for procedure statistics. However, a procedure line item for multi-modality performance is also offered. Staff at the larger
sites frequently have volumes that require
staff dedication to a specific modality
without opportunity for cross-training.
Smaller sites typically have staff that are
multi-modality trained and they can
receive ladder points for that service.
The new ladder offers points for many
varieties of engagement not dependent on
• Staff and student training and mentoring
• Inventory control and management
• Revenue integrity
• Advanced degrees
• Multiple imaging certifications and
• Advanced cardiac life support (ACLS)
• CPR instructor
• Awards (network or hospital)
Staff may submit their ladder portfolios
detailing their work at any time for promotion consideration. Staff in advanced ladder level job titles (level II or III) must submit a portfolio annually for re-evaluation.
Staff may be promoted, remain at level, or
be demoted based on whether primary
criteria have been met and total points for
secondary criteria have been achieved.
Portfolios are reviewed by a committee
comprised of technologists. The committee
chairperson is a member of the management team and coordinates the pre-work,
review session, and post-committee work.
This includes email notification to the
employee and manager regarding portfolio
committee placement decisions. The system also has a defined process for auditing
and for appeals and problem resolution.
The imaging ladders are designed to
be dynamic and reflect a picture of the
employee for a specified period. These are
not jobs for which the employee “proves
eligibility” and then walks away remaining
at that level as a guaranteed minimum in
the future. Within this ladder structure, all
employees are hired or transferred into
tech I level positions. Then, if employees
meet primary criteria (eligibility) requirements and have documented secondary
criteria (points), they may chose to submit
portfolios for placement or promotion.
The initial submission is reviewed by a
committee and may result in either a promotion on the ladder from tech II or tech
III or a denial (no placement—remain at
tech I). Once a technologist promotes on
the ladder to tech II or tech III, there is a
requirement for an annual portfolio submission at the end of the fiscal year. These
annual portfolios are reviewed by a committee for placement. Technologists will
either maintain level (most common), promote, or demote at annual, based on the
content and completeness of their portfolio.
This was an intentional decision of the
ladder workgroup. There was acknowledgement that practice, participation, and
buy-in evolve. The ladder offers opportunity for high performers and gives those
that participate in the implementation and
completion of department and facility
objectives a way to be recognized. Because
needs and desires change, contributions
would need to be re-evaluated via the
annual review each year to ensure that
employees on the ladder were continuing
to perform and offer services at the level
they were placed.
Each year, the manager workgroup
meets to discuss what worked for the lad-
der, what should be added based on objec-
tives or needs for the coming year, and
what needs to be amended, clarified, or
deleted. Staff are provided an opportunity
to offer input to their managers during the
review process. FAQs, “pointers,” and an
open door policy for email or phone input
and questions are maintained.
Usually the term “productivity” is used to
coincide with the number of procedures
or exams that staff perform. Seton ladders
work on a different principle. The ladders, in
general, do not award points for procedures
that are an expectation of all staff in the job
title. Procedures that are expected and routine are requirements of all ladder levels.
The development workgroup team and
managers intentionally chose secondary
criteria (points) to address the areas for
which the department needed to improve,
represent, and develop. For example, Seton
had specific goals around patient fall
events and injury reduction. The ladder
offers secondary criteria for “fall champion” that may fit with this objective for
staff that take on the challenges related to
this objective. Staff claiming these points
must work with the manager and key team
members to develop a plan, train staff,
implement the program, measure suc-cesses, document failures, and delve into
how to make improvements. It is an active
role, not a passive one.
This probably doesn’t meet the intent
of productivity in the literal sense, but does
meet objectives related to growth and
development, best practices, and patient
safety. Since implementation of the ladders, Seton has seen increased participation by staff in three areas—departmental
practice (specialty procedures), departmental objectives, and network objectives.
Some of this participation may actually
pull employees out of the “patient numbers” for active procedure performance, but
the benefits to the department and network
typically outweigh the temporary inconveniences related to these other duties. If
it is managed correctly, all staff can see
actionable results and the benefit of having
representation. It becomes a routine part of
the functioning of a successful department.
The time was taken to identify the activities, services, and committees needed, then
representation on workgroups was requested
for interested parties. The managers and
shift staff chose the representative(s).