2008 Salary Survey Results

Within the growing role of QI, technology playing a big part

In the value-based purchasing world, quality improvement professionals seen as more integral

With the advent of pay for performance (P4P), what quality improvement professionals track and trend now could affect hospital reimbursement more than ever. "I think that quality has taken what I would call a stronger position in the overall hospital operations because they're providing information where choices can be made and they make an impact on the bottom line," says Patti Muller-Smith, RN, EdD, CPHQ, a Shawnee, OK-based consultant who works with hospitals on performance improvement and regulatory compliance.

Because of the financial impact, administrators are now more accountable themselves, so their relation to the QI department is stronger. And with that, they're tasking every department in the hospital to be more responsible for quality, Muller-Smith says.

But Patrice Spath, of Brown Spath Associates in Forest Grove, OR, says QI staff are not immune to the effects of today's struggling economy. Just as the banks, auto companies, and innumerable companies across the nation are feeling the effects, hospitals, too, are being affected by the losses. Spath says many hospitals are cutting employees. "I think anybody who's not working in direct patient care is vulnerable," she says.

Survey findings

Results from the 2008 salary survey, which was mailed to readers in the July 2008 issue, show the highest percentage of respondents, 33.3%, receive an annual gross income of between $100,000 to $129,000. While the 2007 results, showed about half of respondents making less than $79,999 and half receiving more than $80,000, in 2008 about one-third of those surveyed were in the former category, with two-thirds in the greater-than-$80,000 field.

All of the experts HPR spoke with agreed that most QI professionals at the director or manager level are making between $100,000 to $129,000. "It's taken a good number of years to get to $100,000," says Paula Swain, MSN, CPHQ, FNAHQ, director of clinical and regulatory review at Presbyterian Healthcare in Charlotte, NC.

Swain moved from consulting to the hospital setting seven years ago. As a consultant, she was getting more than "what they were paying in the field at the time. It looks like now the field is catching up."

Survey findings also show:

  • the field is still predominantly female, with woman representing 82% of that workforce.
  • most respondents were aged 46 to 55 years.
  • the majority of those showing an increase in salary over the year reported receiving an increase of between 1-6%. Only 5.56% received no increase, with the same percentage also receiving either a 7-10% increase or an increase of more than 21%.
  • the majority of responses, with 33%, showed an average work week of 46-50 hours; 40% worked more than 51 hours a week and 26.7% logged an average of 31-45 hours a work week.

Aging workforce

Seventy-five percent of the respondents to the 2008 salary survey have worked in health care for more than 25 years. "I think it just says that you have to have some experience, be a more mature person," Swain says.

Spath attributes it to the general aging workforce, especially in the health care arena. That 75% figure, she says, "tells me that our quality professionals are aging and the work force is aging, and it really behooves us as quality professionals to mentor the younger people to take over our positions.

"Our educators need to make sure that incoming professionals in different areas are getting a good foundation of quality management. Our professional organizations need to make sure they're operating with beginning education and not just advanced education," she says.

Skills for the future

What's most important, Spath says, is making sure incoming professionals have "the skills that are necessary for the future." A lot of people, including herself, moved into QI because they were good at their clinical jobs, she says. Though she has training in health information management, Spath says she had no formal training in quality improvement and had to pick a lot of that up as she went along, with on-the-job training, books, and workshops.

Those jumping into quality improvement today, especially at the manager/director level, "need to hit the ground running," she says.

All of the experts HPR spoke with agreed that technological and analytic skills are essential to the job. "In the past," Spath says, "you would just leaf through medical records and gather what you what you wanted and write it down with pencil and paper.

"Now, you need to be able to create a data query and get information in electronic form, and it doesn't just mean you need to be able to press a button on a computer. You also need to understand how those data got into that data warehouse, what the data definitions were, and if you ask for a data query, are you getting the information you thought it you were going to get?"

Incoming professionals must have advanced health information management skills, which could be achieved through an informatics degree or certificate, Spath says.

Swain reiterates the integration of data management skills and suggests obtaining the Certified Professional in Healthcare Quality (CPHQ) certification.

Confidence in your data management skills is integral in explaining where the hospital stands on measures, compliance, successes, and failures. If you're sitting in front of a committee and someone points to a chart at you and says, "Look at that. That point went down. We're doing better," she says you need to be able to explain it to them. For example, to say, "No. Six points make a trend. That's the only way we can say this made a difference here."

Is the C-level buying in?

Muller-Smith says with the P4P movement, there has been a push toward increased awareness of quality improvement. Previously, she says, the QI professional didn't have the clout he or she has today. With the amount of technology and the breadth of data one can extract today, we can see performance by each clinician, and those are communicated to the administration. In many hospitals she works with, she is seeing administration not only buy in to quality improvement's initiatives but to task each department to control quality within its own sphere.

Swain says Paul Wiles, president of Novant Health, of which Presbyterian Hospital is a part, "has the philosophy that quality is the thing that makes the difference. He just doesn't talk it; it's embedded in our facility everywhere." All of which makes her feel pretty good about what she does and where she does it.

If you don't feel a fit with where you are, she says, there are "plenty of jobs" out there now. "You can decide to take the regulatory side or the P4P side, core measures side — you're always using quality improvement methodology... Now you've got more opportunity for an outlet for your skills than we've ever had in our lifetime."

Clinical or technical background required?

Bedside or business side: Where does the future hospital quality improvement professional come from?

Because of the "rich underpinnings" of all that falls under the QI professional's umbrella — sentinel events, state issues, deaths and restraints — Swain says you must have a health care background. "Experience in a clinical situation is how you frame up your responses [to hospital colleagues]. It's how you cut to the chase to teach the nurses at the bedside what the important thing is in the standard, how you go through all the gobbledygook and cut through this stuff. Because of that you have to have some sort of experience in the health care process itself. I don't think you can be looking in through the windows."

Most of the people HPR spoke with came from a nurse background and commented on the value of prior clinical experience in the quality director/manager role. But Tom Knoebber, CPHQ, Six Sigma Black Belt and director of performance improvement at Mission Hospitals in Asheville, NC, has a different opinion, and a different background. Trained as an industrial engineer, Knoebber worked with Premier/Sun Health as a management engineer/consultant, and when the hospitals merged he was brought in-house.

"So I gave a harder edge to that soft, squishy stuff, but then also picked up some of the old-fashioned QA," he says.

But then, in the mid-90s he says there was an evolution to a much more statistical focus. "So far I've seen the role change clearly with the start of CMS and the HQID project, the Premier/CMS project, and with that it really took someone who understood sampling on top of the clinical stuff," Knoebber says.

"The QA department was historically considered a transitional role for nurses away from the bedside. Today's quality specialists require a new level of analytical and clinical skills to ensure evidence-based practices are implemented and followed," he adds.

Mission Hospitals' new chief nursing officer wants a quality resource within each nursing unit. Knoebber now has 55 nursing units dealing with his data. To help them, he says he's made some simple spreadsheets where they can plug in data and a graph is created. And six months ago, the hospital implemented a computerized physician oder entry system.

For those entering the field, he emphasizes the importance of being able to work with Excel, especially working with the pivot table function, which allows you "to think three-dimensionally about data." His staff all have their Six Sigma Green Belts. It's helpful, he says, to bridge "the gap between the finance department and clinical departments."

The QI professional continues to have to do more with less, Spath says. "And doing more with less means that we need to do things in quality improvement like applying Lean technologies." QI professionals also need to learn to say no when needed and to delegate functions when appropriate, she adds.

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