Clinical Ladders: The Next
By Paul A. Dubiel, MS and Debra T. Flores, RT(R)
• Existing clinical ladders established in
2005 at Seton Family of Hospitals were
updated and put into place in 2008.
They were based on established nursing ladders.
• Original ladders were first established
to keep technologists motivated by
giving them more responsibilities and
opportunities to grow. Ladders also
gave the higher performing technologists more compensation for doing
• Seton Imaging modified the technologist ladder to include non-technical
responsibilities as well as some non-hospital activities to enable technologists who consistently go above and
beyond their job duties to be promoted up the ladder. The ladder has
62 pathway options for points, so it
allows for tailoring to staff interest or
Clinical ladders have been
used in imaging departments for a number of years. Many clinical ladder programs have evolved from nursing programs. Nursing managers at the Seton
Family of Hospitals have known for a long
time that rewarding staff based on a strict
criteria matrix is beneficial to both the
nurse, by increasing earning potential and
job satisfaction through career growth,
and to the administration, by reducing
turnover and increasing productivity. For
these same reasons, the imaging administration team at Seton decided to develop a
technologist clinical ladder.
Seton Family of Hospitals is a nine hospital system with a wide range of services
and hospitals located in central Texas.
Hospital capacity varies from Level I
trauma with a strong medical residency
program to a small rural critical access
hospital where just ensuring a dependable,
stable staff is a challenge. Creating an
effective ladder was critical to rewarding
all the technologists across the network,
not just those who worked in the large
Establishment of the Original
In 2004, the Seton imaging department
began transforming its technologist hiring
structure to a technologist ladder program.
At the time, the technical positions were a
two level system. Technologists were put
into one of two categories: radiologic tech-
nologist or radiologic technologist, senior.
There was no set criteria that placed a
technologist in either of the two positions
or outlined when an existing technologist
could be promoted to senior. The technol-
ogists were either promoted to a senior
position based on the individual hospital’s
undefined criteria (usually based on length
of service) or hired new into the position
when the initial offer to the technologist
was rejected because of base pay issues.
The manager would then upgrade the
technologist position to senior to give the
new employee a higher base pay. Imaging
management wanted to eliminate the sub-
jective nature of this approach and ensure
staff was paid more equitably.