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.
- Structuring retention bonuses
- St. Luke’s thoughts on retention so far
- “We’re still trying to figure out if it’s financially feasible to pay a bonus”
- Finding net new talent
- Bottom line: Don’t wait until it’s too late
The advice I’ve been given is that we should tie it toward the objective that we’re trying to accomplish—and not only that we completed the objective, but that we did it well.
The first thing we were asked was who is in and who is out as far as receiving the bonus, and it’s really difficult to say that anyone is out because when it comes to deploying new technology, everyone plays a role.
We haven’t really recruited specialists. We’ve really looked for folks that will fit within our culture and have similar behavioral traits that we aspire our employees to have. Then we invest in the education to teach them about the products that we’re managing.
Guerra: I saw one respondent said that his HR department told him the cleanest way to handle retention bonuses was to base them on tenure. I didn’t like that idea. I mean, you wind up getting people making more money for just being there. You would want to tie those to the value the employee brings to the organization, wouldn’t you think?
Gash: The advice I’ve been given is that we should tie it toward the objective that we’re trying to accomplish—and not only that we completed the objective, but that we did it well. So it’s quality of the job as well. And then your contribution toward achieving that goal should probably weigh into that decision as well. I’m not sure what that will look like or what our proposal will be, but I like the idea of it being tied towards meeting the objective and it being a quality job.
Guerra: One of the questions you had asked was are people tying retention bonuses to meaningful use, and in my review of the answers, I think very, very few people are doing that. I guess that would be hard to operationalize, and if I was an employee I wouldn’t want my bonus tied to something that was so big and so vast that I would have probably little control over. Does that make any sense?
Gash: I do think that they do have the ability to influence the outcome. In our development of the technology training and the deployment of it and gaining adoption, there are certain aspects of it that are out of our control from a technology perspective, but I think we can influence a lot of it. So yeah, I can see where an employee might be reluctant, but if we’re all working as a team and we’re all contributing to it, then we should be successful.
Guerra: It gets complicated but there are ways to do both, right? To have a percentage based on individual effort and a percentage based on a team goal—is that something you were looking at? Maybe now’s a good time for you to discuss what you’ve come up with to this point.
Gash: Well I haven’t really come up with any ideas. We’ve had different thoughts about how to do it. We’re really going to take more direction from our HR department and what they would suggest; they have more experience I think in this area than we do. But we definitely want it to be tied toward meeting the objective and then the outcome of that objective, and how well we did in accomplishing that goal. So one thing that has been a challenge is that the first thing we were asked was who is in and who is out as far as receiving the bonus, and it’s really difficult to say that anyone is out because when it comes to deploying new technology, everyone plays a role. Given the pool of folks that would potentially be impacted, we’re still trying to figure out if it’s financially feasible to do a bonus. So we still have to go through that process to determine if we can do it.
Guerra: There are a few more points in the survey responses I’d like to go through. One response said, ‘I’m not losing people, but I am having trouble finding new staff.’ I interviewed a CIO this week who said he was having difficulty finding two Allscripts people to help with his rollout. So what are your thoughts around that—the difference between not losing people and having trouble finding new people.
Gash: We haven’t had a lot of difficulty finding new staff. I think it was a fortunate situation for us in our market that one of the other health care organizations was centralizing their IT department at a corporate office, so they were eliminating resources. We were able to bring some of those folks in to replace our vacancies.
We were just lucky I think timing-wise. We had thought that we would have some difficulty in recruiting a project manager for one of our clinical initiatives, and we were surprised that we’ve had some very talented applicants come forward. We were actually thinking about using a recruiter and I don’t think we’re going to need to do that. So I’m not having issues finding resources, and that could be just unique to my market because of the circumstances, but we’re not having difficulty right now.
Guerra: How much of this do you think is dependent on the vendor in question? For example, do you think of it in terms of, ‘I need Allscripts people,’ or ‘I need McKesson people,’ and another CIO may say, ‘I need some Meditech people,’ or is it sort of at a different level than that?
Gash: We haven’t really recruited specialists. We’ve really looked for folks that will fit within our culture and have similar behavioral traits that we aspire our employees to have. Then we invest in the education to teach them about the products that we’re managing. So turnover can be costly for us because we have to go through this retraining effort. I think if you said, ‘I only want someone who knows Allscripts,’ or ‘I only want someone who knows Horizon Clinicals on the McKesson side,’ I think we would have more difficulty recruiting.
Guerra: Right. One other response—and it sounds like you would caution against this kind of approach—said, ‘We have discussed the need for potential retention bonuses, but until we start seeing more evidence of staff turnover, we have held off on implementing one.’ There is that temptation there to wait until you see a problem, but I think what you’ve said is to be very careful about waiting too long because it takes time to put something into place. Does that make sense?
Gash: That is exactly what I think.
Guerra: Alright. That’s pretty much what I wanted to cover. Are there any other points in the survey results, points about your program or just general thoughts or advice you wanted to offer?
Gash: I think a lot of us know what we need to do. I think we’ve got a lot of management experience and probably have gone through similar issues. It wasn’t surprising what I saw—I just wanted to affirm what I already knew and I thought doing that survey was very helpful. I encourage people to do more of that just to get some information. I took that information to our CFO and leveraged that in my conversation with him about going through this process of looking at developing a more robust retention program, and shared that with comp and benefits. They all thought it was valuable information.
Guerra: As I mentioned and you echoed, the turnout on this survey was very significant, so that definitely indicates this is an issue a lot of CIOs are grappling with.
Gash: Right. It’s challenging times, and if you can just focus on the project at hand that would be wonderful, but in our jobs, we need to be focused on our people too.
Guerra: Alright, Deb. I think that’s all I had for you today. I want to thank you so much for you time and I hope to talk to you again soon.
Gash: Okay, thank you.
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.