommendation for future research is that future studies should include the
collection of data from stakeholders who obtained advanced degrees by 2027, which is the date
set by the HIM Reimagined initiative for 20% of the AHIMA HI professional membership to
have advanced degrees. Research should include sampling of those HI professionals who return
to school for advanced degrees, and include data on methods used to apply, enroll, and complete
advanced degree programs, methods used to fund school, support systems while in school, and
any barriers encountered in the pre-and post-education process. Additionally, data collection
should occur for those who enrolled but did not complete advanced degrees to determine issues
and barriers encountered while in school. This data could provide perspective on additional
barriers to advanced degree completion for the future of the profession.
A second recommendation for future research could involve sampling of advanced
degree graduates to analyze the types of degrees completed, and if employment status changed
after degree conferment. As the purpose for advanced degree completion was for the sustainment
of the profession and to change the profession into one where a graduate degree rather than a
bachelor’s degree is the terminal degree, then extensive continuous study in this area will assist
AHIMA in future planning for the profession. Also, using a larger sample size where all 52
154

Component State Association members actively participate would be beneficial. Moreover, the
addition of global association professional member partner associations, such as the AHIMA
International and the International Federation of Health Information Management Association
(IFHIMA) will improve data collection and analysis for future research on the necessity and
pursuit of advanced degrees in the profession within partner countries worldwide. Overall,
continued data collection and analysis will benefit the organization and enhance the purpose of
the profession in the healthcare ecosystem.
Conclusion
In 2017, the HIM Reimagined initiative developed by the AHIMA CEE set forth a call to
action and organizational goal for 20% of its HI professional members, the stakeholders, to
obtain advanced degrees by 2027. In addition, the stakeholder goal was for 10% of HI
professional members of the AHIMA to enroll in advanced degree programs in colleges and
universities by 2023. This initiative came from the need to transform the HI profession into a
graduate-level profession and to prepare the profession for the impact of disruptive technologies
that might replace entry-level positions in the coming years.
The purpose of this study was to examine the knowledge, motivation, and organizational
assumed influences of the HI profession to return to school to pursue and attain advanced
degrees. This study used the Clark and Estes (2008) framework to perform a gap analysis. This
framework was the foundation for the development of the quantitative survey used in this study.
Data from the study informed the knowledge, motivation, and organizational assets and needs
pertaining to whether HI professionals possessed the necessary knowledge, skills, motivation,
and organizational support to return to school to complete advanced degrees to meet the AHIMA
goal. Using the Clark and Estes (2008) gap analysis enabled the creation of recommendations
155

which solely focused on the resolution of discovered needs. Furthermore, using the Kirkpatrick
and Kirkpatrick (2016) new world model will assist the AHIMA executive leadership and
education council implement and validate the necessary changes required to increase HI
professionals’ ability to apply, enroll, fund, and receive peer support and career strategies to
complete advanced degree programs within the next five years to meet the 2027 goal. Without
the recommended changes, the AHIMA may not meet the 2027 goal, which may further impact
the standing HI professionals hold in the healthcare ecosystem, plus impact the future and
necessity of the profession considering future disruptive technologies.
This study originated to recognize the need for advanced degrees to prepare the HI
profession for the future of healthcare, which involved becoming a graduate-level profession.
The literature review for this study identified how the future of the profession would be impacted
if it remained a bachelor’s degree profession, how technologies could impact entry-level
positions where redundancies occur, and how other health information professionals have
already amended their professional education with entry-level master’s degrees or practice-based
doctorate degrees. Overall, this research should be used as an example of how the AHIMA can
help their professional membership develop the knowledge, skills, and tasks necessary to
successfully complete advanced degree programs, while emphasizing the value and importance
of advanced degree completion for the profession’s longevity and importance as part of patient-
centered healthcare, and for the future of the healthcare ecosystem.

156

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173

Appendix A: Theoretical Framework Alignment Matrix (Quantitative)
Research questions Type of
analysis
Theoretical framework Data instrument
question
What knowledge,
motivation, and
organizational
influences are
necessary to achieve
the AHIMA goal of
obtaining graduate
degrees for their
credentialed HI
professionals?
Descriptive Clark and Estes (2008)
gap analysis using
knowledge,
motivation, and
organizational
influences
Survey questions

Open-ended
survey question
What are the primary
reasons provided by HI
professionals for not
obtaining advanced
degrees?

Descriptive Clark and Estes (2008)
gap analysis using
knowledge,
motivation, and
organizational
influences
Survey questions

Open-ended
survey question
What are the
recommended change
processes and
implementation
methods required in the
organization pertaining
to knowledge,
motivation, and
organizational support
required to meet the
goal?
Descriptive Clark and Estes (2008)
gap analysis using
knowledge,
motivation, and
organizational
influences
Survey questions

Open-ended
survey question

174

Appendix B: Excerpts from Document Analysis
Figure B1
AHIMA Career Prep Workbook, p. 24

Note. An excerpt representing the types of documents analyzed in the study. Reprinted from
American Health Management Association. (2018). AHIMA career prep workbook. American
Health Management Association.
175

Figure B2
AHIMA Career Prep Workbook, p. 25

Note. An excerpt representing the types of documents analyzed in the study. Reprinted from
American Health Management Association. (2018). AHIMA career prep workbook. American
Health Management Association.
176

Appendix C: Survey Instrument
Research questions:
1. What knowledge, motivation, and organizational influences are necessary to achieve
the AHIMA goal of obtaining graduate degrees for their credentialed HI professionals
2. What are the primary reasons provided by HI professionals for not obtaining
advanced degrees?
3. What are the recommended change processes and implementation methods required
in the organization pertaining to knowledge, motivation, and organizational support
required to meet the goal?

177

Table C1
Survey Instrument
Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
Exclusion criteria
1. Do you currently
have a master’s
degree or a
doctoral degree?
Closed • Yes (if yes,
participant will
be thanked, and
exited from the
survey)
• No (if no, the
participant will
go to question
2)
Criteria
2. Are you currently
enrolled in a
master’s or
doctoral
program, but
have not had a
degree
conferred?
Closed • Yes (if yes,
participant will
be thanked, and
exited from the
survey)
• No (if no, the
participant will
go to question
3)
Criteria
Informed consent
3. Do you consent
to taking this
survey?
Closed • Yes
• No

Demographic information
4. Please state your
gender.
Closed Nominal • Female
• Male
• Non-binary
• Transgender
female
• Transgender
Male
• Other
• Prefer not to
answer
Demographic
178

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
5. Please list your
ethnicity.
Closed Nominal • Asian
• African
• Black or
African
American
• Latinx or
Hispanic origin
• Native
American or
Native Alaskan
• Native
Hawaiian or
Pacific Islander
• White/Europea
n origin
• Two or More
• Other/Unknown
• Prefer not to
say
Demographic
6. Please list your
current age.
Closed Nominal • Less than 20
years old
• 21–30 years old
• 31–40 years old
• 41–50 years old
• 51–60 years old
• 61+
• Prefer not to
say
Demographic
7. What is your
current
employment
status?
Closed Nominal • I am employed
full-time.
• I am employed
part-time.
• I am seeking
opportunities.
• Prefer not to
say
Demographic
179

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
8. What is your
current annual
income?
Closed Nominal • Less than
$25,000
• $25,000–
$50,000
• $50,000–
$100,000
• $100,000–
$200,000
• More than
$200,000
• Prefer not to
say
Demographic
180

9. In what region of
the country are
you located?
Closed Nominal • Northeast/New
England
(Connecticut,
Maine,
Massachusetts,
New
Hampshire,
Rhode Island,
and Vermont)
• Northeast/Mid
Atlantic (New
Jersey, New
York, and
Pennsylvania)
• Midwest/East
North Central
(Illinois,
Indiana,
Michigan,
Ohio, and
Wisconsin)
• Midwest/West
North Central
(Iowa, Kansas,
Minnesota,
Missouri,
Nebraska,
North Dakota,
and South
Dakota)
• South/South
Atlantic
(Delaware,
Florida,
Georgia,
Maryland,
North Carolina,
South Carolina,
Virginia,
District of
Columbia, and
West Virginia)
• South/East
South Central
(Alabama,
Kentucky,
Demographic
181

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
Mississippi, and
Tennessee)
• South/West
South Central
(Arkansas,
Louisiana,
Oklahoma, and
Texas)
• West/Mountain
(Arizona,
Colorado,
Idaho,
Montana,
Nevada, New
Mexico, Utah,
and Wyoming)
• West/Pacific
(Alaska,
California,
Hawaii,
Oregon, and
Washington)
• US Territories
• Other
• Prefer not to
answer
182

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
10. What current
certificate or
college degree do
you have?
Closed Nominal • Certificate:
coding
• Certificate:
medical coding
and billing
• Certificate:
health
information
technology
• Certificate:
other
• Associate
degree
• Bachelor’s
degree
• Non-health
related master’s
degree
Demographic
11. What specific
credentials from
the American
Health
Information
Management
Association
(AHIMA) do
you currently
hold? (Select all
that apply)
Closed Nominal • CCA
• CCS
• CCS-P
• RHIT
• RHIA
• CDIP
• CHDA
• CHPS
Demographic
Knowledge (declarative and procedural) of advanced degree completion
12. My level of
confidence to
make an
informed
decision to
return to school
is high.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Declarative
183

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
13. I understand
how to select a
college or
university that
supports my
educational
goals.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree

All Procedural
14. I understand
how to select a
college or
university that
supports my
career goals.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
15. I understand
how to select a
college or
university that
supports my
current lifestyle.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
16. I can recall how
to complete a
college
application.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Declarative
17. I know how to
complete the
registration
process for a
standardized
examination for
graduate school.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
18. I know how to
obtain letters of
recommendation
for my graduate
school
application.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
184

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
19. I know how to
request my
transcripts from
schools I
previously
attended.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
20. I know how to
secure funding
to return to
school by
completing
financial aid
applications.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
21. I know how to
secure funding
to return to
school by
completing
scholarship
applications.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Procedural
22. I understand
how to utilize
the college
admissions
staff,
administrators,
and/or advisors
to assist me in
the college
selection
process.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Declarative

Motivation (interest value, utility value, and self-efficacy) for degree attainment
23. I am interested
in obtaining an
advanced degree
(master’s or
doctorate).
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1 Interest value
185

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
24. My motivation
to return to
school for an
advanced degree
would be based
upon the
following
factors: (rank
from highest to
lowest, with the
most important
being a 1, and
the least
important being
a 5)
Closed Ordinal • Increase
earning
potential
• Job promotion
• Start a new
career path in
my profession
• To further
education and
skills
• To finish an
incomplete
advanced
degree
All Interest value
25. I am confident I
have the ability
to apply to an
advanced degree
program within
the next five
years.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Self-efficacy
26. My interest in
returning to
school is based
upon the
AHIMA HIM
Reimagined
(HIMR) call to
action for health
information
professionals to
return to school
for advanced
degrees by
2027.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree

1, 3 Interest value
186

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
27. I believe that
my previous
experience as a
college student
will help me
successfully
complete an
advanced degree
program.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Self-efficacy
28. I believe that
my experience
working as a
health
information
professional will
help me
successfully
complete an
advanced degree
program.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Self-efficacy
29. I believe that
attending
graduate school
and obtaining an
advanced degree
will fulfill a
personal goal.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Utility value
30. I believe that
attending
graduate school
and obtaining an
advanced degree
will fulfill a
professional
goal.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Utility value
187

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
31. I believe the
following
barriers may
delay me from
applying to an
advanced degree
program in the
next five years.
(Rank from
highest to
lowest, with the
most important
being a 1, and
the least
important being
a 7)
Closed Ordinal • School
selection
process
• School
application
process
• Program/degree
selection
• Financial costs
• Family
obligation
• Time
commitment
• Work
obligations
• other
1, 2 Self-efficacy
Organization (cultural settings and models) related to degree attainment
32. I believe that
my current
certifications
and/or degree(s)
are sufficient for
advancement
and promotion
in this
profession
without an
advanced
degree.
Closed Ordinal

• Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Cultural
Model
188

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
33. I believe that
my specific
credentials from
the AHIMA are
sufficient for
advancement
and promotion
in this
profession
without having
an advanced
degree.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Cultural
model
34. I believe that
obtaining
additional
credentials and
certifications in
my profession is
the equivalent of
obtaining an
advanced
degree.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Cultural
model
35. I believe the
culture of the
AHIMA
organization
promotes
credential
attainment over
the pursuit of
advanced
degrees in this
profession.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Cultural
model
189

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
36. I believe the
bachelor’s
degree should
remain as the
terminal degree
for this health
information
profession.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
All Cultural
model
37. I believe the
AHIMA views
advanced
degrees as
relevant for the
future
sustainment of
the profession.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1, 3 Cultural
model
38. I believe the
AHIMA should
create an
advanced
education
pathway/map to
assist members
who decide to
return to school
for an advanced
degree.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1, 3 Cultural
setting
190

Question Open
or
closed?
Level of
measurement
(nominal,
ordinal,
interval,
ratio)
Response options
(if close-ended)
RQ Concept
being
measured
(from
emerging
conceptual
framework)
39. I believe a
mentorship
match program
with AHIMA
members who
already have
advanced
degrees would
assist the
members who
decide to return
to school for an
advanced
degree.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1, 3 Cultural
setting
40. I am aware of
the AHIMA
Foundation
academic
scholarships for
active members
who pursue
advanced degree
education.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1, 3 Cultural
setting
41. I believe
AHIMA should
help their
membership
with financial
assistance to
return to school
for advanced
degrees.
Closed Ordinal • Strongly agree
• Agree
• Neutral
• Disagree
• Strongly
disagree
1, 3 Cultural
setting
Closing question
42. Please provide
any additional
feedback you
feel would be
helpful.
Open Nominal

191

Appendix D: Informed Consent for Research (Quantitative)
INFORMED CONSENT FORM FOR RESEARCH
Study Title: Applying the Clark and Estes (2008) Gap Analysis Framework to
Evaluate the Attainment of Advanced Degrees in a Health
information Profession: A Mixed Methods Study

Principle Investigator: Toni Jackman
Department: Rossier School of Education
Waite Phillips Hall
University of Southern California
3470 Trousdale Parkway
Los Angeles, CA 90089

Esteemed Participants:

I invite you to take part in a research study which focuses upon the attainment of advanced
degrees, specifically masters and doctoral degrees, for members of the health information
profession. This consent form provides an overview of the study, and if you decide to participate,
please select the consent option prior to starting the survey. Selecting the “I consent” option
acknowledges that your participation in the study is voluntary and that you are aware that you
may choose to terminate your participation at any time.

Please take as much time as you need to read this entire form prior to providing your consent.
Please ask questions if any information is unclear.

Purpose of the study
The purpose of this project is to evaluate how knowledge, motivation, and the organizational
factors influence and impact the decision AHIMA credentialed professionals make to answer the
recommendation and call to action to obtain advanced degrees. Furthermore, the purpose of the
project is to determine if the AHIMA will meet their goal of increasing the number of
credentialed professional members with graduate degrees to 20% of the total membership by
2027. The primary stakeholders for this study are those members who do not currently have
graduate degrees but will include those who are not currently enrolled in graduate degree
producing programs as well. The research questions which will guide this project are as follows:

1. What knowledge, motivation, and organizational influences are necessary to achieve
the AHIMA goal of obtaining graduate degrees for their credentialed HI
professionals?
192

2. What are the primary reasons provided by HI professionals for not obtaining
advanced degrees?
3. What are the recommended change processes and implementation methods required
in the organization pertaining to knowledge, motivation, and organizational support
required to meet the goal?

What are the recommended change processes and implementation methods required in the
organization pertaining to knowledge, motivation, and organizational support required to meet
the goal?
Importance of the Study
Studying the lack of advanced degrees is important to the sustainment of the health information
profession. Failure to meet the goals may impact the AHIMA’s ability to have qualified,
prepared professionals to benefit the healthcare population and ecosystem for the future of the
profession. Recommendations from the Clark and Estes (2008) gap analysis can increase the
future sustainment of the profession in the healthcare ecosystem. The knowledge, motivation and
organizational gaps analysis findings from this study have the potential to sustain the future of
the AHIMA organization as a leading health information professional organization within the
healthcare industry and establish clear pathways for the stakeholders to obtain advanced degrees.
Furthermore, this study will move health information professionals toward the goal of increased
graduate level professionals in the field and align us with other health information professions
who have already moved toward practice-based doctoral degrees (Seegmiller et al, 2015; Tekian,
2014). Advancement in this area can reform the AHIMA outdated entry-level educational and
technical practice models, allowing the profession to keep pace with changes in the healthcare
ecosystem, and ensure the continuity and viability of the profession.
Risks
There is no personal risk associated with the participation of this study. Your participation in this
study is voluntary and you have the right to withdraw from participating in the survey at any
time.
Confidentiality
1. The questions in this quantitative survey are meant to address the research study. The
responses you provide are called data and will be used only for the study. This includes
responses to the survey’s demographic questions.
2. To protect your confidentiality and privacy, we will use a pseudonym or key-code for
your data. Only the researcher will have access to your data.
3. The Qualtrics online software tool will collect the survey data you provide. The survey is
available using the provided link.
4. Access to Qualtrics will be through the researcher’s personal laptop computer, which is
password protected. Access to Qualtrics is obtained via password through the University
193

of Southern California. Qualtrics purpose is to aggregates data and will not contain any
personal identifiable information (PII). PII collected, if any, will be destroyed after
analysis and will not be forwarded to those involved in the research study. The research
study personnel include the researcher conducting the analysis, or the dissertation
committee.
5. The University of Southern California Institutional Review Board (IRB) and Human
Subject’s Protections Program (HSPP) may review the survey responses.
6. It is your right to withdraw your consent to participate at any time. If you withdraw your
consent, we will not collect any additional information from your, and will delete your
data we already collected.
7. All survey data collected will be destroyed within a year of the conclusion of this study.

Contact Information
If you have questions, concerns, complaints, or suggestions, you can reach the study investigator,
Toni Jackman at jackman@usc.edu.
This research was reviewed by the University of Southern California Office for the Protection of
Research Subjects (OPRS) Institutional Review Board (IRB). The IRB is a research review
board that reviews and monitors research studies to protect the rights and welfare of research
participants. Please contact the IRB if you have questions about your rights as a research
participant or have complaints about the research at the following:
720 S. Flower Street, Suite 325
Los Angeles, CA 90089
(323) 442-0114
(213) 821-5276
IRB@usc.edu

194

Appendix E: Qualtrics Survey Information Sheet
INFORMATION SHEET FOR EXEMPT RESEARCH

STUDY TITLE: Applying the Clark and Estes (2008) Gap Analysis Framework to
Evaluate the Attainment of Advanced Degrees within the Health Information Profession
PRINCIPAL INVESTIGATOR: Toni Jackman
FACULTY ADVISOR: Patricia Tobey, PhD

You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. You should ask questions about anything that is unclear to
you.
PURPOSE
The purpose of this study is to examine the knowledge, motivation, and organizational influences
affecting health information professionals’ returning to school for advanced degrees for the
future sustainment of the health information trade in the healthcare ecosystem. This study uses
the Clark and Estes (2008) gap analysis framework to determine gaps effecting health
information professionals’ returning to school for master’s and doctorate, with the purpose of the
future sustainment of the health information trade in the healthcare ecosystem and establish clear
pathways for the stakeholders to obtain advanced degrees.

We hope to learn the knowledge, motivation, and organizational gaps that affect participants’
decisions to obtain advanced degrees. This includes the knowledge and understanding of the
2017 HIM Reimagined (HIMR) recommendation and call to action from the American Health
195

Information Management Association (AHIMA) for 20 percent of their professional members to
return to school for advanced degrees by 2027.

You are invited as a possible participant because you are a health information professional and
active member of the AHIMA, and you currently have a professional certification, associate
degree, or bachelor’s degree. Additionally, you do not have an advanced degree, and you are not
currently enrolled in any collegiate programs to obtain an advanced degree.

PARTICIPANT INVOLVEMENT
If you decide to take part, you will be asked to:
• Volunteer to participate in the study
• Understand that only the primary investigator/researcher and you will know you are
participating in this research study. The researcher will take all precautions to ensure
your participation is kept anonymous and confidential.
• Understand that no participant names or any demographic information is used to
identify any participants in the study.
• The 42-question survey will take approximately 10 minutes and take place in the
Qualtrics online survey software platform, and the link will be provided by the
researcher if you decide to participate.
• The survey data will be stored within the secure, password protected Qualtrics online
survey software tool for the researcher’s review and analysis and used only for the
researcher’s research study.
• The Qualtrics survey link will be included in the recruitment message for potential
participants.
• Once you consent, Qualtrics will lead you to the beginning of the survey
questions.
• If you decide to participate in this study, you will be required to sign the Informed
Consent Form before proceeding to the study’s survey questions.
• The survey link will guide potential participants to the two initial questions to determine
if they meet the criteria for the study.
• The first question will ask if you have an advanced degree. The second question will ask
if they are currently enrolled in any advanced degree-producing program. If the response
to both questions is “no,” the skip logic option in Qualtrics will forward them to the
Informed Consent section.
• If you answer “yes” to either question, or answer “no” to having an advanced degree, but
“yes” to enrollment in an advanced degree program, the individual will see a message
196

thanking you for their response, and directed out of the survey, as you will not meet the
criteria for the survey.
• If you meet the criteria will be directed to the Informed Consent Section of the survey.
Individuals will be asked to read the Informed Consent Form, and informed that a “yes”
response means they agree to participation in the study. If the individual clicks “yes,” the
skip logic option in Qualtrics will forward them to the survey. If the individual responds
with “no” they will see a message thanking them for their time and directed out of the
survey. As previously indicated, this Qualtrics software skip logic capability will be used
for this section to forward potential participants to the survey questions.
• Participants who met the criteria will now be in the section containing the survey
questions.
• You can decide to not participate and withdraw from the study at any time during
the research process, with no repercussions.
• Once the participants complete all survey questions, the last section of the survey will
contain a message thanking them for their participation.
• The final section of the survey will also contain a message informing the survey
participant that they can contain the researcher if they are interested in the study’s
findings. The researcher’s email address will be in this final message.
• The researcher, the administrators of the Online Community, nor the Component State
Association (CSA) Chapter Executive Boards will have access to the email addresses of
participants, so they will not know who participated in the study survey.
• The survey will be created in Qualtrics with the option for anonymity. No personally
identifiable information (PII) will be collected on any participants. The participants’
Internet Protocol (IP) addresses will not be collected by the system software.
• The researcher’s access to the Qualtrics survey will be through their University of
Southern California login credentials. These credentials will not be shared with anyone.
• All collected participant response data will be analyzed.
• After data analysis, the findings will be reported in the researcher’s doctoral dissertation.
An executive summary will be provided via email to survey participants and the National
Professional Organization for Health information upon request.
• No findings of the study will be released prior to the researcher’s final doctoral
dissertation defense and submission of the dissertation to the library at the University of
Southern California.
• The final research document will be completed in May 2022 as the researcher’s
dissertation. It will combine the researcher’s problem of practice, literature addressing the
problem of practice, the methodology for the study, and an data analysis with
recommendations from data collected from participants in this study.
• If you would like a copy of the final dissertation, please inform the researcher using the
contact information on the Informed Consent Form.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will not be compensated for your participation
CONFIDENTIALITY
197

The members of the research team and the University of Southern California Institutional
Review Board (IRB) may access the data. The IRB reviews and monitors research studies to
protect the rights and welfare of research subjects.
When the results of the research are published or discussed in conferences, no identifiable
information will be used.

We will keep your records for this study confidential as far as permitted by law. However, if we
are required to do so by law, we will disclose confidential information about you. Efforts will be
made to limit the use and disclosure of your personal information, including research study and
medical records, to people who are required to review this information. We may publish the
information from this study in journals or present it at meetings. If we do, we will not use your
name.

The University of Southern California’s Institutional Review Board (IRB) and Human Subject’s
Protections Program (HSPP) may review your records. There are no additional Organizations
that may also inspect and copy your information.

Your responses, which are also called “data,” will be stored with the Qualtrics survey software
provided by the University of Southern California. These data will be encrypted in Qualtrics and
retained for three years within the system. After the three years the data will be deleted. No one
other than the researcher will have access to the researcher’s Qualtrics account.

198

Your data and/or specimens collected as part of this research will not be used or distributed for
future research studies, even if all your identifiers are removed.

To understand the privacy and confidentiality limitations associated with using the AHIMA
Access Online Community and Social Media platform to access the Qualtrics survey link, we
strongly advise you to familiarize yourself with their privacy policies.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact Toni Jackman at jackman@usc.edu or
Dr. Patricia Tobey at tobey@usc.edu.

IRB CONTACT INFORMATION
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.

199

Appendix F: Proposed Post-Training Learning Evaluation Survey Sample Questions for
Level 1 (Reaction)
Strongly
disagree
Disagree Neither
agree nor
disagree
Agree Strongly
agree
Engagement
Learning the
content of this
back-to-school
program is
valuable
information for
my future goal of
an advanced
degree

Relevance
Advanced degree
pursuit is
important to me
for my future
goals in the HI
profession

Customer satisfaction
The back-to-school
training
prepared me for
advanced degree
pursuit by
giving me the
required tools to
pursue advanced
degree school
admission,
financial
support, and HI
mentorship

200

Appendix G: Pre-/Post-Learning Evaluation Survey Sample Questions for Level 2
(Learning)

Strongly
disagree
Disagree Neither
agree nor
disagree
Agree Strongly
agree
Knowledge
I can now determine
which health-related
degrees are relevant for
continuation in the HI
profession

Skills
I now feel that I am
prepared to complete
college and financial
aid applications in
preparation for
advanced degree
education

Attitude
I am excited about
pursuing either a
masters or doctoral
degree

Confidence
I am confident in my
ability to complete a
timeline and road map
for my return to higher
education

Commitment
Completing an advanced
degree is worth it to me
regardless of the
amount of time and
money it takes

201

Appendix H: Post-Learning Evaluation Survey Sample Questions for Levels 1–4
Level When to
administer
Strongly
disagree
Disagree Neither
agree nor
disagree
Agree Strongly
agree
Level 1: reaction
The webinar and
workbook training
exercises lived up
to my expectations
One month
post-
training

Level 2: learning
I am confident in my
ability to complete
the selection,
enrollment, and
advanced degree
program entry
tasks prior to 2027
Four to 8
weeks post-
training

Level 3: behaviors
I will enroll in an
advanced degree
program no later
than 2027
Annually: 5
years post-
training

Level 4: results
The back-to-school
program assisted
me with my
preparation,
enrollment, and
advanced degree
completion to meet
the AHIMA goal
by 2027
Annually:
10 years
post-
training

Abstract (if available)

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Asset Metadata

Creator Jackman, Toni (author)

Core Title Evaluating the pursuit of advanced degrees in a health information profession: a gap analysis study

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-12

Publication Date 06/16/2023

Defense Date 11/14/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag advanced degrees,disruptive technologies,health information profession,Knowledge,Motivation,OAI-PMH Harvest,organizational influences

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia (committee chair), Phillips, Jennifer (committee member), Simmons, Sabine (committee member)

Creator Email jackman@usc.edu,tjackman12@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC112661529

Unique identifier UC112661529

Identifier etd-JackmanTon-11390.pdf (filename)

Legacy Identifier etd-JackmanTon-11390

Document Type Dissertation

Format theses (aat)

Rights Jackman, Toni

Internet Media Type application/pdf

Type texts

Source 20230104-usctheses-batch-999 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu