Monday, December 24, 2012

A Raise?

December is Salary Survey month for Quality Progress--your chance to see how you're doing relative to the industry at large.  And if the results are not to your liking, I guess you could always ask for a raise.  (That sound you hear is my muffled laughter.)  In an environment where most people are grateful just to have a job, where Federal workers (me) have't had a raise in three years, go on, make your case.  Just to set the record straight, the ban on raises for Federal workers doesn't apply to political appointees or to those at the high end of the pay scale (SES workers), only to rank and file workers at GS-15 and below.

 Paul Borawski offers some tips on asking for a raise, but this is not going to be easy. Remember, duration of employment doesn't sell.  Just bringing that up may remind me (your boss) that I could hire a new employee for less than I'm paying you.

Quality managers don't come with statistics, like baseball players, so I can't look at batting averages or stolen bases, etc.  Do certifications count?  Only if they're specified in your position description, and then they're a condition of employment, not a reason for a raise.  However, the knowledge gained from studying for the exam may serve you well in solving problems for your employer and thereby demonstrating your expertise/value.  There is a difference between knowing about quality tools and techniques and applying them to everyday problems. 

How much money have you saved the company in the past year?  Yes, you can count time saved, but I'd like to see some hard cash also.  In healthcare, I'd look at standard metrics, like central line infections or response time to call buttons. How about readmission  rates?  That's a big one now and destined to get bigger as hospitals are held responsible for those costs.  Furthermore, that's an area that should be amenable to the quality tools you know so well.  Show me that you have contributed to improvements in these areas.

Tired of hearing employees tell him how good they are, one manager put the following sign above his door: "You're not really good until someone else tells you you're good."  That speaks to the value of auditing, but also to objective evaluations--metrics.

My favorite metric in the healthcare world is time.  How long does it take?  How long for the whole process, and how long for each step?  Time is easy to measure, easily understood, and Excel does time arithmetic.  Time, of course, is money, but the translation isn't always easy.  If you saved employee time, what is that employee doing with the extra time? 

Time can also be a customer satisfaction issue.  I doubt many patients would ask to sit longer in your waiting room.  If you employ LEAN principles, you will be pulling the patient thru your process just in time, rather than pushing him to the next waiting area.   How about surgeons?  If you agree that patients don't like to wait, ask surgeons if they like waiting for the OR to change between cases.

Back to your raise:  Show me all the sections you have worked with to improve their times.  Put a $$ value on it.  Do more surgeons want to work in your OR's because things happen faster there? Have you gained market share because you run a LEAN machine?

Improvement requires change, but all change isn't improvement.  There is an effort now to encourage physician offices to use electronic records, but when our clinic adopted an electronic record, we had to hire another physician to make up for the extra time the new system required of providers.  One thing has always bothered me about this concept:  if electronic records are such a good idea, why do we have to pay offices to adopt them?   It may be impossible to make a business case for electronic records in a physician office.  Many systems are VERY expensive, and to get paid, you have to show you are using the system for some use that a Washington bureaucrat thinks is "meaningful."  Electronic prescriptions are wonderful, but I'm not sure about the rest.  When our office offered an optional electronic prescription module, there was over 99% acceptance within a month.  We don't have prescription pads anymore.  When we introduced an electronic record, productivity plummeted and several threatened to resign.  So be careful of becoming an advocate for electronic records.  They may have a negative effect on your financial resume.

Still, there is a lot to do.  Five years ago, there were two main problems with the US healthcare system:  access and cost.  The access problem was mostly solved with the Affordable Care Act.  The remaining issue, cost, provides a huge opportunity for quality managers.  Show me what you can do, and we'll talk about a raise next year. 

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