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Foundation Members:
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CHIME Presents:
The CIOs Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 8: IT Staffing is Key to Achieving Meaningful Use
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Question posed to members:
IT staffing is widely expected to be a crucial need for healthcare organizations in the years
to come. What steps are you taking to ensure you have sufficient staffing to implement clinical
systems? What ideas for meeting staffing needs, either on a short- or long-term basis, have worked
best for you?
Comments:
Our IS staff are anticipating that we will require the assistance of Consultants to compliment our IS staff. We will need Consultants to backfill our staff while they are training and building the new clinical systems. We also expect to hire some new staff, but are concerned about the availability, especially when salaries are limited to little to no negotiation.
Some IT experts realize they have become a commodity that they can sell for the next few years. We are looking at hiring some new grads to work closely with experienced Analysts to basically grow some of our own. We are also talking with Administration and HR about offering to provide a bonus to attempt to minimize the number of experienced IS staff that may leave to find other
Bringing clinical staff who have an interest in technology into the project. Finding and hiring IS leaders who have experience with these projects. Leveraging qualified consultants with practical experience in fostering clinician adoption of EHRs.
Set reasonable objectives given staffing levels. Leveraged staff augmentation for critical projects. Also focused on retaining staff through a staff recognition program, support work life balance by ensuring staff receive vacation time and workload is balanced across the team, provide training and education opportunities to staff. Have also created career ladder to provide promotion opportunities.
That question is not terribly difficult for us, in that we are at what we believe to be MU today. We have budgeted for and are adding an additional Clinical Informatics Nurse, but staffing wise we are in pretty good shape.
For our clinical system installation, our CNO asked that the best nursing staff take full time positions in IS to support the implementation. Nursing department directors asked some of their staff to apply for information systems roles. We added 3 additional RN's to the department to take on clinical application analysts roles and 2 unit secretaries to take on application analyst roles. Nursing will refill the nursing positions they vacated with recent nursing school RNs. We also were able to "borrow" one of the laboratory clinical application staff to assist with the order system installation. We wanted the "best and brightest" to ensure the install was successful.
Elevate the visibility of the effort and connect it back to strategy and mission;
When possible, recruit (even if for temporary assignments) clinical subject matter experts internally and train them on the technology -- this allows clinicians to try it out and develop a taste for the HIT side, building up an internal recruitment pipeline;
Establish creative incentives (performance and retention $, flexible schedules and telecommuting --if project timelines allow);
Develop partnerships with neighboring schools and explore the potential for internships to enhance recruiting pipelines;
Utilize basic, yet sound management practices like rounding on staff to foster communication and accountability, recognize the team & celebrate interim milestones, reward risk taking, listen to the team and close the loop on concerns raised and other teams for follow up;
Utilize outside (contract and consulting) help strategically where expertise is lacking internally, or the organization lacks internal resource bandwidth for temporary work.
We are working with our newly selected hospital information system vendor on recommended staffing requirements, will be rebuilding skills and hiring as needed.
The best Clinical IT analysts come from internally. They understand our culture and our workflow. I can teach the IT piece. Working with nursing leadership we are identifying those individuals.
We are definitely adding staff especially clinical staff. We will also look at some support from consultants but not too much. It is next to impossible to supplement installs with consulting staff and not bear the burden of picking up the pieces afterwards.
We increased the clinical staffing with the knowledge they would be needed. The organization also created unique positions that were designed to be IT liaisons who work directly with the physicians as support. This has been a blessing in that the position is a dedicated person just to support the doctors and the doctors warmed up to the product quicker knowing that someone was always there for them 7/24 when they needed someone.
Tightly manage project scope, schedule, and costs. Phase the implementation to achieve maximum productivity of existing team members. Have a "pool" of staff supplementation consultants at the ready to be able to take on smaller project requests that are outside the main goal of implementing the clinical system or EHR so that other departments can get their needs met. Plan the project around other major hospital system initiatives such as The Joint Commission, Magnet, etc. so that resources can be maximized from the clinical staffs.
We have had significant success from recruiting from within the organization to attract clinical staff who has a penchant for information technology and a desire to leave bedside patient care. I plan to continue in this mode. We are looking for people with practical experience using technology in our hospitals. We can always teach them how to do the technical pieces that they need to know.
Developing and maintaining our relationships with our key partners in sourcing and staffing to allow for augmentation is a must. In addition, we are investigating alternative ways to leverage off-shore resources for key roles to provide leverage for the anticipating demand.
We are working with the clinical department and pulling staff as needed. It is also very important to try to build your EHR during lower census periods.
As a RHIO CIO, I can answer this from the other way around. CIOs are coming to me for leveraging my staff to help them and views this aspect of what our RHIO does as a value added to having us and to being members. In some cases, I have discussed co managing hospital personnel so that they still have direct report to hospital but I get to manage skilled and trained hospital people and assign them to HIE region effort that supports other hospitals as well. We are looking into seeing if there is Stark contribution advantage to them for doing this as they are give me partial FTEs.
Steal from your competitors who have done it. Also, train from within. Take nursing staff and other hospitalk staff and train in the EHR program to help in the design and build. They will return to their home departments either as super duper super users or will stay on in IT as support and enhancement staff!
Our approach was to not make the effort I.T. or MIS centric by putting together a team of people from different areas of the facility, that still reported up through their respective depts. An important part of this strategy was to place nurses on the team that worked part time on the implementation, and part time in their units/depts, so they maintained their clinical credibility. It is extremely important for organizations to understand that the adoption of ehr technology is more of a journey than a destination, and they need to budget not just the capital funds to implement one, but the on-going operational funds to support the staff that will maintain it....
Our EHR rollout has caused a paradigm shift in our hiring practices. Weve seen a shift (largely due to divergent leadership strategies within the department) to a younger demographic. Our Veteran IT staffers now play a mentor role for younger staff.
We also split the department into two during the implementation. Informatics handled all things EMR while IT handled network infrastructure and hardware. This allowed for us to have a more acute feel for the needs of the department. Had the team remained intact, I think the perception of requiring more staff would have been artificially inflated.
Separation worked for us.
Now that weve been live for over three years, we put the entire team back together and have begun a cross-training with the end-result being an overall reduction in staff.
The EMR training piece (which IT handled from the start) for new hires has been taken over by middle-managers, freeing up IT to focus on other projects. This fosters ownership of the processes and goes a long way toward standardization.
I make sure the HR department stays on top of the pay scale for IT staff so that I can provide honest information to my staff that we are paying in the same realm as our peers. Second, I round to my staff each week to be sure they are aware that I care about them and want them to be satisfied. Third, I try to send a Thank You note to one of them each week for something special I know they did. Fourth, I want to give them the training and tools they need to be the best at their jobs as possible.
During our initial implementation we used outside contracting services to supplement our staff for the short terms to make sure we had enough resources to complete the implementations. We also looked at some incentives like a 9 X 80 staffing model where staff worked 9 nine hours days and had every other Friday off. Due to current economic issues we have cut back on outside consulting and have eliminated the 9 X 80 program and I do have concerns about long term staffing especially if the economy improves.
a. In 2007 we developed an IT staffing plan based on our EHR strategic implementation plan. The staffing plan was designed to ensure the appropriate staffing for support and maintenance of the products (after implementation).
b. The tactics we are using to fill the positions is mostly through recruiters.
c. We are ensuring that our permanent IT staff are the lead analysts on the new implementations
d. We are using consulting resources to augment implementation services as necessary. Mostly in the areas of data conversion, temporary interfaces, project management, etc.
We have been focused on "grow your own" and hire good talent from the marketplace as they become available. In the grow your own, we have been very successful hiring "bright young things" out of MBA programs (and others) and training them in project management for healthcare. They are very qualified to build, test, etc. we tend to forget that many of the high priced staff from vendors have little or no experience in healthcare.
I analyzed my department and reorged it; I transformed it from a tech heavy unit, to a much more functional one. I hired analysts with RN, physician and other clinical background; I brought into IT the super-users from our most tech heavy departments: ED, Lab and OR.
I established a non-IT Informatics group in Nursing
It's important to not simply listen to what the vendor tells you that you will need for staffing. The numbers they provide are typically well below the actual number needed. (I sometimes wonder if they don't sandbag the numbers to make the overall project look less costly, simply so we will buy it
.) Everyone needs to establish the goals for their individual organization and provide the necessary resources to achieve these goals. You can't have a champaign taste and a beer budget. Benchmarking against other "Like Organizations" will help, but dont ever assume they are like you
establish you own needs and criteria.
On a long-term basis, identifying the resources on the Operations side that can be pulled back onto the project at any time for providing assistance is critical. This will be needed for testing of updates, rolling out new functionality and staying current as workflow processes change. Staffing for support of the EHR is always more of an art than a science. A lot depends on the complexity of the system, the competency of the users and the degree to which staff have adjusted to the new paradigm of patient care.
Staffing levels are built into the project costs, but if you cannot find them to hire, anticipate you need to get consultants to fill the void. Your relationships with the consulting firms will help you get the consultants that you need, be sure you have opened the doors before the project begins. Provide the training to those individuals on the project (staff from the floors, IT, consultants) on your processes, project mgmt, goals, objectives, etc. So everyone is on the same page. Have a good organizational & governance structure in place for your project. Include an incentive plan for retention and completion of goals and objectives.
We are trying to include staff at the planning and execution meetings so there is a buy-in and they feel like they do make a difference. Also being considered is some type of Incentive tied to teamwork, quality, and on-time.
We continue to work to hang on to what we have and make smart decisions as how best to augment the staff during the various applications installation phases. We also holding the vendors more accountable for the services that are included in the implementation expense of the contracts and we are expecting more of them during this process. We look internally to incorporate the experts from a variety of areas, not just IT folks. Most of what we are doing requires a level of process expertise; we can either get that internally or bring in expense external resources.
Staffing is always a struggle in the very tight financial situations most health systems find themselves in today. Staffing is a part of the ongoing expense of this journey and a health system should not proceed on
the E.H.R. journey if they cannot afford to invest the human capital. Some systems just cannot. We have tried to stay away from consultants, wherever possible, so that the implementation and support team have an
investment in their local environment. It is not easy.
Hanging on to the staff that I have. Cross training as much as possible. Reminding everyone that healthcare is the most interesting work available in the IT field. Filling in with consulting help. Removing obstacles and uncertainty as much as I can. Saying thank you every chance I get. Being visible, approachable, and empathetic. Standing up for staff when they get in jams. Most of all, listening, understanding and doing everything possible to answer legitimate complaints with reasonable and amenable solutions.
Trying to document the need for additional staff. Were at the limit with current clinical IT staff (and financial IT staff, as well), and its a long-term process to educate senior leadership to understand why we need more. Since they dont see 99% of the effort, during and after hours, its necessary to prove the case with statistics, peer hospital comparisons, and other hard information.
The ongoing need for IT staffing requires a succession plan to replace and expand IT capable resources. There needs to be ongoing skills development in areas of workflow, project management, team building, and systems. Unfortunately, if an organization does not have these programs in place and a culture to support this, I do not think they will be able do this in timeframe that meets the HITECH deadlines. In this case, staffing will need to be supplemented with outside resources, e.g. consulting.
Since we have a small staff we estimate the requirements and cost at contract time and include that in the total cost of the project. Should an additional FTE be required that is also included in the total cost of project and budgeted accordingly.
At this point, were not taking any particular actions to address staffing not sure it will required any additional staff.
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