The Way to Right-Sizing

"The right-sizing equation is a little different for every site, but ultimately it boils down to determining whether the department has enough resources to fully support the goals of the organization," says Schaeffer. "We determined that for us, as a community hospital, we could best support those goals through a mix of internal and external outsourcing."

A Stage 6 hospital must have a full-blown EMR system—including computerized physician order entry, automated medication dispensing, an electronic medication administration record with either barcoding or radio frequency identification technology, and a clinical decision support system—along with full radiology and picture-archiving and communication systems. St. Clair reached the Stage 6 milestone without increasing FTEs for the past 14 years, Schaeffer says.

Making the decision to transfer daily technological operations to an external service provider—in St. Clair's case, Atlanta-based Eclipsys Corp.—can be exceedingly difficult; many IT leaders cringe at the thought of handing over control to an outside source. But, says Schaeffer, the bottom line has to be whether the hospital's current infrastructure is capable of supporting all of its needs. "We track the number of devices we support in the IT department on a regular basis, everything from PDAs to Vocera badges and clinical devices. We've gone from 1,347 devices five years ago to more than 2,700 devices today, but we haven't needed to add staff because of the increased productivity of staff members," says Schaeffer.

Learn from others
Observing where peers have found success—or failed miserably—can be helpful in any industry, and healthcare is no different. But the fluid nature of technology makes using industry standards as a barometer for how much you should be investing or how many IT workers you should employ a risky proposition. "It's tough to compare IT departments from hospital to hospital. Everyone has different levels of automation and goals," Bosco says.

John Hoyt, vice president of healthcare organizational services at HIMSS, says developing a detailed strategic plan is critical when CIOs are trying to benchmark their department against another. "If you know exactly where you want to be in three to five years, you can look to other organizations that already reached your future goal successfully and see where they succeeded and where they stumbled along the way," he says.

Hoyt suggests comparing your hospital's current IT capabilities with future stated goals to identify potential gaps. There are some simple questions each CIO can ask of his of her IT department to help ensure that the right comparisons are being made, he says. "Ask yourself what principles you want to adopt for the IT department. How much are you willing to spend? Do you want to be a technological leader or follower? Will you outsource? Once you determine solid answers to some pretty basic questions, you will have already answered the question of being right-sized."