D'Arcy Gue

Hardball Answers For Staff-Stressed Hospital IT Departments

August 17, 2017

Healthcare IT, IT Outsourcing, IT Project Management, IT Service Desk 8 Minute Read

Continuing congressional efforts to repeal the ACA and replace it with programs that could eliminate insurance for 20+ million Americans are making many hospitals skittish about hiring needed healthcare IT expertise. The ripple effects have implications not only for healthcare workers, but also hospital operations which are tightly integrated with computers, networks, EHRs, revenue management and other critical information systems.

HealthLeaders Media reports: “Hospitals have created 19,900 new jobs in the first four months of 2017, a 54% decline when compared with the 44,200 new hospital jobs created in the first four months of 2016.” Unfortunately, this loss of momentum comes when top notch HIT expertise is essential due to worsening issues that include our aging population’s healthcare needs, an opiate epidemic, increasing data security crises, and the industry’s transition to value based payments.

Solutions that are prudent yet aggressive do exist.

Nicole Smith, chief economist at Georgetown University Center on Education and the Workforce believes that hospitals are being pre-emptive, not hiring workers as much as in the past in anticipation that ACA repeal and replace is actually going to occur. “We can expect hospital hiring to really slow down until people get a handle on what is going to happen.”

Ironically, IT staffing shortages remain a huge challenge for hospitals, even when they are authorized to hire replacements for existing jobs. Keeping up with today’s lightning advancements in healthcare related technology is difficult, and some required talent is rare. Many hospitals’ most skilled IT professionals are being recruited away by other hospitals and industries.

How can hospitals facing this double whammy of budget restraints and lack of up-to-the-minute IT expertise avoid a degradation of IT-based services?

A complete staffing analysis is in order — an assessment of your current overall IT staffing needs, using a “blank slate” approach that ignores assumptions under which your IT department has traditionally operated.  But perhaps labeling this a “blank slate” label is too politically correct; let’s change it out to a “hard ball” assessment strategy. If you really want to make your IT department the best it can be, you will have to avoid giving too much value to typical cultural prejudices, e.g. allowances for staff popularity, personal / family situations, salary raise expectations, even length of service — unless you can salvage these people with education and targeted mentoring.

Read on for a recommended assessment approach that could result in major labor cost savings, access to needed talent, and a very successful IT organization.

Instead of spending new dollars, today may be an opportunity for a major, or minor, IT reorganization which could include a cost-effective combination of cross-functional integration, labor utilization adjustments, elimination of no longer needed jobs, re-training, temporary reliance on specialized external expertise, or ?  Whatever staffing plan a hospital may elect, instead of focusing on bandaids for immediate problems, it should be based on analyzing its overall IT environment today in relation to existing and needed technologies, organizational objectives, and financial projections.

How Much IT Support Does Your Hospital Need?

Unfortunately, little has been published recently to provide clear benchmarks to guide CIOs. An older (2008) Gartner Group study reported that hospitals need .20 FTEs per patient bed to function effectively with fully implemented electronic medical records. This estimate is at best a limited benchmark. Generalized estimates are nearly impossible to make given the varying sizes of hospitals and the wide differences in technologies they employ.

To determine an estimate of resource requirements, each facility has to perform its own staffing analysis.  Here’s how to get started:

Assess Staffing Needs

  1. Begin with a baseline analysis of your operating resources. This list might include people performing the following everyday functions: Service Desk, Desktop Support, Networking, Data Center, Security, Application Support and Database maintenance. Don’t forget the myriad of small tasks that crop up such as adding new users, adding physicians to the billing system, quarterly edits to the coding rules, reporting and so forth.
    You also must consider the level of expertise needed for planned IT initiatives, such as implementations of new systems. Ignoring any IT functions could cause the operations to stop, all at once or more slowly as various components fail, need adjustment, fall prey to criminal attack or become out of date. If you’re not sure of the resources needed to maintain your applications, your vendors should be able to provide baseline numbers to begin your projections. Be especially careful to consider all IT staffers that often work outside their normal scope of responsibility. It’s common, for example, for analysts also to provide additional coverage to the Service Desk in peak hours, and for users to reach out to favorite analysts outside Service Desk, and get “off the books” service.  Our Service Desk Costing Guide (see below) describes this issue and offers solutions to address the problem.
  2. Next, estimate your project resource requirements: the number and qualifications of people you really need to do the projects you have planned. You have some flexibility: you don’t necessarily need the resources to do every desired project simultaneously. On the other hand, risks of emergencies must be considered, e.g. security incidents that may require immediate remediation.
  3. Special note: today’s CIO must have a respected, strategic position within the hospital’s leadership team in order to contribute top shelf technological knowledge that informs the institution’s IT-related short- and long-term planning and decision-making. The days of IT Directors who simply translate organizational directives into technology solutions are over. If you are a CIO, make sure you are in the strategic executive mix!

Eight Factors in Developing a Successful IT Staffing Plan 

  1. Every new project should include an assessment of baseline support resource requirements. Major new systems such as a new EHR can require significant support, including a peak in support calls after go-live. Even smaller projects can have an effect on user needs. Although you probably won’t add a new resource because a new project adds .10 FTEs to your baseline, those tenths of a person add up over time and need to be accounted for.  Otherwise your staffing levels will drift away from operational reality, and performance issues will arise.
  2. Optimization efforts must be a factor. Many — perhaps most — organizations discover that their systems do not work as smoothly as promised by vendors. Whether this is a result of install configuration issues, user workflow, interface problems or any other reason, many IT shops spend so much time on completing day-to-day operations that they don’t have the time to remediate post go-live systems issues. Systems and process optimization is the low hanging fruit when it comes to improving operations, decreasing operational staffing needs, and improving financial return on system investments. In the long run, optimization successes may reduce IT support costs.
  3. Many staff resources are not interchangeable. Every IT executive understands that a database administrator and a nurse informaticist cannot change places.  But it’s common for IT departments to have one or two key staffers that need to be involved in almost every project, plus coordinate a significant number of operational responsibilities. Great care must be taken to avoid overworking these individuals; otherwise, overall department and systems performance will suffer.
  4. Compare existing process maps to actual work processes. If you don’t have the former, you have a challenge but it is one you should take on, at least using appropriate sampling. There may be many opportunities for streamlining that can be identified.
  5. Compare current work practices to industry best practices and document inefficiencies. Again, it is possible that a thorough comparison is impractical…after all, your IT department is having staffing problems that may make this difficult! Nevertheless, some reality checking in key areas against best practices is likely to be eye-opening and provide a big return on your time investment.
  6. Conduct workload assessments. If yours is like many IT departments, some employees are engaged in non-value-added work that could be permanently removed from their daily activities. Understanding when and where these activities are conducted, and eliminating them, could help free up time to take on new responsibilities.
  7. Interview, interview, interview! If the IT staff’s buy-in and input arenot included in the assessment process, it is doomed. Transparent communications and integration of the whole staff in the effort will be the key to success in your analysis and planning. Secretive conversations or requests for unusual reports may very well sabotage this project. Chances are that the frontline staff will have information and suggestions that will have a strong impact on the validity and workability of your final analysis and plan. A plus: if you include your staff in the assessment, the distribution of voluntary input by others will ease your pain!
  8. Where planned projects or non-standard needs are anticipated, consider seeking out external specialized experts who can provide or guide needed solutions temporarily. If you go this route, you can negotiate pricing to avoid budget overload and include a contract proviso that your outsourcer will train in-house staff to pick up the slack when he or she leaves.

If you haven’t performed a “hard ball” IT department staffing assessment in the last two years, it’s time — especially if you are readying for upcoming projects or your hospital risks financial losses if patient revenues decrease. The results could enable reallocation and retraining of staff and be quite manageable without calls to  $20,000+ per pop recruiters. Our bet is that you can lower your staffing budget and create an IT department that shines — but only with the above recommended homework.


If you need help, contact us. With our successful 25-year focus on hospital healthcare quality through consulting and full and selective IT outsourcing,  we can help you design project and staffing plans that maximizes the performance and value of your IT department. We also provide specialized senior support for new systems projects.


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