2009 Salary Survey Results

Quality is a hospitalwide responsibility now more than ever

Skill set required of quality improvement professionals expanding

With the ever-growing focus on transparency, hospitals are demanding more from quality improvement professionals. When Paul L. Green, RN, MS, CPHQ, started his career in health care, QI professionals ran data and filed them away. Mandatory and public reporting wasn't around yet, and sharing data with the public and other hospitals, for benchmarking and comparative data, was still a long way away. But now, QI professionals are not stuck to their offices, running numbers. The arena has changed quite a bit, and with it the expectations on quality improvement professionals.

"I think we're seeing a couple of interesting things that are happening," says Green, chief quality officer at Memorial Hospital of Gardena (CA) and principal, founder of Greenlight Healthcare Consulting LLC.

"First of all, the demand on the profession for health care quality is expanding and getting more complicated. As we get a push toward more public transparency, as we start to take a look at more complicated issues that are happening in the quality arena, the skill set is moving along and advancing as well. Quality folks are getting pushed into taking a look at issues like clinical documentation improvement, RAC audits, case management oversight, taking a look at longer-term outcomes, getting involved in satisfaction improvement activities. So it's moved well beyond the historical issues around accreditation, monitoring, and evaluating," he says.

Survey findings

Results from the 2009 salary survey, mailed to readers with the July 2009 issue, show about 39% of respondents make less than $79,999, while about 61% are bringing in more than $80,000. Not much different from Hospital Peer Review's 2008 survey findings with 33% and 67%, respectively. What has changed more is the increase in salary over the year. In 2009, about 3% report a salary decrease, 33% report no change, 33% received a 1-3% increase, about 19% showed a 4-6% increase, and only 11% received a 7-10% increase. In 2008, the majority of respondents (83%) received an increase in salary between 1%-6%. In step with last year, the majority of respondents (67%) have worked in health care for more than 25 years, with 61% between 51 and 60 years old. Also in step with 2008, in 2009 most respondents (66%) had a bachelor's degree and/or a graduate degree.

Split between traditional, growing roles

Green sees a split in the types of people in the quality field of today. Those who have been in the field are well skilled to deal with accreditation issues and the more traditional demands of overseeing monitoring and peer review issues. While they are certainly "well poised to be able to take on expanded roles," Green sees another group of people "who are a little bit more sophisticated in terms of what they can bring to an organization in terms of working with organizational leadership" on the myriad issues QI professionals are now asked to take on. And he says, those people, with a more advanced skill set and ability to work with executive teams and across an organization, are in demand.

He's now looking for a director of performance improvement, and he says it's a very different world than two years ago when he didn't get many applications. Now, more people are on the market, with more advanced skills. Many of those, he says, come from other facets of health care and other industries such as industrial engineering, the manufacturing sector, or the nonprofit field. He's even received interest from MDs.

He likens the modern QI department to the hospital's finance department. "The finance department really doesn't have any impact over revenue or cost expenditures. They don't own operations. What they do own is the knowledge set, the analysis capabilities, the measurement capabilities, and the coaching and facilitation support to those who do run operations."

That role of working in tandem and not in a glass case of quality is something many experts HPR spoke with agreed on, something that has changed and evolved as health care has.

Shirley Knelly, MS, CPHQ, LCADC, says, "quality departments don't impact quality. The clinicians do." Knelly is vice president of quality and patient safety at Anne Arundel Medical Center in Annapolis, MD.

"Giving up ownership of something that was always laid on the shoulders of the quality program is a tough thing to do, but you have to identify where the true ownership comes. And that's by the caregivers and clinical folks," she says. The quality role then is to support and facilitate. What should be in the "toolbox" of the QI role, she says, is the ability to do process mapping, analyze data, develop action plans, and identify resources to help people actualize those plans.

With all the things on the QI professional's plate — accreditation, reporting, facilitating — she says her staff has prioritized items by looking at the impact on patients. Quality staff focus on 11 strategic aims, including areas such as mortality rate, readmission rate, adverse event rate, and cost per patient. And then there are service line quality councils, supported but not run by the quality department in an effort to put "ownership in people who have the power to make changes as the leaders."

Patrice Spath, of Brown Spath Associates in Forest Grove, OR, also sees a change in the way the quality department functions.

"There's a growing realization among health care leaders that everyone has to own responsibility for quality. And it can't just be given to a particular department, which means that critical care units [for example], they own that responsibility," she says.

"What I'm seeing is more hiring of people in those units rather than hiring people for the quality department. An example would be a medication safety officer."

Her advice to QI professionals: "There always needs to be coordination, so yes, there will be always be a need for [a quality department]," but she advises those looking for jobs in the field not to limit their search to just the quality department.

What better be in your "toolbox"

Green says there are "absolutely critical" and distinct skills that a quality professional should have and hone. "One of them is the ability to craft a concise, compelling message and communicate that to key stakeholders in the organization," he says. Too often, he sees quality professionals blind people with an overabundance of data, numbers, and paper.

"I'm a headline and bullet point kind of guy. And I think most executives today are," in a world of BlackBerries, iPhones, and emails, he says. What a quality professional should be able to do is cull the information for the person or people they are working with — give their audience the three things they most need to know by analyzing and extrapolating from what you have.

Other skill set musts, he says, are:

  • the ability to build relationships and influence through relationships throughout the organization;
  • the ability to understand data sets and new technology to gather data and to turn that around in a meaningful way;
  • the ability to let go. "Let others be able to take responsibilities for their portion of the business." Operational leaders, he says, should "own" their portion of the business/hospital. "My role in that is helping you evaluate and come up with the most effective and efficient way to run that business to get the highest levels of clinical outcomes and customer satisfaction that you can within that business model. But it's still your business to run," he says.

When it comes to getting staff on board to external initiatives, say a Joint Commission core measure, he says the QI person should be able to "translate the requirements into language clinicians understand — to be able to tell the story that's underneath the regulation."

Look for additional certification, education

All the experts HPR spoke with advise quality professionals to obtain certification as a Certified Professional in Healthcare Quality, or CPHQ. It won't necessarily get you more money, but it could distinguish you from the next candidate, and it shows devotion, they say. Spath also suggests taking courses in Lean and Six Sigma.

Knelly says quality professionals at Anne Arundel have a year from the start of their employment to get CPHQ certified. Employees there also take advantage of the Maryland Patient Safety Center, which offers free training in quality and patient initiatives including critical thinking skills such as failure mode and effect analysis (FMEA) and root-cause analysis (RCA). It also offers Black Belts and Green Belts in Six Sigma.

Susan Mellott, PhD, RN, CPHQ, FNAHQ, CEO/health care consultant, Mellott & Associates in Houston, says "certification [such as the CPHQ] can be the one thing that could get you a position vs. someone who doesn't have certification." For those looking to move into quality, whether that be as part of the QI department or within a clinical department, she suggests learning how to use control charts and histograms and how to collect and analyze data.

Going it alone; opening your own consultancy

Mellott speaks from experience about going out on your own as a consultant. "There are many pros and cons," she says.

"The hardest thing for anyone that goes out on their own to understand is you have to spend money to get money. You can't just sit there and hope that the business will come to you somehow," she says.

No. 1, Mellott says, is having an already established network that you can "draw on for business, as well as expertise and assistance." You need a network who you can call on to facilitate contact with the person in the hospital who needs your service, whether that be the CEO or the quality director. And you must be able to sell yourself.

She suggests learning about accounting and using other consultants as resources. There is a group in Houston and other locations called SCORE that helps small businesses free of charge. She also suggests going to a bank with your business plan. If they will loan to you, you know it has some viability. Doing it on your own means learning a whole new skill set. "There's a lot of things that you need to be able to do that you never did before," she says.

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