Planting Seeds: Developing a Mature Health IT Team March 4th, 2016
Karen Marie Wilding, Director IS&T Operations, University of Maryland Medical System
Ernie Hood, Senior Director, The Advisory Board Company
Conflict of Interest
Karen Marie Wilding
Director IS&T Operations, University of Maryland Medical System
Board of Directors, Maryland HIMSS
Ernie Hood
Senior Director, The Advisory Board Company
Have no real or apparent conflicts of interest to report.
Agenda
• Review of Learning Objectives
• Why Are We Here - Present Day Problem
• Common Workforce Challenges
• IT Workforce Development and Management Solutions
• Closing
• Questions
Learning Objectives
• Review the HITECH program approach and subsequent delivery of tools to
support the growing industry of health IT
• Discuss common workforce challenges such as workload balance, new
skillsets, healthcare experience, and their related impact to recruitment and
retention of staff
• Identify IT workforce development and management solutions that may
assist with an organization's productivity, staff engagement and turnover
An Introduction to the Benefits Realized for the Value of Health IT
S Savings
P Prevention
and Patient
Education
E Electronic
Information/Data
T Treatment/
Clinical
S Satisfaction
• Increase staff
satisfaction
with cultural
and process
changes
• Assist
operational
teams with
actionable
guidance
• Develop tools
and checklists
to ensure
consistency
across
management
team.
• Ensure all staff
members are
engaged,
assessed
frequently and
have a
development
plan in place.
Improves
quality of EMR
support for
clinicians.
• Reduces risk of undesired turnover
• Provides consistency in processes, reducing operational inefficiencies
Source: University of Maryland Medical System; The Advisory Board research and analysis.
• Identification of potential staffing issues with action plan development and implementation.
Why Are We Here – Present Day Problem
ARRA - 2009
Office of the National Coordinator (ONC) was awarded $84 million to
implement the Health Information Workforce Development Program.
Main objectives are focused on support training and certification of skilled
workers:
1. The development of high quality education materials
2. Community college non-degree training programs
3. A competency exam program to evaluate trainee knowledge and skills
4. University-based training programs for specialized health IT roles
2015-2016 Refresh Efforts
• ONC has awarded seven grantees $6.7 million to update training materials from the original Workforce Curriculum Development program funded under HITECH.
• Train 6,000 incumbent health care workers to use new health information technologies;
– team-based care environment
– long-term care facilities
– patient-centered medical homes
– accountable care organizations
– hospitals and clinics.
• The updates will focus on the four key topic areas
– Population Health
– Care Coordination
– New Care Delivery and Payments Models
– Value Based & Patient Centered Care
Health IT Workforce – Early Data
In the landmark 2009 ARRA legislation, HIMSS estimated there was approximately 108,400 HIT jobs in hospital settings.
2012 – Forecast - workforce needs to require an additional 40,800 HIT
– Clinicians
– IT professionals
– HIM professionals
Data Limitations
– Mostly located in Hospitals
– Does not include Vendors, Biomedical Engineering, Consultants
• An English NHS study found workers to be distributed among
– information and communication technology staff (37%)
– health records staff (26%),
– information management staff (18%)
– knowledge management staff (9%)
– senior managers (7%)
– clinical informatics staff (3%)
• Australian study classified jobs into two broad categories, but noted that many individuals work in more than one role, either within or across the categories:
– Those who work "in the system,"
• e.g., records, analysis, direct, decision, communications, and training
– Those who work "on the system,"
• e.g., systems, info structure, improvement, education, resource, and administration
Other Countries
Changing Healthcare Environment
• Meaningful Use (Stage 1, 2 & 3)
– EMR Data Elements
– Quality Reporting
– Vendor Standards - CCHIT
• International Classification of Diseases (ICD-10)
• Health Information Exchange – Increased integration across complex systems
• Affordable Care Act
• State Public Health Reporting
• Reimbursement Reform - CMS Regulations (2 Midnight – example)
• Organizational growth, desire for data
2014 HIMSS Workforce Survey
IT Staffing Increases Were Planned in 2014
Further Increases Planned in 2015
5%
11%
35%
49%
Don't Know
Decrease
No Change
Increase
N = 328
Source: 26th Annual HIMSS Leadership Survey
How many more?
• 2008 Bureau of Labor Statistics report projected the need for an additional
35,000 HIT workers by 2018
• 2008 analysis of the HIMSS Analytics database estimated that U.S.
hospitals will need an additional 40,000 workers to meet HIMSS EMR
Adoption Model Stage 4
• ONC estimates that hospitals and physician practices need an additional
50,000 HIT workers during the next five years to satisfy EHR “Meaningful
Use” criteria
• The American Medical Informatics Association 10x10 program is based on
the assertion that there should be at least one physician and one nurse
trained in medical informatics in each of the 6,000 hospitals in the US
HIMSS Survey of Member Orgs in 2011
Perception
“ Lack of Trained IT Professionals to Handle Future Workload”
– Respondents were most likely to report that there would be a shortage of implementation experts and clinical informatics professionals that would impact their organization’s ability to handle future work.
Hiring Past and Present
• Nearly three-quarters of
respondents reported that
they planned to hire IT
FTEs in the coming year
(2014-2015).
• Nearly 25% of respondents
reported planning to add 6
or more IT FTEs to their
staff in the next year.
Planned Number of IT Hires in the
Next Year by Healthcare Provider
Organizations
2014 HIMSS Workforce Survey
Organizational Barriers
2014 HIMSS Workforce Survey
• 2010 Modern Healthcare survey of executives asked about 12 month priorities:
– 58 percent of respondents planned to increase HIT staff
• These increases are substantial— 40 percent said 10 percent or more,
and 9 percent said between 31 and 50 percent
– 49 percent reported difficulty recruiting, and of that group 70 percent listed
“lack of availability of IT professionals in our market” as a major cause
• A 2010 College of Healthcare Information Management Executives (CHIME)
survey of members about concerns associated with meeting EHR meaningful
use criteria found:
– Staff levels and capabilities was one of the top three concerns of 49.1
percent of respondents and the most frequently mentioned number 2 and
number 3 concerns
Additional Concerns
IT Initiatives ON HOLD due to Staffing
2014 HIMSS Workforce Survey
Who is Hiring Health IT Workers?
• Hospitals, health systems
• Software vendors and consulting firms
• Education / Academic
• Insurance / payers
• Start ups
• Associations in healthcare
• Physician organizations
• Bio-Tech companies
• Pharmaceutical companies
• Government
What is needed?
• Executive, senior IT leaders
• Clinical and medical informatics leaders
• Technical and IT security positions
• Department chairs, professors and faculty
• Directors/managers/supervisors, team leads
• Project management leaders, application, implementation specialists
• Systems analysts, data analysts, web designers, system architects, interface experts
• Sales, marketing and business development
Common Workforce Challenges
Forecasting Nurse Staffing
• 42 Code of Federal Regulations (42CFR 482.23(b) requires hospitals
certified to participate in Medicare to
– … "have adequate numbers of licensed registered nurses, licensed
practical (vocational) nurses, and other personnel to provide nursing
care to all patients as needed“
• “Hospitals with low nurse staffing levels tend to have higher rates of poor
patient outcomes such as pneumonia, shock, cardiac arrest, and urinary
tract infections”
- according to research funded by the Agency for Healthcare
Research and Quality (AHRQ) and others.
• ANA sponsors a Safe Staffing Campaign
EMR Adoption Model (EMRAM)
• Average staffing ratios generally increased with adoption score, but
hospitals at Stage 4 had a higher average staffing ratio than hospitals
at Stages 5 or 6.
Average IT staffing ratios varied based on EMRAM stage
* No hospitals at
adoption Stage 7
at the time
of the study.
Low turnover - but increasing stress and competition
A Dangerous Situation?
Clear Preference For Health Care Experience
Respondents answered this question using a one to seven scale where one was not at all likely and seven was
highly likely.
2014 HIMSS Workforce Survey
How do you counter these challenges?
Key Challenges to IT Staffing
The Same Challenges Impact Both Recruitment and Retention
Challenges
• Unbalanced
workloads
• Increasing demand
for new skillsets,
• Need for healthcare
experience
Impact
• Recruitment
• Retention
Turnover Costs are Real
• Recruitment Process: Advertising, interviewing, sign on bonus, relocation, Utilization of an agency
• Onboarding & Orientation: Management time, team support, dedicated sessions
• Training cost: Vendor based, specialty or organizational
• Lost productivity: it may take a new employee 1-2 years to reach the productivity of an existing person.
• Lost engagement: other employees who see high turnover tend to disengage and lose productivity.
• Cultural impact: Whenever someone leaves others take time to ask "why?"
• 5k – 45k
• 10k-15k
• 5k-10k
20k – 75k at minimum
with a short window of time and a reasonably skilled replacement
Not included - Backfill – average of 3months, 30k a month – 90k minimum
Will These Be Enough to Retain Valuable Staff Into the Future?
Strategies for Retaining Existing IT Staff
23%
8%
8%
8%
4%
4%
58%
39%
27%
32%
35%
19%
15%
8%
4%
15%
39%
50%
32%
39%
46%
35%
50%
42%
19%
4%
12%
12%
20%
15%
23%
35%
39%
31%
35%
4%
4%
8%
8%
8%
15%
12%
19%
42%
Job Sharing
Mentorship Program
Challenging Opportunitiesand Choice of Work
Incentive Bonuses
Telecommuting
Well-defined Career Path
Flexible Work Hours
Competitive Salary and Benefits
Training and Development Programs
Open Communication andTransparent Work Environment
Never Rarely Sometimes Usually Always
• Source: The Advisory
Board Company survey
analysis.
Source: The Advisory Board Company survey analysis
Tools used to Recruit
2014 HIMSS Workforce Survey
IT Workforce Development & Management Solutions
Key Imperatives for the IT Workforce
• Work Force Planning
• Development
• Management
Checklist for IT Workforce Planning
Pro active Work Force Planning
Five Key Imperatives for IT Workforce
Development
Protecting your stars
• What roles do you hire now (e.g., DBA, Analyst, Programmer, etc.)? What are the key
characteristics for an employee in each role?
• For each role, who are your stars? How often do you re-evaluate them? How are their
roles likely to change in the future? Are your stars likely to continue their success as the
role evolves?
• Does the organization have an image among professionals in your community? Does this
image vary from professional group to professional group? For example, what does the
local business intelligence community think of your organization? Are any of your staff
well respected in the community for their professional expertise?
• How are rewards and recognition designed? How do the pay and benefits align with the
performance levels of your stars? How does the organization monitor staff satisfaction
and engagement?
"Most people don't quit their jobs, they quit their managers,“
- Wendy Duarte, VP of recruiting at Mondo
Developing the staff you have
• Is adequate training provided on key competencies for each role?
• Does staff in each role ever add credentials/education/experience in
order to take on new assignments? What is done to encourage such
growth? Is public recognition given within IT for new certifications /
degrees?
• What are the most salient issues for staff in each role?
• How are priorities and expectations defined? Do managers drive
career planning and succession planning initiatives, and offer
opportunities for career advancement, coaching, and mentoring?
Attracting new talent and implementing ongoing retention strategies
Attract and Retain Strategies
• How long does it take to hire for each role? What are the “break in” periods
and transfer rates for each group? What is the normal length of service?
• How many of the current staff are likely to leave in 3, 5, and 10 years? What is
the cost of a vacancy for each role?
• Who are your chief competitors for each role? What are your organization’s
advantages and disadvantages over its competitors? What can be done to
improve advantages over the next 3, 5, and 10 years?
• What are the most common reasons for staff in each skill category to quit?
What were the most important issues that came up during past staff retention
efforts and exit interviews? What actions worked or failed in retaining staff?
Planning work effectively
• Taking into account market changes, demographics, and technology changes, what
are your projected staffing needs over the next 3, 5, and 10 years? Do you estimate
the candidate pool for each role to grow or shrink? What is the basis for a projected
increase or decrease of staff in each category?
• Do you have benchmarks for staffing ratios for each role such as the number of
servers a single engineer can support or the ratio of employees to help desk
analysts? Are staffing models available for each role?
• How is capacity managed? How does the management determine the necessity and
timing for addition or reduction of staff with specific skills? How are staffing
increases justified?
• Do you track metrics for weekend work and email handled outside of normal work
hours? Does the staff get comp time-off that they can really use? How is coverage
provided for unexpected extended absences?
• How much lead time does the management get for voluntary separation (retirement
or transfer)? Does the management regularly check in with staff on this issue?
Marketing your IT organization in the community
• Does the organization have a talent pipeline with schools that produce
qualified candidates?
• Do staff maintain relationships with trade organizations associated with
required skill groups as well as with other general industry groups?
• Does your staff publish in trade magazines or actively participate in
credible online forums? Do they get involved with groups like HIMSS
and take on leadership roles?
• How do the compensation packages you offer compare with industry
standards and competition?
Success of Recruiting Tools
Respondents answered this question using a one to seven scale where one was not at all successful and seven
was highly successful.
2014 HIMSS Workforce Survey
Create Development Plans That Add Both Depth and Breadth
Specialists vs. Generalists
Case studies show that most organizations have a small number of individuals like Linda with both depth
and breadth of skill .
Thoughtful development of staff with a broad set of skills and deep knowledge and experience can
increase engagement and flexibility and make you a more attractive employer.
Don’t you wish all your staff were as skilled as Linda?
Skill
Analysis Design Code/
Configure
Test Manage
Barry Advanced None None Moderate None
James Beginner Moderate Moderate Beginner None
Shelby Moderate None None None Advanced
Linda Advanced Advanced Advanced Advanced Advanced
Create Thoughtful Development Plans
A Process for Staff Development Planning
1. Identify Skills
2. Define Evidence
3. Assess Staff 4. Development Plan
5. Track Progress
• On a team-by-team basis
• List all of the skills required by a
team to fulfill its function
For each skill define
an action that
demonstrates a level
of mastery
Use a skills matrix to
track progress
Assess all team
members mastery of
each skill
Create a development plan for
each team member that
advances their mastery
Tracking Staff Development
Skills Matrix Example
Skill
Analysis Design Code/
Configure
Test Manage
Barry
James
Shelby
Linda
No
Experience Attended training;
understands
concepts
Applied the
concept
Demonstrated
consistent application
Deep understanding
& consistent practice;
able to train
Closing Thoughts
Key Takeaways
• Our industry will continue to change at a pace that will demand highly-skilled and dynamic teams.
• Regulatory and Organizational project work will not slow down; investment in your staff needs to be continuous.
• Identify and implement a staffing plan that accounts for a strong recruitment and retention plan, staff development and management growth.
• Protect your stars.
An Introduction to the Benefits Realized for the Value of Health IT
S Savings
P Prevention
and Patient
Education
E Electronic
Information/Data
T Treatment/
Clinical
S Satisfaction
• Increase staff
satisfaction
with cultural
and process
changes
• Assist
operational
teams with
actionable
guidance
• Develop tools
and checklists
to ensure
consistency
across
management
team.
• Ensure all staff
members are
engaged,
assessed
frequently and
have a
development
plan in place.
Improves
quality of EMR
support for
clinicians.
• Reduces risk of undesired turnover
• Provides consistency in processes, reducing operational inefficiencies
Source: University of Maryland Medical System; The Advisory Board research and analysis.
• Identification of potential staffing issues with action plan development and implementation.
Questions
Karen Marie Wilding
Director IS&T Operations, University of Maryland Medical System
Ernie Hood
Senior Director, The Advisory Board Company
