2010 Salary Survey Results

As measures, reporting grow, so does the need for QI

QI professionals roles differ by hospital, but across the board their workload is increasing

If hospitals don't get it by now, then they're not reading the writing on the wall. Quality will increasingly affect hospitals' financial welfare. If that's not enough to show hospitals the need for quality improvement professionals, additional emphasis on reporting data and improving outcomes will highlight the need for QI and accreditation personnel at the front line. Over the last few years, "health care facilities have realized the financial value of quality," says Patrice Spath, RHIT, of Brown-Spath & Associates in Forest Grove, OR.

"There's a relationship between monitoring the quality and appropriateness of care and your payment in a lot of different areas... So, having people to support the ongoing monitoring of quality of care is going to be increasingly important, whether health care reform gets turned around or not. Because, even right now it's considered fraud if you request payment for something that wasn't medically necessary," she says.

She also emphasizes the overlap between QI and accreditation and other disciplines within the hospital — risk management, the compliance officer, case management, patient representatives, or the ombudsman.

"The risk manager is basically there to protect the financial assets of the organization. And now, the financial assets can be threatened by things like billing for medically unnecessary services or not having good quality or effective peer review," she says.

"I think people are beginning to see the relationship between each of those functions a little bit more and that's why they're starting to align those functions under one vice president so that the integration is forced a little bit more and there's less duplication of effort."

Hospital Peer Review's 2010 salary survey was mailed with the September issue. Fifty percent of respondents were quality improvement managers/directors. The largest percent (50%) reported an annual gross income of $100,000 to $129,000, with 8% earning more than $130,000 and 42% earning between $60,000 and $89,999. In 2009, 61% were bringing in more than $80,000 compared to 75% in 2010.

Also in 2010, 50% received a 1% to 3% raise in salary, 25% received a 4% or higher increase, and the same either reported no change or a decrease in salary. In line with results from the 2009 survey, the majority (58%) of participants have worked in quality for 19 years or longer, and 67% have worked in health care for more than 25 years.

Whether your title is director of quality or director of accreditation, and whether you're at a large academic institution, a multi-hospital system, or a rural critical access hospital, you've got a lot of responsibilities under your belt. Even those at larger facilities might have myriad responsibilities like those in smaller, rural organizations.

For Paula Swain, RN, MSN, CPHQ, FNAHQ, director, accreditation and regulatory at Presbyterian Healthcare, part of Novant Health, the job bucket is pretty big. She handles accreditation, Joint Commission complaint response, requests for improvement, action planning, mock surveys, survey preparation and continuous survey readiness, and all disease-specific certifications. Swain reports both to her hospital's COO and the senior director at the corporate level for systemwide regulatory efforts. She oversees those efforts for four hospitals and for Presbyterian.

Joann Paul, RN, MSN, director of quality and infection control at Wesley Medical Center, a 760-bed, university-affiliated hospital, reports to the chief medical officer. She's responsible systemwide for "all things quality," including accreditation, all regulatory compliance, publicly reported data, disease-specific certifications, internal metrics including patient satisfaction and HCAPS, performance and process improvement, as well as infection control and surveillance. Data abstractors report to her on all core measure data.

Doris Vigen, RN, BSN, director of nursing at Sanford Hospital in rural Mayville, ND, is responsible for all accreditation activity. " The majority of critical access hospitals aren't Joint Commission-accredited. But we are surveyed, then, by the state health department. So, I would be responsible for managing the quality improvement activities as it relates to CMS. I also do the core measure abstraction for our facility," she says.

Each department has to participate in compliance. "One of the things that makes [meeting regulatory requirements] more manageable in a hospital our size is just the volumes that we have. Because, even when we're talking about abstracting the core measures, on a quarterly basis, that might be 12 to 15 charts. So, the volume makes it more manageable. On the other hand, having such small volume, you can have one measure that was missing on one chart and it really makes your total picture look bad. So, it's both a good and a bad thing, I would think, the low volume," she says.

All the experts HPR spoke with have a clinical background. Is that necessary for the QI role?

Paul says: "I tend to be pretty analytic, and I really am clinically focused in that I am passionate about — first of all, I'm a nurse at heart — excellence in nursing care. And then, I am just as engaged in the overall care delivery of a health care system. So, in the way that you make changes, and because of my analysis background — my analytic personality tendency — is, you make change by being able to look at data, gather data, measure it, and to look at it critically."

Understanding data is a skill all the experts agree is integral, and will continue to be integral, to the QI role. "Quality professionals need to be up to speed in health information technology because in the old days you would sit down with a paper patient record and scour through it to get the information you needed. Now, you press a button and do a report writer and query a database. Quality professionals need to understand how that data got in the database to be able to appreciate whether or not what they're getting back out is valid information and information that can be used to monitor the quality of patient care," Spath says.

Quality professionals also will be integral to creating IT infrastructures, with their knowledge of data definitions. "Which means that the quality people, instead of just being on the back end of the whole IT revolution need to be on the front end also," she says.

Paul sees some shared components among successful professionals in the QI field:

  1. "being able to communicate effectively and articulately with passion" and to effect a change in behaviors;
  2. instead of carrying a "big stick," leading from the bottom up;
  3. a clinical and statistical background. "You have to be able to have that credibility regarding those processes that you are trying to impact," she says.

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