2005 Salary Survey Results: Quality’s power, importance increasing, but so is workload
2005 Salary Survey Results
Quality’s power, importance increasing, but so is workload
Pay-for-performance and public scrutiny are two reasons why
The role of the quality professional is more important than ever, agree experts in the quality field interviewed by Hospital Peer Review.
"Quality professionals are becoming more and more valuable to organizations when you consider all of the various requirements for monitoring and evaluation that are required by the JCAHO standards, elements of performance, and National Patient Safety Goals," says Kathleen A. Catalano, RN, JD, director of regulatory compliance services at Dallas, TX-based PHNS Inc.
That perceived value is being reflected in at least some salaries, according to the 2005 Hospital Peer Review Salary Survey, which was mailed to readers in the June 2005 issue. This year’s results show that 26% of quality professionals reported an annual gross income in the $70,000 to $79,000 range, with 9% reporting income greater than $100,000.
Slightly fewer than half of the respondents reported a salary increase of 1% to 3%; 23% reported an increase of 4% to 6%, while 12% received an increase over 7%.
In addition, the trend toward pay-for-performance incentives is giving quality managers more leverage to obtain needed resources."Leaders of health care organizations are concerned that their reimbursement or market share will be adversely affected when performance doesn’t meet payers’ and/or consumers’ expectations," says Patrice L. Spath, BA, RHIT, a health care quality specialist with Forest Grove, OR-based Brown-Spath & Associates.
More hats to wear
As a quality manager, you must be able to provide leaders with performance data that show two things, Spath says: How well the organization is doing at meeting performance expectations, and what improvement opportunities exist.
Increasing demand for transparency and public reporting of health care performance data has placed more responsibility on quality professionals’ shoulders.
"Data gathered for public reporting must be accurate — and data sources, such as patient records, must be well-documented," says Spath. Performance trends must be tracked, and statistical analysis tools used to identify undesirable variation.
In addition, the effectiveness of a growing number of performance improvement and patient safety projects must be evaluated.
"Often, these responsibilities are added to an already over-burdened quality department," Spath says. "The challenge for today’s quality professional is how to do more with less and do it well."
Despite these challenges, there appears to be increasing longevity in the quality field. According to the survey, only 14% of respondents worked in quality for three years or less, with 53% working in the field more than 15 years.
"The reasons for this are not totally clear, but it may be related to the increased recognition of the value of the position to the organization," suggests Frederick P. Meyerhoefer, MD, a Canton, OH-based consultant specializing in JCAHO and regulatory compliance. "In spite of all the difficulties, the quality professional may feel the recognition and increased responsibility makes it more comfortable to continue to work in this area."
It’s true that the importance of quality professionals is growing due to the link between reimbursement and quality.
"On the other hand, more and more work is being piled on to these professionals," says Catalano. "The question to answer is: How long can quality professionals sustain their excellence without increased staff and, possibly, without increased recognition?"
To succeed, quality professionals must determine which tasks are no longer necessary and what can be done to streamline those tasks that must still get done. "The quality department that is not computerized will find it difficult to keep up with the increasing demands of the job," says Spath.
Quality professionals sometimes have responsibility that far exceeds their placement on organizational charts and monetary rewards, says Judy B. Courtemanche, president and CEO of Courtemanche & Associates, a consulting firm specializing in regulatory compliance and outcomes management, based in Charlotte, NC.
"Even though they are viewed as the regulatory watch dogs and trouble shooters for their organizations, less than 6 % are vice presidents or senior leaders with commensurate salaries," she adds.
The survey’s results showed that more than half (57%) of quality professionals are working 45 hours or more a week, with 20% working more than 55 hours a week. Just 9% work less than 40 hours, and another 34% work between 41-45 hours a week.
"The increased job duties have added to hours worked, but the salary has not increased commensurate with the job burdens and time," argues Meyerhoefer.
The bottom line is that quality professionals are not considered revenue-enhancing staff in organizations, Courtemanche says. "Rather, they are viewed as an obligatory cost of doing business," she says.
As a result, organizations often limit the resources allocated for quality monitoring. "Organizations can easily lose sight of the need for quality monitoring and performance improvement operations to enhance clinical effectiveness and the bottom line," Courtemanche says.
Quality methodologies such as Six Sigma may be too expensive and time intensive for organizations, says Catalano. "They are probably best off sticking with the Plan, Do, Check, Act’ methodology or simple processes, and do them consistently and well," she says.
Many quality professionals are wearing multiple hats, finding themselves in the roles of quality manager, risk manager, privacy officer, security officer, and patient safety officer. "Some institutions have enough money and are large enough to pay an individual to take on each role, but many cannot," says Catalano.
Probably the most common new responsibility for quality managers is that of the patient safety officer, Meyerhoefer says.
"Other quality managers are also taking on the role of compliance officer," says Meyerhoefer. "As these responsibilities expand, the qualifications for the position also seem to be increasing." The job description now frequently includes different educational requirements such as a master’s degree, he adds.
Quality managers need help
To satisfy these added requirements, the quality manager must continue to expand the ability to understand and manage data and information, to satisfy all the internal quality initiatives along with external regulatory requirements, says Meyerhoefer.
"Coupled with these changes is the slowly evolving shift in job title. More individuals responsible for the quality programs now carry the title of vice president," he says.
To get ahead, quality professionals ideally should have two things: A clinical background and computer literacy, Catalano says. "Without those two ingredients, they may find themselves in the dark," she says.
Quality managers are responsible for a long list of expectations, including core measures, annual periodic performance reviews, mock surveys, and mock tracers, and must involve others in the process to avoid becoming overwhelmed, says Paula Swain, MSN, CPHQ, FNAHQ, director of clinical and regulatory review at Presbyterian Healthcare in Charlotte, NC.
"Engage staff, physicians, and leadership in all that is important," she advises. "For example, the National Patient Safety Goals might be the responsibility of the safety officer, but others are still accountable for compliance to standards," says Swain.
According to the survey, 42% of quality managers currently supervise more than 10 people. "Staffing for quality management responsibilities is slowly increasing. This is due to the overall increase in work needs which is also tied to the mounting requirements for concurrent data collection, audits, analysis, and implemented actions based on the analysis," says Meyerhoefer.
However justified, additional quality personnel may not be allocated due to budget problems at the organization, he adds. To support the need for more staff, point to the expected increase in efficiency, quality, and safety of patient care, Meyerhoefer advises.
If there is a bigger group of data collectors, the integrity of the quality might be a concern, says Swain.
Problems with inter-rater reliability might introduce variations or inconsistencies that render the data meaningless after analysis, she explains.
"The definition of each indicator is a primary focus of the quality manager, as well as the methodology for the data collection," she says. "Nothing is more frustrating than taking a report to a committee that is riddled with inconsistencies. This would be like leaning your ladder on the wrong wall. A lot of work with nothing accomplished."
To manage a multitude of requirements, quality managers need assistance, even for making appointments to meet with the multiple teams, committees and groups involved, argues Swain.
"If the quality manager doesn’t have an assistant to work with other people’s raw data and organize the findings from mock review and tracer activities, they will be sunk at the dock," she says.
These tasks can be done by individuals who don’t have the knowledge base or global perspective of the quality manager, adds Swain.
In general, quality managers are reporting higher up than the earlier years, to CEO, COO, or other senior leaders, says Swain. "This is necessary, as the quality professional is going to be pulling resources from everything that is available. It would be very difficult to have to go to every director to request help," she says.
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