April 13, 2018
By any measure, superior IT departments with highly specialized staff have become an essential factor in the success of today’s healthcare industry. Across several recent surveys of hospital leaders, all have reported operational priorities that include, indeed require, a strong IT component. Three years ago, employment of HIT professionals was predicted by the U.S. Bureau of Labor Statistics to grow more than 15% from 2014 to 2024, and that prediction remains on track. But the IT workforce pool is not keeping up, and today’s healthcare IT labor shortage has become a huge and even debilitating challenge for hospitals. Over half of the hospital IT leaders responding to HIMSS’ 2018 Leadership and Workforce Survey claimed their organization either scaled back or placed an IT initiative on hold in the last year due to a workforce challenge.
Any HR Director will tell you it is very difficult to recruit skilled HIT staff, and as pressure continues to fill specialized positions for critical projects, hospitals’ most skilled team members are often recruited away by other hospitals and IT vendors. How can this frustrating demand vs. supply situation be mitigated? Read on for our recommendations.
Healthcare just became the nation’s largest employer, according to The Atlantic, surpassing longtime previous leaders, retailing and manufacturing. While there are several drivers, the #1 reason is our aging baby boomer population, which wants to live longer and stay healthier, frequently through modern medical care. The Atlantic article notes that by 2025, 25% of adults will be over 55. As this group continues to age it will need ever more care—and that means healthcare will need more workers.
HIT specialists and managers are in high demand across healthcare, and competition for the best and brightest is intense. HIMSS data shows that smaller healthcare organizations find it especially difficult to compete, offering lower average salaries than larger healthcare organizations. Salaries for IT positions in many large hospitals are increasing at double-digit percentages. But when hospital leaders react to new projects with a knee-jerk requisition for more IT employees, it can be an unnecessary expense and may delay the project by months.
Rethinking IT With a Blank Slate Approach
Before stretching their budgets to add new employees, many hospitals are creatively rethinking and reorganizing their IT operations to be more flexible and cost-effective. Starting with a “blank slate” analysis that drops automatic assumptions about what specific positions are needed in IT, and focuses instead on current and projected real functional needs, issues, skills requirements (and more) can be a striking game-changer in designing a more nimble and cost-effective organization. Outcomes of the analysis may enable departmental re-engineering that includes more cross-functional integration and teamwork, creative labor utilization adjustments, elimination of no longer needed roles, dismantling of silos, simplification of reporting trails, elimination of redundancies such as top-heavy management, re-training, morale-building promotions and much more. Some hospitals are finding that one result is a reduction in the IT department’s need for staff additions.
Hospitals should perform periodic blank slate analyses of their IT environment, needs, and projections to develop staffing plans with a holistic foundation of up-to-date data. Using a band-aid approach, e.g. requisitioning a staffer here or there to address immediate problems may resolve short-term needs but easily results in department bloat. Here’s our recommended approach:
Assess Resource Needs
Begin with a baseline estimation of your operating resources. These are people-hours and skills dedicated to essential operation and maintenance of your IT systems. The focus should not be on particular people at this juncture. This inventory might cover work performed in the following functions: service desk, desktop support, network/infrastructure management, data security, application support, database maintenance, implementation management, other specialized analyst functions, and management. It’s also important to consider the myriad of occasional but necessary tasks that crop up such as adding new users, preparing quarterly edits to coding rules, reporting, training, responding to security threats and so forth. These are all functions that are critical to operational continuity. If you’re not sure about the resources required to maintain your infrastructure and applications, your vendors can provide some baseline numbers to begin your projections. Or, find an external expert to give you a hand.
Be especially careful to include work performed by staff that is outside their daily scope of activities. For example, managers must attend time-consuming meetings and assemble special executive reports. Large and small systems glitches can instantly interrupt planned schedules. Analysts may need to provide add-on coverage to the service desk in peak hours or stop everything when a physician reaches out to a “favorite” to get personalized off-the-books service. Our Service Desk Costing Report describes this issue and offers potential solutions.
Next, estimate your project resource requirements. This includes the number of people-hours and the array of skill sets needed for projects that are planned. Judicious flexibility may be required. Hospitals in today’s environment cannot afford the resources to do every project they want simultaneously. Many hospitals (and not all of them small) are stretched just to cover the bare minimum, e.g. projects related to regulatory requirements, systems upgrades and replacements, and security enhancements.
Also consider the strategic domain of the CIO and the IT leadership committee, especially the challenges of choosing which projects will add the most value to the department, organizational goals, and the bottom line. Again, your software vendors can be of great help in providing estimates on project hours required to perform particular installations or upgrades under consideration.
A Sampling of Methods to Help Smooth Out Staffing Estimations
1. Decisions to undertake any major new project should include an assessment of changes in baseline support resource requirements. Complex new systems such as an EHR can require special management and significant support including a peak in post go-live support calls leading to significant trouble-shooting. Even smaller projects are subject to unexpected complications and can have effects on usability that will have to be resolved. Although you probably won’t add a new employee 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 from operational reality, and performance issues will arise.
2. Optimization efforts help. Many organizations discover that their new or upgraded systems do not work as smoothly as expected. 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 there is little room to improve systems and resolve such issues. Systems and process optimization is the low hanging fruit when it comes to improving operations, streamlining staffing needs, and improving financial return on system investments. In the long run, optimization successes often reduce IT support costs.
3. Many resources are not interchangeable — but many can work together. Every IT executive understands that a database administrator and a nurse informaticist cannot change places. Nevertheless, it’s extremely common in IT departments to have one or two key resources that need to be involved in almost every project, in addition to coordinating many other operational responsibilities. Great care must be taken to avoid overworking these individuals; otherwise, overall department and systems performance will suffer. On the other hand, similar care should be taken to minimize the siloing of staff who have the skills or potential to team with others and create new efficiencies and greater value.
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 could 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.
Obviously, thoroughly analyzing any hospital IT operation objectively and developing a new or updated departmental modus operandi is much more than a 1-2-3 endeavor. Detailing a complete methodology is beyond the scope of this blog post. But suffice it to say that if you haven’t performed an IT department staffing assessment in the last two or three years — a period of many IT developments and changing issues — it’s time, especially if you are readying for upcoming projects.
The results of your effort could point to staffing gaps that may transform the shape or magnitude of your current perspective and enable a more productive and cost-effective IT operation. It’s quite possible that HR will need to make fewer calls to $20,000+ per pop recruiters. Our bet is that you can lower your staffing budget!
If you need help, contact us. With our focus on business value, we can help you design a staffing plan and project portfolio that maximizes the use and value of your staff.