Ask any financial advisor to give you a rundown of the areas they cover with their clients. Most people think of savings and investing as the primary focus, and those are certainly two that are important. But, there are several others that are just as important, like tax planning, insurance and estate planning. That last one seeks to leave things to the client’s heirs in the most advantageous, tax-efficient and low-cost way. It is succession planning in the purest sense.
The process is designed to cause minimal disruption to the estate and minimal disruption to those receiving the proceeds. It seeks to pass the baton without dropping it.
Succession planning in the biomedical or clinical engineering department seeks a smooth transition also with minimal disruption to the operation of a hospital or health system. For leadership, it includes identifying and developing replacement managers. The process also seeks to replace retiring HTM staff in an efficient manner without disrupting internal resources.
A Numbers Game
The line at the exit is longer than the line at the entrance. This is a big problem when you look at the dilemma facing the HTM profession in the years ahead. There are 76.4 million baby boomers in America and they started reaching retirement age in 2011. From the first day of that year, and for every day for the following 19 years, 10,000 baby boomers will turn 65. There is a point in most people’s careers where they decide to enter retirement. The HTM profession will not be spared from this certainty.
Concurrently, that same aging baby boom generation puts more pressure on the country’s health care system, with larger numbers of potential admittances for age-related conditions.
Strategic succession planning is not only a fact of life in the financial planning profession, but is a stark reality in HTM, which faces a daunting challenge in maintaining staffing in departments across the country. The senior members of HTM departments are collecting their gold needle nose pliers and heading for the exit. With their exit comes the departure of years of experience, training and maturity. Planning for their replacement, and the training of each department’s next generation of experts, along with replacing managers, requires forward thinking.
“We have learned that succession planning cannot be a one-time process without follow through and staff development,” says Walter Barrionuevo, director of Clinical Engineering Services at BayCare Health System in Clearwater, Florida.
“It requires continual attention to ensure our profession and industry are served for the many years to come,” he says.
That opinion is shared by F. Mike Busdicker, MBA, CHTM, system director of Clinical Engineering at Intermountain Support Services/Supply Chain in Midvale, Utah. Busdicker believes it is not only good policy, but incumbent on managers to plan ahead for their own replacements.
“In my opinion, the development and career succession planning for HTM departments includes personnel at all levels within an organization and the industry,” Busdicker says.
He adds that good leaders do not sit back and enjoy their status until the day comes for them to retire. This type of attitude does a disservice to the organization they serve and to the industry. He says that current department and industry leaders should be proactive in developing their replacements and the leaders of the future.
“Recently I had a mentor relay a message that has stuck with me. He said ‘We should not be concerned about our legacy, but should be more concerned with the handprint we leave on the organization and health care as a whole.’ This statement really hit home with me and provides an example of a leader looking beyond their specific accomplishments,” Busdicker says.
“I would suggest that organizational leaders need to look within their individual departments and understand the desire and talent of current personnel,” he adds. “Once this information is understood, and documented, it becomes part of the leader’s responsibility to help create opportunities for growth and development.”
Not only are Busdicker’s suggestions relevant for future planning, but for many in HTM leadership, they are a reality that is hitting home as the profession waves good-bye to the baby boomers within its ranks.
“This is real and I am living it,” says Douglas Dreps, MBA, director of Regional Clinical Engineering for Mercy Health in St. Louis. “I am just starting to put a plan together as I will have four to six senior biomed and imaging technicians planning to retire over the next five years, starting early 2017. This is a huge issue in our industry.”
Ramping up the Rookies
Finding new staff, to replace those retiring, would seem to be an easy task. It’s not as if the HTM field is not attractive. There is plenty of incentive for a young person, planning their future, to choose HTM. The projected growth for CEs is particularly strong, and even the growth for BMETs beats many professions.
U.S. News and World Report ranked “medical equipment repairer” in the number one spot among maintenance and repair jobs. Their assessment included a projection of an expected six percent growth rate between 2014 and 2024. Using statistics from the Bureau of Labor Statistics, the publication estimated that there should be “2,900 new positions created by 2024.”
These figures may be conservative. Anecdotal evidence appears to suggest that the need will be far greater.
The medical equipment repairer position also made U.S. News and World Reports “100 Best Jobs” list for 2016, coming in at 96.
That publicity should have created an avalanche of new entrants into the profession, but the reality is that the line at the entrance is not long enough and there is no way to acquire instant experience. The new generation of biomeds may have more exposure to the networking and security components that are now an essential component in the field, but they haven’t had the opportunity to learn from those vexing challenges that molded the accumulated experience of the veterans.
“Succession planning has always been a top priority for our leadership,” Barrionuevo says. “We are committed to both developing the competencies of our leaders and providing the tools to develop our technical team members.”
He says that technical development utilizes formal assessment and development plans that address individual competency needs. His department utilizes several processes to develop their technical staff. The plan includes providing technical training to staff for all new equipment purchases to keep them competent.
Barrionuevo’s department also created an in-house CBET training program for all entry-level team members to ensure they are all at the same technical level and to promote the HTM industry by partnering with local educational sources, including St. Petersburg College, to ensure future candidates meet the needs of the HTM field.
He says his department’s technical training includes providing networking/IS information since HTM is becoming more IS centric. They have also taken steps through the “creation of a DI Associate position which helps bridge the gap between clinical engineering service and field service diagnostic imaging service,” he says.
Big systems have an equally bigger challenge when career progression, recruitment and staffing are considered across a vast number of facilities. Some have employed a well-thought-out strategy for managing career transitions so that management positions are not left empty.
“This is definitely a challenging issue and we have experienced what happens when we don’t take the opportunity to work through robust succession planning,” says Perry Kirwan, MSE, CCE, vice president of Technology Management at Banner Health.
“We have since put in a talent management review process to try and identify both talent and likely successors to advanced positions in Banner, whether they be technical/specialists positions, or management ones,” he says.
Kirwan says that each employee not only receives an annual review, but is also asked to identify career aspirations. Employees are then mapped relative to their current capabilities for their aspiring positions. He says that career development plans are built to help each employee reach the required steps to achieve their goal.
“The goal is to identify two to three people for each position higher than the one that they are in so that we always have a pipeline for advancement,” he adds. “These plans are reviewed twice a year so that they stay current and can be refreshed accordingly if the organization should experience turnover or other mitigating factors.”
“Career development plans consist of mentoring with a more senior employee to learn both technical and managerial skills, taking on stretch assignments designed to grow employee skills, interim leader assignments – for managerial track employees – and taking educational courses, both within the hospital systems, and through formal education to prepare the employee,” Kirwan says.
In addition to developing internal resources, his department spends time working with community colleges and for-profit educational institutions, like DeVry, as well as state colleges and universities “in an advisory capacity to try and win both interns and new talent into the organization,” he says.
“We also have a few staff members that speak at local middle and high schools through the state AHA chapters to build enthusiasm for HTM and biomedical/clinical engineering,” Kirwan adds.
He says local trade organizations can help with recruiting talent as well.
“AzMIA (Arizona Medical Instrumentation Association) is just beginning to tap that process by sponsoring community activities that help prospective students get exposure to hospital-based technology management professions. This is a new area for this chapter, so there is not so much to report,” he says.
While experienced biomeds can fill the manager ranks, there has to be a process to get the rookies ramped up. A team from GE Healthcare will be presenting “Leveraging Learning Technologies: Tools to Address an Impending Workforce Shortage and to Train a New Generation” at the 2016 AAMI Conference & Expo.
“A phased approach, or a training continuum, is recommended to provide incremental learning for developing a technical workforce. Entry-level workers should be provided competencies – aggregates of knowledge, skills, abilities and tools – to understand equipment operations, participate in basic maintenance tasks and assist in minor repairs,” says Art Larson, general manager Global Services Training at GE Healthcare.
Larson says that new biomeds can then engage in follow-up training that may include visits to equipment manufacturer’s institutions, online training modules, on-the-job training, simulation and/or other learning experiences. He points out that a flexible model, with multi-faceted learning delivery methods, should include opportunities to apply learning before additional training is required, allowing for discussion with peers in the field and real-life experience which will enhance future training, understanding and retention.
Ahead of training those new recruits is finding qualified candidates in the first place.
“I have built up relationships with several schools in my area. I have affiliation agreements for intern and externships with three of them,” Dreps says. “The past seven years, I have hired many of the interns or externs that were at one of our hospitals. Training is another area that I have already started on to boost others’ knowledge, so they can fill in for those that plan to retire.”
Mapping it All Out
It’s been said that writing down a goal brings you half way to achieving it. With the projections of a retiring workforce, the best approach is to face that fact and develop a succession plan. It’s all about mapping out known future events and being prepared.
“Back in 2012, I developed a comprehensive succession plan for our entire division, and identified the following major concerns,” says Dave Dickey, CHE, CCE, corporate director of Clinical Engineering for McLaren Health Care in Flint, Michigan.
Dickey began by charting the estimated retirement target dates of his staff at the time. The breakdown included 12 MCES staff members who would be retiring within five years, 20 who would be retiring within 10 years, 10 others who would be retiring within 15 years and 20 who still had 15 or more years to work before retirement.
The resulting fact was that half of his staff would be retiring within 10 years. As a director, Dickey saw that he had four time periods of concern which needed to be “properly planned for and managed.”
At the time, he captured the relevant data to formulate a plan.
“In 2015, the CE lead tech (supervisor) at one of our sites will be retiring. Also, during this same year, two of the senior biomed staff at one of our other hospitals will be retiring (representing 33 percent of the total biomed tech staff),” he explains.
For this year, and next, he found that two of his current call center/admin staff (FTEs) would also be retiring.
“Both of these individuals share phone (call center) duties. One has primary responsibility for invoice management for all locations, and also serves in the role as office coordinator; the other is responsible for customer service report generation and distribution,” he says.
For 2019 and 2020, Dickey is faced with his own retirement and about half the corporate program managers. In 2022, “36 percent of the service specialist staff will be retiring, along with 18 percent of the biomed tech staff,” Dickey adds. “In total, 13 individuals will be retiring at this time. At our Lansing site, three (42 percent) of the biomed tech staff will be retiring.”
Put in context, and with 2022 not that far off, the need for succession planning is front and center. In defining the challenge, a manager should consider timelines and resources. The solution for staff replacement, skill set consideration, sourcing and timing, according to Dickey, looks like this:.
“According to a Deliott Best practice leadership survey report, the best method to prepare new leaders incorporates a 70:20:10 ratio, of 70 percent on the job experience in various progressive leadership roles, 20 percent one-on-one mentoring with coaching and performance management, and 10 percent classroom instruction, training, reading, and seminars,” he says.
He points out that typically, clinical engineering professionals obtain their experience in different ways.
For technicians, Dickey points to internship programs, followed by entry-level employment within hospitals or external service organizations.
“Ideally, hospital CE programs should have, as a goal, to have 10-30 percent of its staffing being entry-level technicians, with zero to five years of experience. What has happened, historically, is that due to the low turnover of staff within properly managed CE departments, most of the biomedical technician staff are all extremely experienced, with little to no entry level staff available that have upward career mobility,” he adds.
“This situation leads to loss of new, young talent, as they pursue new career opportunities within five years of employment at their first job out of school. This can be averted by having a structured career advancement program, whereby an entry-level technician can gain promotion to a Level 2, then Level 3 technician, based upon experience and obtainment of CBET certification,” Dickey adds.
The real challenge he cites, is that there is currently “only one local technical college in Michigan offering a structured AA degree in biomedical equipment service, that being Schoolcraft College in Livonia, Michigan.”
He says that in preparation for the need for new BMETs, it is recommended that MCES explore a formal internship program with them as a means to generate a source of replacement BMETs as the existing workforce enters retirement.
The challenge faced by this one HTM department supports the perception that the turnover in HTM staff, in the coming years, will reflect the percentage of baby boomers in the workforce.
As stated earlier, good leaders begin working on the process of filling their own shoes ahead of their own retirement. For some, this process is well planned and considers a number of factors.
“Succession planning has to first begin with committed and dependable associates. I have to be certain the successor is here for the long haul,” says Roger Kyrouac, clinical engineering site manager for Advocate Eureka Hospital in Normal, Illinois.
“My succession plan began four years ago, when I hired a new biomed with bachelor degrees in both business administration and clinical engineering; he also aced the interview. I was 58 years old at the time and saw the opportunity to groom my replacement,” he says.
“The plan was and is simple,” he says. “I have always been rather aggressive bringing talent up to speed.”
His planned successor is currently a Biomed II doing Biomed III work.
Kyrouac says that during annual evaluations, and periodically throughout the year, he has had conversations with that candidate about this plan.
“He is committed to this area and is excited about this plan,” Kyrouac adds.
As his retirement nears, Kyrouac will periodically expose his replacement to more leadership opportunities: “joining me for physical environment and leadership meetings and filling in for me on occasion; putting him in charge of higher end projects; spending more time coaching him as a leader rather than a biomed.”
“The year that I plan to retire will ramp up his exposure to those activities while I personally back fill some of his biomed responsibilities. The end game is to spend my last month as a biomed while he assumes the role of manager, which will ease me into retirement while getting him acclimated with me nearby for support,” Kyrouac says.
Beyond the planning for leadership succession, Kyrouac also has staff retirement challenges to contemplate. His imaging tech has been very successful at keeping imaging costs low, but he is two years older than Kyrouac. The challenge is that there is not a viable replacement in-house and his system’s policy will “only allow a max of three-month overlap of FTEs which is not satisfactory to replace the imaging tech. This will require a new position,” Kyrouac says.
The plan to justify an additional position is to use “recent major cost savings in imaging, overtime, contract and outside service reduction for the entire shop (all data driven with no imaginary numbers); I was able to document $120K against $65K (salary and benefits) for another FTE for a savings of $55K annually.”
With this in mind, and the additional benefit of increased “associate satisfaction,” he would submit a request for another Biomed II (hybrid) “with imaging experience or imaging training or imaging skill sets and interest,” Kyrouac says.
“Once on board, the focus would be to fully orient as a biomed II and enter the on-call schedule within six months. Followed by a realignment of PM assignments and mentoring by my Rad II. Ongoing responsibilities will be balanced between biomed and imaging,” he adds.
The upside is that the new position has the support of Kyrouac’s director and vice president, as well as the vice president of finance.
Hiring Potential Managers
In the quest to develop the next generation of leaders within a health system, Busdicker suggests that there are certain important building blocks.
“Teach them, and help them understand, the importance of building relationships with the organization and the industry,” he says. “Provide them with the tools and training necessary to develop natural and learned leadership abilities and competencies.”
Busdicker also suggests that they be allowed to manage some projects and functions that will provide valuable experience and learning opportunities. He says that leadership should also be mentors and/or provide them with an opportunity to interact with other leaders within the industry.
“Help them learn through your experience and provide them opportunities to learn through individual experience,” he says.
Busdicker says that HTM personnel, who have management aspirations, should make it clear that this is a career path choice.
“It is just as important for them to be proactive in their own careers and let others know of their desires. Over the past few years, I have had the opportunity to conduct a number of interviews,” he says. “One of the questions I have asked is ‘Where do you see yourself in five years?’ There have been a couple of occasions when the response has been: ‘I would like to have your job or something similar to it.’ In my opinion, this is a great response and demonstrates an individual’s desire to develop professionally and become a difference maker within the industry.”
“Leadership development provides competency training through classroom instruction, individual and team coaching,” Barrionuevo says. “Using our organization’s succession planning process, we identify exceptional team members who demonstrate leadership potential and provide additional training opportunities such as Aspiring Leaders Track, Emerging Leaders Track and Experienced Leaders Track.”
“Through these efforts combined and due to the continued growth of our department, we have successfully promoted 18 team members in the past six months,” he adds.
That same type of in-house leadership preparation process is playing out at McLaren Health.
“As internal candidates are identified as potential replacements to move into CE management within MCES, it is recommended that they be assigned to attend the MHC Leadership Academy Core I classes, at least one year in advance,” Dickey says. “If no internal candidates are available or meet job requirements, I recommend that an employment announcement be placed in the AAMI careers website.”
“Ideally, I would like to identify a qualified successor at least three months before I retire – in about 3 years – for cross training,” Dickey adds.
While many HTM leaders have developed their own approach to meeting these challenges, AAMI has also published several online resources to aid in the planning and implementation process. Those resources include: The AAMI Career Planning Handbook, the AAMI Leadership Development Guide and the AAMI Mentorship Program.
With preparation and forethought, the metamorphosis of the HTM profession, post baby boomer, will present less disruption and result in a transition that replenishes every department with minimal downtime.
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