Staffing issues lead to borrowing from Peter to pay PACS

June 11, 2001

The question of how many people it takes to operate PACS is not a joke, as those hospitals that do step over the digital line soon discover. Developing a staff adequate to meet the demands of filmless radiology operations is a continuous challenge,

The question of how many people it takes to operate PACS is not a joke, as those hospitals that do step over the digital line soon discover.

Developing a staff adequate to meet the demands of filmless radiology operations is a continuous challenge, said Rosemary Honea, PACS manager at Texas Children's Hospital (TCH) in Houston.

The right number of PACS full-time equivalent employees (FTEs) depends on several factors:


?the size of the imaging operation and how dispersed it is
?workload
?number of physician customers
?round-the-clock operation requirements
?how much service and training the vendor has contracted to provide

The staffing at TCH has tended to evolve along with the hospital's PACS, from support for a single ultrasound unit in 1991 to personnel for a system that includes CT, MRI, computed radiography, portable CR, fluoro, nuclear medicine, a RIS interface, and two additional health centers.

Now, with 1000 Web users and 300 review station users, TCH has 10 FTEs assigned to PACS support:


?one manager
?one administrator
?four analysts (two on day shift, one each on swing and night shifts)
?two analysts for weekend coverage
?one trainer
?one technologist

The hospital staff is augmented by two vendor (Agfa) service engineers on-site day and night.

"That may not be the right answer for everybody," Honea said.

The right number depends on installation-specific factors. How a hospital acquires those FTEs, however, can be as important as how many it ends up with. One popular tactic has inherent hazards.

"Borrowing employees who already have a full-time job elsewhere in the hospital to run PACS seems to be the popular way of getting started, but that can be a mistake," Honea said.

Borrowing is not an uncommon strategy for organizations just getting started in PACS. Soon after installing PACS, they discover the system needs more support than expected, so they pick somebody and assign that person the additional PACS duties.

"But pretty soon PACS gets to be a 24-hour job, and these people get tired," Honea said.

Sometimes, when employees complain about the increasing amount of work they're expected to do, they're told to spend eight hours on PACS just once a week, which is unrealistic, Honea said.

While giving the employee additional duties can mean new opportunities and new job titles for workers, the disadvantage is these employees frequently end up doing two jobs for one paycheck, a situation that can lead to resentment at being overworked and underappreciated. This, in turn, can lead to high turnover.

"We did this type of borrowing, but our Human Resources department graded the new PACS positions as lateral moves, undeserving of additional pay," Honea said.

As a result, as these employees gained additional skills and experience, they resented the fact they received no additional money. Many eventually left, taking their PACS skills with them.

A better way to handle PACS staffing, according to Honea, is to decipher the compensation code HR uses to determine pay grades, rewrite the PACS job descriptions accordingly, and create separate cost centers for PACS employees.

"You go in and find what positions have similar duties, take the higher paying jobs and conform it into what you're actually doing for PACS, and then call it something similar to what HR already knows sounds like this job," she said.

Some hospitals believe they can cost-justify a PACS purchase partially by the money they will save by reducing or eliminating film-handling FTEs once they go filmless.

"That's another big mistake," Honea said. "You may cut the number of FTEs running film and those numbers may look good, but you also need to hire other people with more skill sets then just moving film around."

Honea is skeptical of hospitals who claim to have reduced total FTEs in a PACS environment.

"They may say they didn't hire anybody, but if you look at who's running the PACS, they have vendors all over the place," she said. "You better have some big bucks up front to give to that vendor because if the vendor pulled out, the hospital would have to figure out how to run PACS in a hurry."