2007 Salary Survey Results

Expect new roles, skills as quality becomes top priority

Make yourself the expert who can lead, be 'consultant to all'

Hospital-based quality professionals have a golden opportunity to step into new leadership roles, due in large part to the growing impact of pay for performance.

"Today's quality professionals have an increasing impact in their organization, as the entire health care system in the United States shifts its focus to the quality of patient outcomes and begins to tie or structure reimbursement processes to those outcomes," says Carol L. Sale, RN, MSN, director of performance improvement for Norfolk, VA-based Sentara Healthcare. "No longer are insurance providers paying the same thing for an appendectomy that stays two days vs. six days."

Patient safety is "bubbling to the top of the priority list" for hospitals, says Sale.

To make the most of this development, become the "consultant to all" and volunteer to help with many projects, advises Patricia A. Wardell, RN, CPHQ, CIC, vice president of quality management at St. Jude Medical Center in Fullerton, CA.

"Read everything you can get related to performance improvement. Increase your knowledge about infection prevention. Be the expert who can lead or mentor others to perform root cause analysis and failure mode and effects analysis processes," says Wardell.

You need analytical skills

The findings of the 2007 Hospital Peer Review Salary Survey, which was mailed to readers in the June 2007 issue, show that a growing number of quality professionals have graduate degrees. According to the survey, 50% of respondents have a graduate degree, while 25% have a bachelor's. "A bachelor's or master's degree for this role is becoming the minimal educational level many organizations are looking for," says Sale. Other key findings:

  • 89% of respondents were over age 45.
  • Only 7% of respondents worked in quality for three years or less, while 50% worked in the field more than 15 years.
  • 43% of quality professionals supervised three people or less.

Long hours are the norm: More than half (58%) of quality professionals are working more than 45 hours a week, with 26% less than 40 hours, and another 36% work between 41-45 hours a week.

But putting in a long day's work isn't enough to really get ahead: Educational preparation and clinical experience will clearly improve your marketability and credibility, says Sale.

More and more, quality professionals are expected to have or develop analytical skills, giving them the ability to step back and look at the entire process in the sequence of patient care to identify the human factor errors, the causal factors, and what process changes need to be made to prevent a reoccurrence, says Sale.

In addition, when an adverse event occurs, you need to be able to critically think about the "portability" of that event, says Sale. In other words, where else in the hospital or the health system could this type of error occur? If the failure was a lack of attention to detail or lack of having a questioning attitude, could failure of that behavior in another setting create a similar event under different circumstances?

"These are all skills that quality professionals will need to have going forward in health care," says Sale.

The industry is gradually responding to the growing demand for knowledge and expertise in these quality and analytical skills, adds Sale. Seminars and workshops dealing with data management, peer review, accreditation readiness, and event analysis are being offered by risk management consulting firms, medical staff consulting firms, The Joint Commission, the Agency for Healthcare Research and Quality, and the Institute for Healthcare Improvement.

"Education dollars tend to be the first thing that hospitals cut when funding gets tight," says Sale. "But those need to be considered strategic investment dollars to help get an organization where they need and want to go in quality management."

Obtaining credentials as a Certified Professional in Healthcare Quality (CPHQ) does three things for you: It increases professional self-confidence, it gives you more potential to become your organization's expert, and it gives you a better chance for new roles and salary increases, says Janet A. Brown, RN, BSN, BA, CPHQ, FNAHQ, principal of Pasadena, CA-based JB Quality Solutions Inc.

"I have participated in the preparation of health care quality professionals for the CPHQ examination for over 20 years," says Brown. "My observations over time are that those who choose to become certified have to commit to study and be accountable for a significant, defined area of knowledge."

The CPHQ designation is now required or recommended for many roles in health plans and government-sponsored health care programs, and is encouraged and supported financially in many provider settings, adds Brown.

To command a leadership role in quality, you will need more knowledge of statistical analysis, information systems, and be able to evaluate the content of benchmarking data, says Wardell. "What web sites are reporting, where do they get their data, and how are they interpreted?" she asks. "Are the data accurate? Are they old?"

Exciting new roles

There is no question that quality management is having an increasing impact on hospital operations. New roles are being developed such as patient safety specialists, accreditation/regulatory specialists, quality coordinators, quality improvement nurses dealing with medical staff peer review, clinical effectiveness health data analysts, data analysts for health informatics, and many more, says Sale.

As the emphasis on public reporting grows, so does the quality professional's role as an expert to help analyze and interpret all the data, says Wardell. "The quality professional can also be invaluable when it comes to survey processes," she says. "Become the expert about The Joint Commission standards. Take on the role of survey coordinator."

Added responsibilities such as peer review, patient safety, and compliance with The Joint Commission's National Patient Safety Goals all add value to your role at your organization, which gives you more leverage to demand salary increases, says Wardell.

Quality professionals are getting involved in all aspects of organizational readiness for accreditation and regulatory compliance, including The Joint Commission, state inspections, and Leapfrog surveys, says Sale. "They are also delving into adverse event analysis, facilitating root cause analysis teams, and determining causal factors for events and how to prevent them in the future," says Sale.

Another new role is dealing with process improvements to enhance a patient's safety as they move through transitions of care — from critical care to step-down to the acute care unit, and all the ancillary services tied to their care, says Sale.

"As the health care industry begins to feel increasing pressure to improve the quality outcomes of their patient care, they will undoubtedly begin to look at their quality departments and the need to attract strong, qualified candidates," says Sale. "I would expect the dollars to follow as these roles grow and further emerge."

According to the survey, 50% of respondents reported a 1% to 3% increase in salary, 32% received a 4% to 6% increase, and 14% received an increase of 7% or greater. Just 36% of quality professionals reported an annual gross income under $70,000, with 64% earning more than $70,000, and 35% reporting incomes more than $100,000.

To really get ahead both salary- and clout-wise, you need to balance compliance duties with a leadership role for innovation in the future of health care quality, according to Martin D. Merry, MD, a health care quality consultant based in Sanbornton, NH.

"I feel so sad for quality professionals bogged down in compliance duties, even as I see their contemporaries who genuinely stake out territory in quality and innovation," says Merry. "I meet these successful people all the time, each of whom has escaped the 'gravity' of compliance to the 'orbit' of quality innovation."

Compliance will never be rewarded highly, while vision and innovation will be honored, promoted, and rewarded by organizations that recognize the value of these people, says Merry.

"The innovators move up, while those focused on compliance remain focused on the next Joint Commission survey," he says. "The best and brightest of the quality professionals are either honored by their current employers with promotions and financial gain, or they easily find jobs in more innovative and visionary organizations."

If you want to pursue the leading edge of health care quality, your opportunity is wide open, says Merry. "If you're comfortable with compliance, this is very good, and you will always be in demand if you do compliance well," he says. "But don't look for big salaries. Compliance is always a reactive, small game, compared to the big picture of quality innovation."

We are seeing quality professionals as vice presidents of patient care services and vice presidents for quality of health systems, says Brown. "I have one colleague and friend who moved from health care quality to work in quality and service for a major airline," she reports. "The sky really is the limit."