Today, most hospitals understand the need to incorporate a dedicated service desk in their IT operations. With the complexity of EHRs and other hardware and software systems — plus new security requirements — a poorly managed service group that offers slow responsiveness and inadequate help quickly frustrates and eventually alienates medical staff and other users. It also creates surprisingly high and unnecessary costs.  Quality support is acutely necessary in all hospitals, but like many business objectives, is easier said than achieved.

Inefficient service desks put extreme, often hidden burdens on IT budgets. Unfortunately, so do new IT projects. Which get priority during the budget planning process? Typically, it’s the new projects; they often are strategically important components of an integrated IT plan and have high C-Suite visibility. This imbalanced scenario is understandable, but needn’t be a given. A healthier balance is quite achievable if approached systematically, and will benefit both the IT budget and the hospital’s users.

Service desk operations can become alarmingly ineffective and yet more expensive if not managed properly. Perfunctory analysis of service desk issues and poorly projected future usage in the annual budgeting process are often the culprits. How many times have new EHRs been installed without considering the transitional and longterm impacts on users’ service needs and service desks’ ability to respond?  Within the IT department’s complex budget, It’s easy to view the service desk as a behind-the-scenes utility that needs general maintenance at best. But if IT leaders can take a few days for systematic cost/performance analysis prior to the budgeting process, they can actually reduce costs and increase user satisfaction via targeted investments and better service desk management strategies.

At least three cost factors must be examined and analyzed to create a healthy, sensible budget for meeting all service desk objectives for the coming year. (Let’s assume your IT department has service desk objectives.)

Every IT leader must understand what the hospital is actually spending on its service desk operations, review likely changes in users’ needs, and plan accordingly.  Three factors are essential in this process. Get a handle on:

• Immediate or “obvious” costs
• Frequently overlooked and less direct costs
• Indirect “hidden” costs

Obvious Costs of Service Desk

Salaries of Service Desk Staff: These include salaries plus fringe benefits. For most purposes, using the hospital-wide average benefit cost as a percentage of salary is a suitable approach.

Software Purchases: Ticket management typically is the most common expenditure. Exact pricing varies widely by vendor. If software is purchased as a one-time expenditure, it may be amortized over the estimated life of the software.

Software Maintenance: Usually a one-time annual cost associated with the ticket management software, this expenditure may be amortized over a twelve-month budget.

Hardware and Furnishing: Hardware will include desktops, laptops, monitors, servers, and telecommunication equipment. Don’t forget “small” items like headphones and mice along with chairs, carpeting, and other furnishings which need fairly frequent replacement in a very busy service group. Service desk agents put them to hard use, creating surprisingly high costs. As these typically are capital expenditures, IT may not budget or report depreciation of furniture and equipment at the department level or in sufficient detail to impact service desk cost reports. To understood true costs, they should.

Communications Costs: This includes phone service and internet costs, along with security expenses. If other paid services such as remote hands-on troubleshooting, conferencing, etc. are used, these costs should be included.

Support of New Hardware and Software: Despite the enthusiasm hospital leaders and clinicians may have for new IT strategies and investments, the costs of supporting usage are often overlooked or underestimated. IT leaders should work with vendors to predict potential changes in user needs. Even better, they should consult with other hospitals who use these technologies.

Frequently Overlooked Costs

On-call and Overtime Pay: Many hospitals, particularly small ones, do not have a staffed service desk 24 X 7 in off hours.  IT service requests must be handled by on-site or on-call analyst staff. These people are usually more highly paid than service desk staff and are paid special premiums for off-hours, either via overtime or extra on-call pay. In many cases, this approach to support is unnecessarily expensive, and could be handled by restructuring service desk staffing and scheduling.

Space or Rental Costs: In many budget analyses, space costs are ignored or taken for granted. Most hospitals are short on space and may even rent space off-site. But space is a meaningful cost, and typically requires dedicated infrastructural spending. Continuous usage of electrical, heating, and air conditioning is surprisingly costly. For example, service desks commonly require additional air conditioning because of the large concentration of staff and equipment located in a relatively small space.

Training: Initial new hire training costs and ongoing training of service desk agents are necessary for high productivity and quality performance. Some of the costs may be direct, based on labor costs.  Insufficient training can create less obvious costs, in terms of poor issue resolution time and slow or unsatisfactory response. Essential certifications, such as ITIL (Information Technology Infrastructure Library) should be required of key staff, and the necessary training and actual certification costs should be calculated.

Recruiting: Turnover can be high in service desks, partially because the agent’s job is an entry-level position and relatively low-paid. Burn-out is not unusual. Market demand for experienced healthcare service desk agents has increased. Managers must expect that turnover, as well as expansion of operations, will require recruitment of additional agents and supervisory staff, most of whom must have specialized knowledge. These efforts are normally made by the HR department without a direct allocation to the IT department. However, if a search firm is used, these costs are identifiable and should be covered in service desk costs.

The Hidden Costs of Wrong Problem Management

Self-Solution: It is human for a clinician or other system user to personally try to resolve his/her problem before seeking help. Or a co-worker may be enlisted to spend additional valuable time to help out. However, frequent and/or lengthy attempts at inexpert solutions are costly — and also may be a signal that users do not have confidence that service desk will solve the problem quickly and well.

Involvement of Other IT Staff: IT staff outside of the service desk often become unnecessarily involved in problem resolution. Many medical staffers have their favorite “go to” people within the IT department, including IT leadership. When users  contact these favorites instead of the service desk, costs go up.  Analysts’ and CIOs’ salaries are substantially higher than service desk agent salaries. The above-described behaviors result in an unnecessarily high problem resolution cost, particularly if the problem would not have merited eventual analyst intervention.

These hidden costs and their impact on the bottom line are illustrated in the diagram below:

Poor Usage of Service Desk Technology: Many hospitals purchase expensive service software without utilizing modules or capabilities that directly impact agents’ performance and/or costs. This occurs when service managers don’t have a mandate to optimize usage of the software, or don’t understand how to work these features to their advantage. To do so, they must  complete needed training, utilize strong vendor support, and take the time for new process set up and management.

The Bottom Line:

Many hospitals’ financials are compromised unnecessarily by the costs listed above, whether management knows it or not. We recommend that you perform an analysis of your operations’ costs to understand exactly where your dollars are going. Such cost analyses often offer new internal solutions to reducing costs and actually improving service desk performance. Some hospitals that weigh expenditures and benefits carefully choose to move their service desk operations to dedicated hospital service desk outsourcers for cost savings, consistent quality and round-the-clock accessibility.

Download our Cost Estimation for Hospital Service Desk Operations report for detailed instructions and examples to guide your assessment and analysis of costs.

For information to consider outsourcing your service desk or patient portal service support, please contact us. We can help save service costs because we leverage our dedicated on-shore service desk team across many hospitals 24 X 7 X 365.