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.
A rising tide of employee turnover
The correlation between workload and turnover
“It was a work/life balance issue for many”
Working with HR
Getting feedback from staff
Knowing when the sprint will end
The big challenge when you’re looking at compensation… is that it takes time to go out and survey the market, determine what the market target is for a particular role and determine whether you need to make an increase.
I think it’s important to be as transparent as you can be about why the workload is as it is, what our goals are, and what we’re trying to accomplish. I think people need to understand why they have to do the things that they’re doing, why is the workload high—and then they can rationalize it better.
We’re competing for dollars just like everyone else. So you try to provide a good solid business case and demonstrate the return on that investment. I think if you can present it in those terms, you might be able to compete better for those dollars.
Guerra: Let’s go through some of the specific results. First off, the heavy majority said—and this was surprising to me—that they are not seeing staff turnover. So that was 82 responses saying ‘no,’ compared to 27 saying ‘yes.’ That was surprising to me, did that surprise you?
Gash: No, because the turnover that we were seeing, you could correlate it to an anomaly. I just have the sense that this was going to be a trend that it was going to get worse. When I did this in January I only had a couple of FTEs leave, and since then as we’ve been implementing our plan, unfortunately we had more people leave and had a complete turnover in our clinical team. I think I was right when I thought there was a problem there. We tried to intervene, but these things take time, so unfortunately we lost more people, and it was critical to our deployment. So it may not look like there is an ongoing trend, it might look like an anomaly; I just think there may be more to it than that. So it doesn’t surprise me that a lot of them were not seeing turnover. Also, I guess it depends on the volume of work that you have. Maybe you’re not being as aggressive as our organization was in deploying the technology, so if you’re not seeing a huge increase in your workload, it may not impact your staff. So I guess there could be a lot of factors that would contribute to that.
Guerra: It’s very interesting trying to figure out if turnover is a result of someone just moving for a better opportunity because they can get more money or if they want a change, versus to what degree an increased workload is contributing to any change.
Gash: I did exit interviews also, talking to folks about their decision to leave and why they made that decision. You try to retain folks as best that you can, but it was a workload, work/life balance issue for many. Then a nice opportunity—to make more money or receive a promotion of something like that, there were situations like that as well.
Guerra: Now when you hear that, do you say to yourself or do you say to them, ‘I wish you had come to talk to me’ or does that factor into it because you really can’t moderate the level of work that needs to be done because it just needs to be done?
Gash: We did try to intervene in situations where there was dissatisfaction, but ultimately, some of them left anyway.
Guerra: Right. Do you think some of those could have been moderated with increased compensation, or they were going to go because it was a work/life balance or quality of life issue where it really didn’t matter if you gave them another $5,000 to $10,000?
Gash: We tried to increase compensation and that didn’t keep them, so it had to have been other reasons that were driving them away.
Guerra: Right. I like your thoughts on working with HR. You mentioned that it sounds like you wish you had been able to act a little more aggressively in terms of putting something in place. Obviously large organizations can be a little bureaucratic; sometimes HR has a lot on its plate. Any advice you can give your fellow CIOs in terms of working with HR to get these things created and activated as quickly as possible?
Gash: I feel like I got great support from our compensation and benefits team here. The big challenge when you’re looking at compensation—are you paying the right amount and should you increase pay—is that it takes time to go out and survey the market, determine what the market target is for a particular role and determine whether you need to make an increase.
That work takes time and you have to allocate and account for that so your HR department can complete those efforts. Then you have to assess what that means from a financial perspective and go out and communicate that to your organization, because if you do need to increase pay, then you have to negotiate that through your organization. That takes time, and there are a lot of people or a lot of areas within the organization that might be impacted by it.
So I think it’s worthwhile to perhaps have a process in place where you’re having some kind of regular review of compensation and not just doing it as issues occur. That would be kind of a lesson learned for me; I think I will be more proactive engaging my compensation and benefits staff to continually be looking at salary surveys and assessing whether I am in the right place and my market is right for my particular skill set. And then if you need to make adjustments, you’re continually making them rather than waiting for an incident like turnover to say, “We need to make adjustments to compensation.”
Guerra: Have you had any thoughts on how to more proactively or increase communication with staff that may be becoming dissatisfied, and to get that information more quickly so that you can respond to it before they’ve already found another job and they’re out the door?
Gash: I don’t think I have the magic bullet on that. We found that people sometimes don’t want to talk about or share their particular issues, so we’ve implemented survey tools to try to get at that information or understand that dissatisfaction if it’s there. I’m not sure I know the right answer there. I’ve tried multiple different techniques to get feedback from staff, do all the things that people recommend; I’m just not sure I have the right answer.
Guerra: Also, if you go about doing that, you have to somehow figure out the difference between regular, everyday complaining, which every employee always does, and the really serious issues. Everybody wants to work less and make more money, some people really deserve to work less and make more money, and some people will go elsewhere. But you have to be able to separate the everyday complaints from the serious issues. Does that make sense?
Gash: Yeah, and I think it’s important to be as transparent as you can be about why the workload is as it is, what our goals are, and what we’re trying to accomplish. I think people need to understand why they have to do the things that they’re doing, why is the workload high—and then they can rationalize it better. For me personally, that helps when I’m trying to keep myself motivated. I need to understand what the ultimate goal is, why we’re working the way we are, what are we trying to accomplish from an organization perspective, and how that work helps the organization as a whole. I think that’s important. The feedback I get from my staff is that they appreciate that kind of information and it helps them.
Guerra: I was speaking with an individual who knew of a situation at a health system where the IT staff had been asked to work at a very high level. They could handle that for a while, but turnover started once he felt the staff did not see an end to the sprint they were being asked to run. So you can have them sprint for a little while, and they may sprint well, but they need to know that the sprint is not endless. Do you agree with that?
Gash: Yes, and I think that goes back to what we are trying to do; what’s the ultimate goal, and how are we going to get there and try to do what we can to celebrate the successes we have along the way and continually reaffirm what we’re trying to do, where we’re going. We really try very hard to protect the holiday timeframe for folks. We’ve actually delayed things to make sure people can have time off to be with their families. I think you have to respect that. Even though you do have these goals to meet, there has to be some balance there and my team has tried very hard to make sure that we’re protecting that as well.
Guerra: So we talked a little bit about working with HR. Let’s talk about working with the CFO, COO, CEO or the board—basically the people that you need to get the dollars approved. And I’m sure this would depend on each organization’s governance, but I’m thinking that at a higher level, there is a limit to what you can pay and stay solvent. And while we’d like to pay people a certain amount that would keep everyone happy, we just can’t afford that. So sometimes you come up against the financial realities of the limits.
Gash: That’s true. I think that we’re no different than any other hospital department or any other part of our organization; we’re competing for dollars just like everyone else. So you try to provide a good solid business case and demonstrate the return on that investment. I think if you can present it in those terms, you might be able to compete better for those dollars. There is going to be a limit and there is going to be a point where you say we can’t do anything more, but then you have to be able to explain the impact that might have on completing those projects. And I think the organization has to make decisions about whether that’s okay, and perhaps reset expectations. I think ultimately it does come to the point where you have to say, “We can’t do all of that. We have to reset our expectations, and this is what we can accomplish.”
Guerra: One other response that was funny read like this: “Asking for key staff to have retaining bonuses, acting CEO who I guess is also the CFO is against it. It costs money, go figure.”
Gash: I’m fortunate that I don’t have that kind of response. Actually, the retention bonus is something we’re considering. There’s a lot of work that has to go into that; what that’s going to look like, how it’s going to work, and how you define that. But it’s something we did during Y2K and it had the desired impact—the organization was able to get through that without issue. And I think meaningful use is one of big those events where it would seem reasonable to do some kind of retention bonus.
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.