According to the American Hospital Association (AHA), “Healthcare is fundamentally about people caring for people.”1 This is a statement that Corazon wholeheartedly agrees with! In fact, within healthcare organizations, people are THE most important asset! The AHA also believes that society should “increase recognition that human resources are a core, strategic resource of hospitals; fully value and invest in workforce recruitment, retention and development; design work patterns and employment practices attractive in today’s and tomorrow’s workforce while improving performance and productivity; encourage upward mobility in the workforce and make hospitals and health systems employers of choice.” One process hospitals have utilized extensively to achieve these goals is the development of career ladders. Such structures are also be referred to in some organizations as clinical excellence programs or bridge programs. Career ladders play a significant role in outlining the steps necessary for career advancement and continued professional development. Career ladders are common in most hospitals and healthcare settings, especially within the nursing discipline. We believe these types of advancement programs set the stage for increasingly higher levels of responsibility, authority, and autonomy, along with increased compensation. Given the success of the “career ladder” for nursing and other healthcare professionals (Figure 1), we advocate a similar approach to bring success in terms of upward mobility for the cath lab staff. Indeed, there are career advancement opportunities in the cath lab, and any clinical setting can benefit from cross training. Applying a career ladder in the cath lab can no doubt motivate and encourage staff and non-nursing personnel in order to raise the bar of care at all levels. What career advancement opportunities exist for cath lab staff? As the cath lab staff member gains experience, there is the possibility for progression into a “lead” cath lab technologist-type role. Continued tenure and training can lead to a “senior” role, and through additional training and education, potentially an “assistant manager,” “manager,” or “director” role. Growth into these leadership positions often requires additional formal education as well, though the process can begin with more accessible professional development programs. An established career ladder can help outline the required steps for the advancement of various positions, which eventually can lead to improved quality outcomes, along with higher rates of employee satisfaction, customer satisfaction, and retention within the cath lab. How does an organization develop and implement the career ladder program? A career ladder system typically accounts for employee title changes, role levels, and salary progression in order to provide for advancement through a set of graded levels, or “rungs” on a ladder. As an organization begins the development of such a program, it is essential to follow a multi-disciplinary team approach and include various levels of cath lab and radiologic leadership, human resources/compensation, educators, senior administrators, staff technologists, and key physicians. The process can be daunting, but with the right team members at the table, collaboration will foster greater agreement with the ladder and participation among the staff. As the ladder is created, it is important to clearly define all aspects of the advancement steps that the staff must follow to begin their upward climb. The entry and end points for each rung must be established as objective in nature, and perhaps most importantly, quantifiable. Subjectivity or unclear parameters could lead to inappropriate reward practices and/or lack of participation. Topics that can be included in the career ladder are involvement with a quality improvement program, achievable patient or physician satisfaction targets, functioning as a mentor for new staff, involvement in cross-training of roles, and/or gaining continuing education credits. Obtaining additional professional certifications can also be included in the career ladder program. Some examples of professional certifications that can be included in the career ladder are successful completion of all requirements to obtain the designation as a Registered Cardiovascular Invasive Specialist (RCIS) or a Registered Cardiac Electrophysiology Specialist (RCES), each of which are administered through Cardiovascular Credentialing International (CCI). These certifications demonstrate clinical proficiency for the technologist, while also giving greater distinction for the team member through enhanced credentials. Another option for professional development is through the allied professionals sections of the International Board of Heart Rhythm Examiners (IBHRE), which demonstrates electrophysiology expertise. These specialty examinations apply to both nursing and technologist team members. Once a career ladder has been developed, communicating the program and launching it to the staff is very important. To begin, we recommend that all staff members first be made aware that a committee has been created to develop a career ladder. Then, care must be taken during the implementation so that staff members do not see the career ladder as an obstacle to success. Most will embrace the program, though if others are not supportive, this has the danger of negatively influencing others. A collaborative team approach to help staff with poor perceptions will be paramount to helping everyone understand the importance of the program and its merits. As they and their colleagues climb the ladder, the experience should demonstrate that the program is beneficial, objective, and rewarding both personally and professionally. To better illustrate how a career ladder structure can take form, see Figure 2, from Corazon client Ohio State University Medical Center.2 Maintaining momentum As with any such program, the career ladder will need to be monitored for effectiveness. A formalized evaluation process should be initiated, with the committee regularly reconvening to determine whether the program is meeting the goals of the department and of the organization. Often, this review becomes a forum to focus on any barriers that impact achievement of the program goals and/or the challenges of sustaining the program. For instance, the full staff is participating in the program, but there’s been little or no advancement, or, advancement is happening much too slow or even, too quickly. The assessment should also evaluate staff usage. If no one is using the program, the team needs to understand why. If the staff members are not taking advantage and climbing the “steps,” the manager may need to re-clarify the incentives available to the team for following and completing the steps to reach to the next rung. The committee should take the feedback and findings, and determine the best method of assimilating the modifications into the program to decrease the challenges and to help the program achieve the original goals of higher staff satisfaction, which will increase recruitment and retention rates. Summary Career ladders have been proven to be an effective means to increase productivity and staff versatility, and enhance staff retention, morale, and job satisfaction. The program should also lead to increased clinical quality, more diverse professional growth, and overall staff enrichment. But implementing this type of program is not easy. Keep in mind the necessity of utilizing a multi-disciplinary approach for the planning committee, the need for effective communications during the program implementation phase, as well as a continuous program evaluation to ensure compliance and achieving programmatic goals. While this may sound straightforward in terms of development and implementation, we would warn against rushing the process. Doing so may cause more problems in the long run, such as decreased morale, which inevitably leads to a higher turnover rate, and poor customer and staff satisfaction. Your staff is your most valuable resource. Inherently, healthcare workers want to help make a difference in society, impact outcomes, and be successful while providing for themselves and their families. By establishing a career ladder, you can ensure that your team is working together while climbing the ladder for career satisfaction and improved patient satisfaction and outcomes, while establishing a cohesive team. Kevin is a Senior Recruiter at Corazon, offering consulting, recruitment, and interim management for the heart, vascular, and neuro specialties. To learn more, visit www.corazoninc.com. To reach Kevin, email firstname.lastname@example.org. References 1. Workforce Supply for Hospitals and Health Systems Issues and Recommendation: Interim position statement by the American Hospital Association Board of Trustees, January 23, 2001. 2. The Ohio State University Medical Center. Nurses: Clinical Ladder. Available at: http://medicalcenter.osu.edu/careers/nurses/clinicalladder/Pages/index.aspx. Accessed February 19, 2010.