2 Introduction Information technology (IT) professionals (such as help desk, project management or implementation specialists) are without a doubt critical to the success of the health IT industry. Indeed, the successes and failures of IT implementations in many hospitals for example, can be directly tied to IT workforce issues. Yet, evidence from HIMSS Analytics suggests the unprecedented growth the health IT industry has experienced during the last two decades, is starting to slow. the coming year. It also tracks the type of candidates employers are seeking, how employees are being recruited and retained, and the challenges of managing a fully staffed health IT operation. We are pleased to once again present this important study to the market to provide context around current and projected IT hiring practices. We are confident the insights contained within will be beneficial to those who are involved in some way in hiring IT workers. Recognizing the implications this changing market has for IT professionals, HIMSS commissioned HIMSS Analytics in 2013 to benchmark and track the IT staff hiring practices among healthcare providers, industry vendors and consultants. This year s report is the second installment of the annual HIMSS Workforce Survey. The successes and failures of IT implementations in hospitals can be directly tied to IT workforce issues. As in last year s study, this year s report covers a number of topics critical to organizations involved in the hiring of health IT professionals to include staffing experiences during the past year, as well as hiring plans for
3 1 Contents Executive Summary 3 Methodology/Respondents 5 Staffing Environment in the Past Year 7 Hiring Plans for the Next Year 21 Candidate Characteristics 27 Employee Recruitment, Hiring and Retention 32 Barriers and Concerns in Hiring Qualified Professionals 39 Conclusion 43 About HIMSS 44 How to Cite This Study 44 For More Information 44
4 2 Executive Summary The findings in this report are based on responses from 200 individuals representing healthcare providers, vendors and consulting organizations. Contacted during the May through June 2014 timeperiod, the 200 individuals participating in the 2014 HIMSS Workforce Survey can be considered generally representative of the health IT staffing needs and experiences of healthcare providers, vendors and consulting organizations operating in the United States. Evidence from this year s study suggests healthcare presents as an attractive market for IT professionals for three main reasons. First, health IT workers have been in high demand (albeit via recruiting/hiring workers or outsourcing the tasks to external companies), with vendor organizations being more active in recruiting and hiring health IT personnel than provider organizations. Second, the market expects to need health IT workers this coming year. Four out of five (80 percent) healthcare organization respondents, for example, reported their organization had plans to hire additional IT staff in the next year, with almost all vendors indicating similar plans. We did observe a notable decline in organizations planning to outsource an IT function this year suggesting the possibility that the outsourcing market may be constricting. Third, health IT continues to be a stable industry. While the percentage of healthcare provider respondents reporting their organization laid-off any IT personnel the past year is relatively low (13 percent), this year s figure does reflect an uptick in lay-offs and is something we will want to carefully watch in subsequent years. With respect to the types of employees organizations are seeking, provider organizations are most likely to hire clinical application support positions while vendors plan to target field support staff. These findings should be particularly encouraging to seasoned professionals with relevant industry experience as both healthcare provider and vendor organizations indicated they were most interested in hiring these types of workers. That said the percentage of organizations interested in training current employees to fill needed roles or willing to hire recent graduates increased this year over last, suggesting good news for workers with less relevant experience. Regarding the recruitment of desired health IT professionals, all organizations tended to rely heavily on employee referrals although vendors seemed to be much more aggressive in their use of this recruitment source than providers. Vendor organizations were also more likely to use social media and relationships with local universities as a way to recruit for open positions than healthcare providers. But of all the recruitment tools available to employers, recruiters/executive search firms were deemed to be the most effective in helping an organization fill IT staffing voids. To entice candidates to accept a job offer, organizations most often used a competitive salary and benefits package as their preferred hiring strategy. Finally, in order to retain staff, organizations tended to offer professional development opportunities and flexible work schedules. Vendor and healthcare provider organizations differed rather notably on the components of compensation packages used to hire and retain staff.
5 3 The availability of qualified workers in the area emerged as the most significant challenge for vendor and provider respondents, a challenge which seemed to worsen between 2013 and Healthcare provider organizations in particular face challenges completing IT initiatives because of staff shortages. In fact, over one-third of respondents working for a healthcare provider organization reported scaling back or putting an IT project on hold because it could not be fully staffed. The implications for healthcare provider organizations delaying IT projects include allowing workflow and automation inefficiencies to continue, project management struggles and the risk of aging equipment breakdown, each of which can ultimately affect patient care.
6 4 Methodology/Respondents A total of 200 individuals, including hospital and health IT executives and executives from health IT companies completed the 2014 survey. Data was collected via a web survey in May and June In comparison, the 2013 survey received 224 responses. Approximately two-thirds (65 percent) of survey respondents were employed by a healthcare provider organization with the remaining respondents representing a vendor organization (Figure 1). All respondents were based in the United States. Figure 1 For purposes of analysis, respondents were grouped into two broad categories based on their work location; providers or vendors. Respondents who reported working for a clinical practice, the corporate offices of a healthcare system, a hospital that is part of a delivery system or a stand-alone
7 5 hospital are classified as healthcare provider organizations. These respondents answered questions specifically regarding IT staffing at their organization. Respondents representing consulting firms, vendor organizations and other types of organizations (e.g. non-profit associations; health information exchanges) are reported as vendor organizations. These respondents answered general hiring questions.
8 6 Staffing Environment in the Past Year The findings from this year s study clearly show health IT workers continue to be in high demand. Over 84 percent of survey respondents reported their organization hired at least one staff member in the past year; a finding consistent with the 2013 finding (86 percent). A larger percent of vendor organizations (91 percent) hired staff compared to provider organizations (81 percent). This is similar to 2013, when 91 percent of vendors and 82 percent of healthcare providers reported hiring at least one IT staff member. Healthcare Provider Organizations The array of IT full-time equivalents (FTEs) hired by healthcare provider organizations reflects a bifurcated pattern (Figure 2). Over half (56 percent) of healthcare provider organizations indicated they hired between one and ten IT full-time equivalents (FTEs) in the past year, while 20 percent hired twenty or more staff this past year. A similar pattern emerged in last year s survey although the findings this year appear to suggest a shift towards hiring twenty or more staff members.
9 7 Figure 2
10 8 The 2014 survey included a new question regarding the incumbency status of the jobs they were filling (new positions, replacement hires or a combination of both). As depicted in Figure 3, of the provider organizations that hired at least one IT FTE in the past year, 72 percent hired at least one individual for a new position (12 percent hired exclusively for a new position; 61 percent hired both replacement and new hires). Only 27 percent limited their hiring efforts to replace existing positions. Figure 3
11 9 Among the 81 percent of healthcare provider organization respondents that hired at least one health IT FTE in the past year, the most commonly sought personnel were clinical application support professionals (64 percent). Help desk and IT management professionals were other common staffing needs, reported by 57 percent and 45 percent of respondents, respectively. These were also the top three reported staffing needs in the 2013 survey (Figure 4). Figure 4
12 10 One strategy healthcare provider organizations can pursue in meeting their IT staffing needs is to outsource select tasks to an external company. This strategy appears to be widely embraced by provider organizations. In fact, three-quarters of healthcare provider respondents indicated their organization outsourced at least some of their IT staffing needs to a vendor or consultant rather than hiring the workers directly. Clinical application support (30 percent) was the most commonly outsourced area, followed by project management and system design and implementation (25 percent each). While the percent of healthcare provider organizations reporting a specific outsourced area varied slightly from the 2013 survey, the top five areas remained the same. See Figure 5 below. Figure 5
13 11 There is great consistency in the outsourcing/hiring practices of provider organizations. When comparing the top 10 areas where healthcare provider organizations hired IT staff and the top 10 areas where they outsourced services, nine of the roles appeared on both lists (Figure 6). Clinical application support was the most commonly sought after position, both as an IT FTE hire and as an outsourced position. Figure 6
14 12 Respondents were also asked whether their healthcare provider organization had laid off any IT staff during the past year. While the vast majority (87 percent) of healthcare provider organizations indicated that no health IT staff was laid off during this timeframe, the percentage of staff layoffs crept upwards this year; eight percent in 2013 and 13 percent in 2014 (Figure 7). While these numbers are in within the margin of error of one another, we will want to closely monitor this question in future studies to see if a directional trend in the data emerges. Figure 7
15 13 Given the small sample of healthcare provider organizations that had IT staff layoffs, the analysis for the next two figures should be interpreted cautiously. When asked to detail the number and type of IT FTE layoffs experienced this last year, two-thirds of the effected respondents reported their healthcare provider organization laid off less than six FTEs (Figure 8). Figure 8
16 14 In terms of the positions most commonly targeted for layoffs, provider organizations tended to focus on clinical application support (40 percent), followed by help desk and IT management roles (33 percent each (Figure 9). As these three areas are also reported as the areas with the most hires and are in the top four areas where providers plan to hire, these positions may experience turnover more frequently than other areas. Figure 9 For the first time in 2014, respondents were asked if their IT staff decreased due to attrition, where a position becomes open after an employee retires or resigns. Nearly one-quarter (22 percent) of healthcare provider organizations experienced a decrease in their IT staff because of attrition.
17 15 Vendor Organizations Most (91 percent) of the respondents working for vendors and consulting firms reported that their organizations had hired staff in the past year. This is identical to what was reported in Nearly half (47 percent) of vendor organizations hired more than 20 FTEs, a decrease from 58 percent in 2013 (Figure 10). Again, because these organizations serve the broader healthcare industry, this study surveyed a broad range of positions, not just specific IT areas. Figure 10
18 16 For the first time in 2014, vendor respondents were asked to identify if hires were for new positions, replacement hires or a combination of both. Interestingly, 92 percent of these respondents hired at least one individual for a new position (18 percent hired exclusively for a new position; 73 percent hired for both). Stated differently, only eight percent of vendors hired exclusively to fill existing positions, (Figure 11) suggesting there is much growth and opportunity in the vendor workforce. Figure 11
19 17 Among respondents working for vendor organizations that hired staff this past year, the most frequently reported roles hired were for the sales/marketing team (78 percent) followed closely by field support staff, such as system implementers (75 percent), and support staff, such as human resources, finance and web teams (73 percent). The percent of vendor organizations reporting hires for sales/marketing and field support staff decreased from the 2013 survey, while support staff and executive team hires saw a slight increase (Figure 12). Figure 12
20 18 Slightly more vendor organizations initiated layoffs in 2014 (31 percent) than in 2013 (29 percent). Given the small sample of vendor and consulting organizations that had staff layoffs, the analysis for the next two figures should be interpreted cautiously. Of the respondents from vendor organizations that reported layoffs, over half (53 percent) had laid off less than six FTEs. Another one-quarter (26 percent) laid off between six and ten FTEs (Figure 13). This question was not asked in Figure 13
21 19 The most frequently reported area from which vendor organizations laid off FTEs was field support staff (50 percent). Support staff and those on the sales/marketing team (45 percent each) also experienced FTE layoffs (Figure 14). Figure 14 For the first time in the 2014 survey, respondents were asked if the organizations staff decreased due to attrition, where a position becomes open after an employee retires or resigns. One-fifth (20 percent) of respondents working for vendor organizations reported that their staff decreased due to attrition.
22 20 Hiring Plans for the Next Year The outlook for IT professionals is positive. Survey respondents were asked about their organizations hiring plans for the next year; 82 percent of all survey respondents indicated that they planned to hire at least one FTE which reflects a slight increase from the 2013 survey where 79 percent of respondents reported plans to hire at least one FTE. Healthcare Provider Organizations Nearly three-quarters (74 percent) of provider organizations plan to hire at least one IT FTE in the coming year, similar to the figures reported in 2013 (73 percent). Half of the respondents plan to hire between one and five IT FTEs, a decrease from 59 percent in 2013 (Figure 15). Another 16 percent plan to hire between six and 20 IT FTEs. Increasing from two percent in 2013, eight percent of healthcare provider respondents for the 2014 survey reported plans to hire more than 20 IT FTEs. Figure 15
23 21 The most sought after position for healthcare provider organizations in the next year will be clinical application support staff (58 percent). This year s figure represents a notable increase compared to the 2013 study, when only 34 percent of provider respondents planned to hire clinical application support staff (Figure 16). Figure 16
24 22 Use of outsourced services by healthcare provider organizations is expected to continue in the next year. Over two-thirds (70 percent) of respondents reported at least one area of anticipated outsourcing. This is a notable decrease from the 93 percent of healthcare provider organizations that planned at least one outsourced service in the 2013 survey. This is certainly an area we closely monitor in next year s study. The areas of IT security (26 percent) and project management (25 percent) were the roles most commonly cited for outsourcing opportunities. With the exception of help desk and database administration, the 2013 and 2014 outsource plans were very similar (Figure 17). Figure 17
25 23 Vendor Organizations Among the respondents working for vendor organizations that were aware of their organization s hiring plans in the next year, virtually all (98 percent) planned to hire at least one FTE. The number of professionals that vendors plan to hire reflects a bifurcated pattern with 54 percent of vendors planning to hire 10 or fewer workers and one-third (34 percent) planning to hire more than 20 FTEs. The total number of planned FTEs for vendor organizations appears to have decreased in the past year. The number of respondents reporting their organization planned to hire more than 20 FTEs in the next year decreased from 43 percent in Conversely, the percent of respondents reporting their organization planned to hire between one and five FTEs increased in the past year (Figure 18).
26 24 Figure 18
27 25 Each of the pre-defined staff positions executive team, field support staff, sales/marketing and support staff saw a decrease in the number of vendor organizations planning to hire in these roles (Figure 19). Field support staff (75 percent) was the most frequently reported area in which vendor organizations planned to hire FTEs, followed by sales/marketing (70 percent). The percent of respondents reporting other position types increased to 18 percent from 11 percent in 2013; specific write-in areas supplied by respondents included IT, interface engineer and programmer. Figure 19
28 26 Candidate Characteristics Recognizing the market s continued interest in hiring IT professionals, respondents were then asked to share their thoughts on select candidate characteristics, most notably the importance of industry certifications 1 and industry experience. Interestingly, providers and vendors differed on the intensity and priority assigned the 14 industry certifications considered. Respondents working for vendor organizations generally rated certifications more important than provider respondents, averaging a rating of 4.78 across the 14 areas compared to an average rating of 4.20 from healthcare provider respondents. Compared to the 2013 study, overall importance of these certifications decreased among vendor respondents (5.05 in 2013) and increased among healthcare provider respondents (4.14 in 2013). 1 Respondents answered this question using a one to seven scale where one was not at all important and seven was highly important.
29 27 The most important certification area identified by healthcare provider respondents was for security personnel (5.26), followed distantly by project manager (4.86) and network/architecture support (4.83). Security personnel and network/architecture support were the two most important certification areas in the 2013 survey (Figure 20). Figure 20
30 28 Respondents working for vendor organizations were most likely to report that network/architecture support (5.33) and security professionals (5.26) were the two most important areas for certification. While the ratings for the importance of certification in each area decreased from the 2013 study (Figure 21), the top three areas were the same for both years network/architecture support, security professional and informatics professional respectively. Figure 21
31 29 When asked to describe the types of individuals they would likely hire for their open positions 2, all respondents favored seasoned professionals with relevant industry experience (combined average rating of 6.11). This year s score reflects a slight decrease from the 2013 rating of 6.12 (Figure 22). Employers also seem to have a growing interest in current employees with the correct qualifications when considering open positions, as the rating for these types of candidates increased from 5.74 in 2013 to 5.93 in Finally, while new graduates represent employer s least desired candidate pool, this year s findings show that employers seem to be more receptive to hiring recent graduates (average score in 2013 was 3.96; average score in 2014 was 4.39). Figure 22 2 Respondents answered this question using a one to seven scale where one was not at all likely and seven was highly likely.
32 30 Respondents working at vendor organizations were more likely to use professionals with industry experience, recent graduates and professionals with experience in another industry than respondents working for healthcare care provider organizations (Figure 23). Healthcare provider organization respondents were slightly more likely than those at vendor organizations to promote qualified staff internally for open positions. Figure 23
33 31 Employee Recruitment, Hiring and Retention Recruitment Given the high demand for health IT professionals, the type of recruitment and retention efforts an organization pursues should be important to the organization s overall success. When asked to identify the types of tools their organizations used to recruit staff in the past year, employee referrals were the most commonly cited tool with three-quarters of all survey respondents using this tool (Figure 24). This was also the most reported recruitment tool in 2013 (69 percent). Nearly two-thirds (65 percent) of all survey respondents reported using public job boards as a recruitment tool, while over half (56 percent) indicated use of professional society job boards 3. Survey respondents were least likely to use advertisements (online and print) for recruitment with just over one-third (39 percent) using this type of tool, a decrease from the 2013 survey findings (50 percent). 3 For the 2014 survey, the options for job boards were separated into two distinct types; public job boards and professional association job boards. Therefore a direct comparison to the 2013 cannot be made.
34 32 Figure 24
35 33 There are a few notable differences in recruitment tools based on respondent organization type (Figure 25). While employee referrals was the most reported tool for both healthcare provider and vendor organizations, vendor organizations tended to be more dependent on employee referrals (90 percent) than provider organizations (66 percent). In addition, vendor organizations were more likely to use social media and relationships with local universities as a way to recruit for open positions than provider organizations. Healthcare provider organizations, on the other hand, were more likely to create online/print advertisements in their local newspapers to recruit staff for their IT departments. Figure 25
36 34 Respondents were also asked to identify specific sources used in their recruitment efforts. Each source saw a notable increase in use from 2013 to 2014, but this change may be due in large part to a change in the way this question was presented. In 2013, this question was an open-ended question while in 2014 respondents were provided with a list of sources to select from. LinkedIn was the most commonly reported recruitment source, used by 40 percent of all survey respondents (Figure 26). Figure 26
37 35 Finally, respondents were asked to identify the level of success they had with each of the recruitment tools utilized by their organization 4. While recruiters/executive search firms were used by just over half of survey respondents (a notable increase over the percentage of organizations relying on this resource in 2013), respondents generally considered recruiters/executive firms the most successful approach to use in meeting their recruitment needs (average score of 5.45). This is similar to the 2013 rating of The most commonly used recruitment tool, employee referrals, had the second highest success rating (5.34), which was a slight decrease from the 2013 rating (5.68). The success rating for the remaining recruitment tools also tracked in the 2013 each experienced a slight decrease in their rating from last year (Figure 27). Public job boards received the lowest success rating of Figure 27 4 Respondents answered this question using a one to seven scale where one was not at all successful and seven was highly successful.
38 36 Hiring Respondents working for both vendor and healthcare provider organizations were most likely to report that offering a competitive salary/benefit program was crucial to hiring qualified staff (Figure 28). Those working for vendor organizations were more likely than their counterparts at healthcare provider organizations to indicate that their employer included telecommuting (53 percent) and time off for volunteer participation (36 percent) in their compensation packages (26 percent and eight percent respectively). Including sabbatical leave was the component of compensation packages least likely to be offered by healthcare provider or vendor organizations. Interestingly, 19 percent of healthcare provider organizations indicated that they did not offer any of the listed components in their compensation packages. Figure 28
39 37 Retention In an effort to retain qualified staff, organizations were most likely to offer professional development opportunities, identified by 64 percent of healthcare provider organizations and 66 percent of vendor organizations (Figure 29). Professional development was the most reported strategy for retaining qualified staff in the 2013 survey. Offering flexible work schedules was a strategy to retain staff reported by 60 percent of respondents. Respondents working for healthcare provider organizations were more likely to offer paid tuition (64 percent) than vendor organizations (37 percent), while vendor organizations were more likely to pay for membership in professional associations (54 percent) and offer telecommuting (51 percent) than healthcare provider organizations (45 percent and 31 percent respectively). Offering loyalty programs was the least reported strategies to retain qualified staff.
40 38 Figure 29
41 39 Barriers and Concerns in Hiring Qualified Professionals The last section of the 2014 HIMSS Workforce Survey queried respondents on the challenges in hiring health IT professionals as well as the impact of operating with staffing voids. The results of the survey not only reinforce the idea that healthcare provider organizations do face barriers in their attempt to operate fully staffed environments, but that these challenges are increasing. To illustrate, 85 percent of all respondents (92 percent of healthcare provider respondents and 74 percent of vendor respondents) claimed their organizations faced barriers in fully staffing their environments. The results this year reflect a notable increase in the percentage of vendor organizations claiming the presence of barriers in achieving a fully staffed environment. In 2013, 57 percent of vendor respondents claimed their organization faced hiring barriers. Of the respondents who indicated that they faced hiring barriers, the lack of a qualified talent pool in their area was cited as the biggest challenge to achieving a fully staffed environment (69 percent for providers; 71 percent for vendors) (Figure 30). The lack of a local qualified talent pool was also the most reported barrier for all survey respondents in the 2013 survey. Half of respondents working for provider organizations indicated that hiring vendors/consultants was too expensive compared to only six percent of vendor respondents. At least 19 percent of respondents working at vendor companies and 21 percent of those working at healthcare provider organizations reported other barriers to fully staffing their environments, such as budget and financial limitations.
42 40 Figure 30 Respondents working for healthcare provider organizations were asked two questions about the impact staffing shortages could have on IT initiatives. The feedback suggests staffing challenges do impact a segment of providers, but that an equally sizable percentage of the market is not impacted by these challenges. More specifically, just over one-third (36 percent) of provider respondents did not scale back any IT projects due to being short staffed, while approximately the same percentage (38 percent) claimed that they did have to scale back at least one IT project. An addition one-quarter (24 percent) of respondents noted that they had not scaled back an IT project but were considering doing so.
43 41 In comparison to the 2013 study, healthcare provider respondents were more likely to report putting a project on hold in 2014 than they were in 2013 (Figure 31). Over one-third (35 percent) of provider respondents had to place at least one IT initiative on hold due to staffing voids, up from 31 percent in Another 24 percent of respondents indicated that while they had not yet placed an IT initiative on hold, they were considering doing so. Figure 31 Nearly one-third (30 percent) of healthcare provider respondents indicated that their organization had both scaled back an IT project and had to put an IT initiative on hold due to staff shortages. Another 17 percent were considering scaling back an IT project and putting an IT initiative on hold because the organization could not fully staff them. Over one-quarter (29 percent) of respondents working for a
44 42 healthcare provider organization did not have to scale back an IT project or put an IT initiative on hold. Respondents working for a provider organization that had to either scale back an IT project or put an IT initiative on hold because of staffing issues were then asked to describe the impacted initiatives. In a theme reminiscent of the 2013 survey, respondents most frequently cited software and equipment upgrades and replacements. These types of projects were typically delayed until Meaningful Use or ICD-10 requirements could be met or implemented in a phased approach rather than all at once. Finally, respondents were asked to identify the implications for their organization in scaling back/putting projects on hold. Numerous implications were identified including: Creating inefficiencies for staff leading to end user frustration and dissatisfaction. Disruptions in patient care. Increased reliance on manual processes. Increased concerns of potential security breaches.
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