2006 Salary Survey Results
P4P gathers momentum and changes quality roles
Work simplification, new skills are essential tools
With the growing emphasis on pay for performance initiatives, quality professionals are seeing their roles change very quickly.
"It is no longer enough to simply gather and report performance data," says Patrice L. Spath, BA, RHIT, a health care quality specialist with Forest Grove, OR-based Brown-Spath & Associates. "Now quality professionals must be proactive in initiating improvements to help keep their employer from being financially penalized for under performance."
Quality professionals must work with clinicians to ensure that patient records contain the documentation necessary to support reporting of performance measurement data to the Centers for Medicare and Medicaid (CMS), says Spath.
For example, it's part of the quality manager's role to ensure there is documentation of all the required aspects of discharge instructions.
Hospitals are financially penalized for not submitting performance measurement data to CMS, meaning lesser pay for hospitals not participating. Some hospitals are financially penalized by payers if performance doesn't reach a certain level for a particular measure, such as compliance with management criteria for patients with a myocardial infarction.
"In those hospitals, quality professionals should take a leadership role in facilitating multidisciplinary QI teams charged with improving performance," says Spath.
Rather than using the same old "blame and shame" tactics to improve the quality of care for patients, quality professionals need to encourage a systematic evaluation of clinical processes to identify the best way to change the system so that patients receive appropriate care, says Spath.
In addition to numerical literacy, quality professionals must be able to work with all aspects of the organization to assist in the application of quality tools during improvement initiatives.
"Quality professionals must help clinicians and non-clinicians decipher and understand the complex root causes of quality problems," says Spath.
Numerous variables influence the quality of patient care, she explains.
"Often we focus on changing the behavior of caregivers, when in fact, caregivers are doing the best they can given the often dysfunctional systems they work in," says Spath. "The latent conditions that influence the behavior of people working at the sharp end of the system must be identified and resolved."
For example, a common latent condition is lack of personal responsibility for patient safety. To resolve this latent condition, the organization's system of accountability must be examined and realigned so that people are rewarded for safe actions, not just productivity, says Spath.
More graduate degrees
The findings of the 2006 Hospital Peer Review Salary Survey show that a growing number of quality professionals have graduate degrees. Leading quality efforts may soon require skills beyond the baccalaureate level, especially as health care organizations are becoming more sophisticated in the application of quality concepts such as Six Sigma, Lean, and systems thinking, says Spath.
However, at the same time that responsibilities and workload are increasing, there hasn't been a significant increase in departmental personnel and non-proportionate salary increases, says Frederick P. Meyerhoefer, MD, a Canton, OH consultant.
According to the survey, which was mailed to readers in the June 2006 issue, 51% of respondents reported a 1% to 3% increase in salary, 33% received a 4% to 6% increase, and 13% received an increase of 7% or greater.
Twenty-one percent of quality professionals reported an annual gross income in the $70,000 to $79,000 range, with 33% reporting incomes under 70,000 and 44% reporting incomes over $80,000.
"They see the work load increasing as there is more demand from agencies such as JCAHO for data-driven decision support," says Meyerhoefer.
The survey's results showed that more than half (67%) of quality professionals are working more than 45 hours a week, with 31% working more than 55 hours a week. Just 8% work less than 40 hours, and another 26% work between 41-45 hours a week.
Another factor affecting the quality manager's role is the widespread implementation of electronic health records and other computerized information systems. "Quality professionals should be involved in their facility's data warehouse initiatives to ensure the information needed for performance measurement is readily accessible," Spath says.
To reduce the costs of manual data collection for performance measures, hospitals are building electronic data systems from which they hope to be able to extract the needed data elements for the various measures required by CMS, the Joint Commission, and other external groups, she says.
However, data retrieval from these electronic data systems won't go smoothly if the IT people building the system don't understand the data requirements of the quality department. "Quality professionals should be consultants to the IT project, to ensure that the hospital's data system will yield the right information for performance measurement activities," Spath advises.
In spite of growing challenges, there appears to be longevity in the quality field. The survey found that only 8% of respondents worked in quality for three years or less, with 61% working in the field more than 15 years.
Strength in numbers
With annual periodic performance reviews requiring more and more from the staff and management, quality managers must find ways to achieve work simplification, advises Paula Swain, MSN, CPHQ, FNAHQ, director of clinical and regulatory review at Presbyterian Healthcare in Charlotte, NC. "Streamline and standardize. Give everyone one data tool for all the patient safety goals, and have them respond to those that affect them."
Swain points to solutions from the VHA and Joint Commission consulting services for continuous survey readiness. These groups use quantity membership to keep costs down and support each other in methods to meet new regulations and additional evidence-based practice objectives.
"The quality professional needs to take a moment to evaluate other methods of support for themselves and their organizations," says Swain. "In summary, there is strength in numbers."
The growth of quality, cost, and compliance has fused managers of all types to those who oversee quality operations, says Swain. For example, managers in other units are reviewing medical records for data on compliance with core measures and National Patient Safety Goals, which is also needed for the ongoing review required by the Joint Commission. "Do it once, and report it for multiple requirements," she says.
Likewise, Magnet preparation encompasses many Joint Commission requirements such as competencies, standards of practice, and patient safety monitoring, including fall risk assessment. "Get in with the nurses and have all those standards checked off from the JCAHO perspective," says Swain. "There is no question that expertise in communication and motivational dynamics are essential to keep an organization afloat in the sea of changing regulatory requirements, new core measures, and spiraling costs."
Without additions to your organization's quality or compliance personnel budgets, the only alternative is to find solutions to streamline day-to-day operations, says Swain. This may take the form of electronic products which allow input from stakeholders on any given issue. The stakeholders can put their ideas into the "think tank" when it is convenient for them. Then, the organizer can integrate all the input by reading one document.
"This eliminates multiple e-mail responses that require aggregation and usually more e-mails," says Swain. Another type of electronic solution is used to track plans of action for non-compliant standards and issues identified through monitoring activities.
"Data are collected and linked to standards and the term 'continuous survey readiness' becomes reality," says Swain. Tracer data, monthly expired drug data, environmental rounding, hand hygiene, and administrative rounds all can be extracted from one place and reported from the unit level to the board, by the entire organization. "That is a solution to the rewriting of hundreds of audits into reports," says Swain.
It is true that the "electronic evolution" requires new skills, but you only have to learn them once, says Swain.
"Then, once learned they can be applied in many situations," she says. "Our safety and infection control rounds are done and reported in the electronic format — then the data are good for use in a variety of ways, not just to meet a frequency requirement of JCAHO."
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