Retaining talent is one of the biggest challenges CIOs face in today’s ultra-competitive health care IT industry. Between area hospitals that are expanding their IT staffs to meet meaningful use requirements, and vendors that are beefing up their workforce to provide adequate support, it’s become more challenging for CIOs to keep their best workers in house. To address this growing problem, Deborah Gash, VP and CIO at the 11-hospital St. Luke’s Health System in Kansas City, Mo., turned to her colleagues by distributing a survey through CHIME, and found that other CIOs facing similar situations were willing to share their employee retention strategies. To learn more about Gash’s work, healthsystemCIO.com editor Anthony Guerra caught up with the California-based CIO.
About St. Luke’s
Retaining employees while working toward MU
“People are working a lot harder that they typically did”
McKesson inpatient/Allscripts Ambulatory (CPSI for crucial access)
RelayHealth for connectivity
Supporting 80-90 core applications and “too many interfaces to count”
Neon Impact for interfacing
Operating in a competitive environment (Cerner is here)
Clinical informaticists (especially those with RN background) highly sought
Soft vs hard compensation
With all of the time spent working on meaningful use, the workload has increased, as you can imagine. And people are working a lot harder than they typically do, spending time on the weekend and putting in extra hours just to get all of the work done.
We’ve got several feeder systems that send data to Relay Health, so it acts as our information exchange within our organization.
We’ve seen a lot of our talent get recruited away by vendors—and I’m not saying Cerner is out there recruiting our staff, that’s not the case. But of the folks that have left our organization, many of them have either gone to work for consultants or gone to work for vendors to do implementations. So that seems to be what’s drawing away our staff, not necessarily other hospitals in our market.
You have to come at this from multiple methods. We’re all motivated differently, and what motivates one employee may not motivate another. So I think having multiple approaches to address the problem is the right way to go, and that was the advice that I received from our comp and benefits department.
Gash: Good morning to you too.
Guerra: Let’s set the table here. To start off, tell me a little bit about St. Luke’s, and we’ll go from there.
Gash: St. Luke’s Health System is an integrated delivery network located in the Kansas City region. We have 11 hospitals located in both Missouri and Kansas. We have a fairly large base of employed physicians within the organization and a homecare and hospice organization. Our IT department is a corporate entity of the health system; we have roughly about 123 employees in our IT department supporting the health system.
That comprises both the technology side as well as clinical and biomedical engineering. We, like most other health care organizations, are working toward becoming meaningful users of health IT and have been focused on deploying our various clinical modules in both our ambulatory clinics and our acute care hospitals. We’ve enjoyed a rather positive employee retention rate over the last four or five years, with retention being about 99 percent year-to-year, and have seen very little turnover in our IT organization. Employee satisfaction has also been very high in the 80 percent-plus range, and that’s been very positive for us.
With all of the time spent working on meaningful use, the workload has increased, as you can imagine. And people are working a lot harder than they typically do, spending time on the weekend and putting in extra hours just to get all of the work done. We started to see a little bit of a higher turnover rate in certain portions of our teams, and that was kind of concerning to us. We also saw some indications, not statistically significant, but indications that employee satisfaction and perhaps morale were declining.
So I began working with our corporate compensation and benefits department to look at ways that we could ensure retention of these very critical positions, and we started looking at creating a retention program. One of the first things I wanted to do was to see if what we were experiencing was unique or whether other organizations were also starting to notice similar trends. So I initiated the CHIME survey and wanted to get some feedback from my peers and see what other people were seeing and what they were planning to do to address this issue as it was starting to develop.
Guerra: Alright, and we’ll get into those results, but let’s talk a little bit more about your IT staff and what they’re supporting. You mentioned a few departments—you said you have 123 people, 11 hospitals. Let’s talk a little bit about the main vendors that they’re working with. What is your core inpatient system and what is the main HR vendor you’re using on the outpatient side?
Gash: We use McKesson Horizon Clinicals for our inpatient acute care facilities, and then we also have Allscripts in our ambulatory clinics. And that is the EHR that we’re deploying to all of those practices. We have three critical access hospitals that are in our organization and those facilities have an instance of CPSI that does all of their hospital as well as outpatient services, and provides their electronic health record and their revenue cycle management and financial systems.
Guerra: Not to get off track, but where are you with any sort of McKesson/Allscripts integration?
Gash: We have not integrated Allscripts to McKesson. We’re using Relay Health as our connectivity solution, and our hospital systems are sending data to Allscripts through that Relay Health connection. We’ve got several feeder systems that send data to Relay Health, so it acts as our information exchange within our organization.
Guerra: So there is some information flow, but not a direct interface between McKesson and Allscripts.
Gash: That’s correct.
Guerra: Okay, but you have a solution there to get something going.
Gash: Correct. It’s pretty comprehensive in that we’re able to send all of our results that are being created either in our regional lab or in our hospital directly to the Allscripts environment.
Guerra: Some of the other figures that I hear discussed when we talk about the complexity of an IT environment would be the number of applications in your portfolio. Some have them in the hundreds. Do you have that number approximately?
Gash: The number of core applications we have is probably close to 80 to 90. It’s a significant number of products that we’re supporting.
Guerra: What about interface—do you know approximately how many you are supporting?
Gash: Too many to count. The diagram is pretty ugly.
Guerra: Do you have an interface engine that you use?
Gash: We do, we’ve been using a product that used to be owned by Sybase. I think it’s changed hands several times, and it’s called Neon.
Guerra: Okay. So let’s talk a little bit about the environment in terms of Kansas City. How would you describe that on a competitive scale? This will dovetail into some of the results that I’ve seen in the survey you put out. But just tell me about how you would describe it in terms of degree of competitiveness for talent.
Gash: I would say it’s very competitive. We have a number of healthcare organizations in Kansas City that we compete with when it comes to staffing, and the other challenge we have is that Cerner is here in Kansas City. So we’ve seen a lot of our talent get recruited away by vendors—and I’m not saying Cerner is out there recruiting our staff, that’s not the case. But of the folks that have left our organization, many of them have either gone to work for consultants or gone to work for vendors to do implementations. So that seems to be what’s drawing away our staff, not necessarily other hospitals in our market.
Guerra: That’s a great point that I think many people don’t think about. I’m wondering, have you lost staff members to any of the programs that the government has put into place to supposedly help you, such as the regional extension centers? I mean, they have to get staff from somewhere.
Gash: I have not seen or had any staff leave to go to those types of organizations.
Guerra: Probably a smart move on their part, seeing as the funding is questionable for those organizations. But I digress. Anyway, so you initiated the survey and I will say that I don’t know if you’ve seen or looked at many of the CHIME survey results, but your results were extremely robust compared to what I’ve seen on other surveys. And I’m guessing this topic really resonated with the CIOs out there. Did you get a pretty good response rate?
Gash: I did get a great response rate and actually received emails from folks that were going through similar situations who shared with me more details about what they were doing in their organization.
Guerra: You mentioned turnover before—can you narrow it down to specific areas of staff that have seen the most turnover?
Gash: It’s been folks that have a clinical background and an IT background and have done implementations. So a lot of our clinical informatics people are the ones that are being heavily recruited. If they have an RN background, that is a particular interest as well.
Guerra: That’s interesting. So let’s talk a little bit about the results. And I think a good way to parse the results at a high level to start out with the soft compensation and hard compensation. The hard compensation is very easy to characterize as dollars and cents. So that’s on the one side, and the soft compensation is everything else. I’m going to read to you one of the results that I think really describes these soft compensation-type things. It’s the recognition; it’s the training, the movie tickets, the staff celebrations, the lapel pins—my wife worked in a hospital and she used to get coffee certificates, service excellent awards, recognition on the internet, and just general engagement. Do you think that makes sense as a way to start thinking about this from the soft and the hard compensation?
Gash: Absolutely, and I think those are things that are really easy to implement. It just takes some attention and someone making sure that those things are being done. Those are not the real costly things but probably a little bit more time-intensive to do. But they seem to have a great impact on the employees and on their satisfaction with their work.
Guerra: Just to throw this out there, to me there’s a limit on how far you can get with those—and it really depends on the employee. Because for some people, those are going to be great and they’re going to do the job; but for other people, they’re going to do very little. And for anyone, they probably have their limits. For example, with some of the different employers I’ve worked for, if I heard one more time about the special opportunity I was going to be given but there wasn’t going to be any money attached this time, I would’ve jumped out the window. So there are limits to lapel pins, right?
Gash: Well, I think you have to come at this from multiple methods. We’re all motivated differently, and what motivates one employee may not motivate another. So I think having multiple approaches to address the problem is the right way to go, and that was the advice that I received from our comp and benefits department.
CHIME Member to Member Survey
(Jan 3-17, 109 responses)
Member Deborah Gash, VP & CIO at Saint Luke’s Health System, would like to survey members to determine if any organizations are utilizing retention bonuses or other retention strategies to keep staff necessary to become a meaningful user of HIT.
Are you seeing an increase in staff turnover?
82 – No
27 – Yes
Are you considering a retention program?
80 – No
29 – Yes
If yes does it include a retention bonus tied to achieving MU?
63 – No
12 – Yes
What are your plans to retain staff?
1. Plans are multi-threaded including a re-evaluation of pay scales relative to the market and the competitiveness for specific experience and skills. Additional focus on team-building and improving management visibility with staff.
2. Adjust compensation timely, keep them engaged and challenged.
3. Increase compensation, benefits, and training.
4. Typically our retention is very good (less that 5% per year). Right now we’re treating as an anomaly, but will watch and evaluate.
5. exciting work seems to be keeping in people engaged and happy
6. We have a Pay for Performance program
7. Providing flexible work hours
8. Ensure our pay rates are competitive in the region and focus on employee involvement and job satisfaction
9. Looking at a Yearly incentive plan to pay IT strategic employees that will help the healthcare system meant the IT needs to receive the stimulus payments from the Government agencies. I am looking at a 10% of annual salary. The issue we have is how to measure what is accomplished to determine annually payment and how long to extend this plan.
10. Offer meaningful employment at a reasonable price.
11. we are relatively rural and tend to keep talent once we get them. I feel for those of you in urban areas.
12. None at this time.
13. Keep them challenged. Provide adequate training opportunities. Give them opportunities outside of their normal tasks/responsibilities. Keep them informed. Keep salaries competitive with the local market.
14. Retention bonus primarily tied to MU-certified system implementation, but not tied to achieving MU.
15. increased training; benefits such as comp time, telecommuting, flexible hours.
16. market analysis project bonus salary increase for really high performers
17. We have an annual incentive bonus for all team members depending upon the hospital’s performance financially and in various quality and satisfaction scores. We also offer career
ladders and excellent benefits. We have not had issues with turnover yet.
18. Create a retention program tied to MU major milestones.
19. Retention bonus, work at home, flexible hours, great working environment, professional development, etc.
20. Asking for key staff to have retaining bonuses. Acting CEO (CFO) is against it. It costs money. Go figure.
21. Competitive wages commensurate with their licensure, i.e., Clinical IT RN is paid higher than general RN staff.
22. High staff satisfaction through staff engagement and development.
23. Treat people like professional adults — give them a sense of mission, an opportunity to manage themselves, build a selfless team environment, and make it more fun to work here than anywhere else.
24. We have just started working on this program.
25. Satisfaction surveys and follow up, goal setting
26. Prayer and alcohol
27. Using open communications with staff on the status/growth of the facility
28. We have completed extensive market surveys with all of our IS clinical team staff and increased their salaries by 10 to 20% depending on experience. Also, we have created a commitment for all employees that go to new training/certification programs that they have a time commitment of 2 years to work here or they will owe a prorated amount of the cost if they
leave before then.
29. provide a good working environment, interesting work, opportunity for advancement and reasonable pay.
30. Invest in culture, connect to mission and develop employee engagement. Create professional development opportunities. Competitive compensation and for key positions, incentive payment tied to meeting timelines, budget and user satisfaction targets.
31. Provide a stimulating and supportive environment where employees want to come to work.
32. Continue to monitor until it becomes a problem and adjust rates as appropriate.
33. Other forms of recognition
34. We have a very low turnover rate.
35. Have been anticipating turnover due to MU and have not seen it yet. I will be interested in the results of this survey to determine if we need to create an incentive plan.
36. We are retiring our Revenue Cycle System and have offered a retention bonus to the two key programmers who support it to stay until the new system is fully implemented.
37. Good working environment and good employer.
38. Growth opportunities and periodic increases that meet or surpass market
39. Nothing specific, and nothing in the compensation area. Have started other initiatives intended to improve staff satisfaction, e.g. team building, professional development, leadership
development, communication enhancements, etc.
40. I am not losing people, but I am having trouble finding new staff.
41. Provide excellent working environment, competitive salaries — not different from what we usually do.
42. In this economic climate, we are not having IT staff turnover issue.
43. We have had little to no turnover in IS.
44. Most of our staff participate in a project-based bonus plan which they all like.
45. More educational opportunities and base salary readjustment.
46. We are in a small market so no issues with this.
47. Continue to address our employee engagement survey items. Flexible work schedules and work from home.
48. We are looking at incentive bonus, team bonus, plus merit. We also are reviewing other non monetary incentives, such as work from home, casual dress, etc.
49. Conduct market salary adjustments and education opportunities
50. We use retention bonuses very sparingly (our HR dept. has temporarily suspended the use of them because they were not being consistently applied – criteria under development). We primarily use recognition – liberal public praise, gift cards, movie tickets, staff celebrations, special lapel pins and certificates for accomplishments, service excellence awards posted on our intranet, career and personal development planning, internal mentoring programs, employee surveys and action plans, an employee advisory committee, and spotlights in our department newsletter. Also, our merit increases are heavily tied to individual performance via fiscal year goals. We do a salary review every other year or more frequently as needed based on market hot job fluctuations to understand pay scales within and outside of our industry.
51. Identify the top talent, continually recruit them, and keep HR involved and educated on organizational risks of staff attrition.
52. Periodic review of the market. Adjustments which follow
53. Keeping them engaged in meeting Meaningful Use as well looking for input on strategies for achieving Meaningful Use.
54. 1. new projects, 2. education opportunities 3. Market competitive salary’s 4.keep them busy with more responsibility
55. We are and have been working on a company wide “employee engagement” program.
56. So far, not a problem. That may have to do with our geographic location.
57. Continue to offer a progressive agenda with high levels of recognition.
58. We just finished a three year retention plan last year for clinical informatics positions. Our turnover rate has been on the rise since we completed the program. We are considering the need to do something again. Consulting groups are getting very aggressive with recruiting our staff.
59. We are starting to do retention bonuses but they are not specifically tied to MU attainment. They are simply based on time staying on the job as our HR department advised us that was the cleanest way to bonus.
60. more flex time, telecommuting options, compensation studies to keep abreast of market changes.
61. Support continuting education, professional development, andlife balance.
62. We have discussed the need for a potential retention bonus but until we start seeing more evidence of staff turn over we have held off on implementing one.
63. Flexible work schedule, work remotely, special incentive bonuses.
64. Continue with and upgrade employee engagement programs.
65. Standard – stay retention bonus. Paid quarterly. Have it budgeted but have not put it into operations yet.
66. If anything it would be tied to successful go-live and support of our Stage 1 project.
67. Training, mentoring, career directions
68. update salaries to be competitive improve employee working experience
69. Trying to keep them challenged and appreciated. Lots of verbal recognition.
70. The project manager on our clinical system implementation has bonuses tied to milestones of the implementation.
71. Continue doing what I am doing and focusing on employee engagement.