What I Wish I’d Known Before … Taking a Travel-Heavy Job

I wish I’d been aware of the social isolation and pressure to get things done in my limited time at home. There are friends I used to see regularly that I haven’t been in touch with for years now. With weekends really being my only time at home, I spend the majority of that time doing things that need to get done around the house, running errands, going to the doctor. It doesn’t leave much time for a social life or even seeing family.

Whatever your lifestyle health-wise, it will just be amplified by the travel. Work out regularly now? You’ll have an even better schedule to accommodate it. Not great about getting to the gym? Don’t romanticize that travel is going to help with a gym in every hotel. It only makes it harder and you’re eating restaurant food more than ever.

Choose your credit cards wisely to maximize perks.

The importance of inflatable lumbar support pillows. And how difficult it is to do any meaningful work on flights — neither the environment nor the ergonomics are conducive to productivity.

How much I would miss my family.

I wish I’d known I wasn’t as adventurous as I thought I was. Turns out I don’t like exploring new cities by myself.

I wish I’d known how much of my weekend time would be spent playing catch-up: dry-cleaning, laundry, cleaning, friends, family. All the little stuff that gets spread out through a normal week is condensed into two far-too-brief days.

I wish I’d bought shoes that were more comfortable.

How much I would miss my son. I originally thought that early mornings to the airport, overnight stays, and getting home late at night would impact my ability to get things done, find time to exercise, eat well, etc. However, I was quickly able to adapt and those areas of my life were not impacted. The hours from my son was the toughest part. I no longer weighed the time traveling with the time or more productive time in the office. I now weighed that time with the time a way from him. I’ve since left that job and started my own company where I can control my time based on its REAL value.

How it can strain a marriage. After doing it for 5+ years, we had not much in common. Weekends were spent catching up on chores and then getting ready to leave on Sunday or early Monday. We have no children, so we made the decision for him to spend several weekends with me at my long-term location to give us a common talking point, which did help. I gave the job up after six years and the marriage is still going strong at 41 years. The good part about the travel was the friends I met and have kept across the country and the experiences I would have never otherwise have had. I’ve been sailing in Long Island Sound and also experienced Fleet Week on a house boat in San Francisco Bay.

That the clients were actually interested in applying best practices vs. creating more layers of status quo.

Always bring workout clothing on a trip. You never know if you’ll get the chance to hit a great gym or run even if you’re not in the mood while packing. Always keep a charger, a pair of socks, and some cash in your briefcase or backpack.

You have to live on the road the same way you do at home, meaning that you must have the discipline to maintain your diet and exercise routines and not succumb to overeating and drinking.

That my employer mandates carry-ons (won’t pay for checked bags), requires adults who have never met to share rooms, believes that $45 per day will cover three square meals in major cities, and refuses to reimburse tipping of any kind.

Working a 12+ hour day. You pretty much need to be available to meet with the customers during THEIR 8-5 day job, but you also have to prepare for those meetings, etc. after the normal workday is over. I’ve seen this in both sales and implementation roles. Some companies are cheap and insist that you stay at low-end hotels (think Ramada Inn with outside doors) and have all kinds of budgetary constraints. It’s kind of hard to ask for the travel expenses policy during the interview, but somehow try to find those things out. 

Buy a second set of makeup and leave it in the suitcase for travel days. Get the back-office phone numbers for airlines and rental cars and call them as soon as you realize your plane is delayed and you need to book a hotel or car before the rest of the herd. I realized that there is an entirely other population of people on this earth who are “travel people” and they know a LOT of stuff. Talk to them as you wait to board your plane. They can save your hide some days.

When you do the math after you divide the number of real hours worked into the salary you accepted, you really only earn $2.50 an hour.

If I had one thing to do over, it would be to somehow add a day (on my own dime) and explore the city I had traveled to. Easier said than done, as most days I just wanted to get home, but sounds good anyway.

That regardless of travel schedules, colleagues still expect you to respond in a timely manner, which means working at night to catch up on all the day’s missed emails and phone calls.

How I would always be tired and spend my weekends doing expense reports, laundry, and sleeping.

While during my interview process I was asked if I would be willing to travel for my job, I didn’t think much of it, given the position description stated 5-15 percent of my time would be on the road. That’s not much, right? I should have known something was up when, on my first day, I was asked if I had a valid passport. Nineteen months later and more than 300K air miles logged from monthly trips to Europe, Asia, and plenty of domestic trips, I left after I couldn’t sleep for more than 90 minutes at a time. I could never get my body clock adjusted to all those changing time zones. Some people are cut out for it, but I learned I definitely was not one of those people.

Wish I’d known how agreeable it would be to the way I like to work. Depart, immerse, get it done, then go home. Rinse, repeat. And when I am home, I mean I am HOME.

Get a credit card that offers lounge access. Sure, it’s good to have a quiet place to work, but I also really need a place to get drunk after a flight delay at the end of a long work week.

You will lose all track of time and the seasons of life. I remember once sitting in a boarding lounge and a family was sitting in the row behind me and they were taking their son or daughter to college and it was an emotional discussion. I was touched by it, but was so consumed by my conference schedule that I didn’t even realize that the seasons of life was going on all around me while I was going from the Javits Center to the McCormick Place to Moscone Center and so on.

If you are single, your friends will stop inviting you to events because, well, you are just never home.

Flying sucks. It is exhausting for your wife who has to keep the family ship and the sailors (the kids) on course while you are gone. Eating out all the time is tough on trying to stay in good shape. As I have gotten older, the three-hour time change from West to East Coast has become a bigger impact on the sleep pattern. At least there is Uber and Lyft now so I don’t have to hassle with rental cars as often (those guys must be having a major negative impact in the revenues of Hertz, Avis, etc.)

How much weight I’d gain if I did anything other than maintaining a disciplined diet and exercise regimen.

That there is no benefit to letting the corporate office handle travel plans. Make sure to negotiate the ability to control your own travel, get a good travel-specific credit card, invoice for your expenses, and then reap the rewards. It took me a full year on a job (three weeks of travel a month) before someone let me know they asked and corporate agreed. Within the next six months of travel, I had upgraded status on all of my flights and hotels and had enough points to take my entire family on a vacation we’d normally never afford.

Unless you are going to or coming from a meeting in which specific attire is required, always fly in specific travel clothes. When you get to your destination, put all of the clothes in a bag (they are covered in whatever grossness wasn’t cleaned on your flight) and don’t touch them until it is time to fly home. This way you limit your (and your clothes’) exposure to travel-related disgustingness to just one outfit. I have sat on broken airplane seats and ruined suit pants, I have had people miss the emesis bag and get it all over a nice dress shirt, I have seen and smelt unthinkable things. But luckily I am now forever wearing clothes that I don’t worry about when it all happens. When you get home, toss them in the wash on “kill everything” cycle of the washer by themselves and you’ll feel like you are keeping germs and stink (relatively) at bay.

Try not to take travel-heavy jobs. Honestly, they are just not worth it. The novelty wears off, the lack of life balance is endemic to those you’ll meet, and in the end, you’ll be grateful you decided to find something closer to home. Unless it is a once-in-a-lifetime opportunity, keep looking instead of being a road warrior. Very few people who have retired from travel-heavy jobs have ever told me they really enjoyed it. If you can, try NOT to take the position.

Clinical depression is highly likely. You’ll become almost obsessed with maxing out loyalty programs. Wal-Mart becomes a source of “healthy” food in rural areas. Too many people have pre-check. Too few airports have dedicated pre-check lanes. Getting squishy/soft/fat is almost inevitable. Vented car seats are heavenly. Podcasts are your best friend.

How much time would be wasted from flight connections when your home airport isn’t a major one.

The impact to your family is huge. You have to have a good support structure, and if you have kids, you have to have backup plans in place for the inevitable sickness or childcare issue. You also need to really understand your company’s policy up front about scheduling your travel and the ability to dictate some home weeks when needed.

That US companies do not consider travel time as work (contrary to labour laws where I live).

The importance of willpower and honoring your commitments. It’s too easy to cheat, in every aspect, when you’re on the road.

I wish I’d  had access to a company handbook to verify printed policies. The manager I was hired under explained that we travel Monday and Friday and are on site with clients the rest of the week. If we needed to travel on a weekend, we’d receive comp time. He retired and was replaced by a manager who felt that as salaried employees, we didn’t deserve comp time, so there were many go-live weeks where we worked seven days or even back-to-back weeks that formed 14-day hits without a break and with no comp time. When we investigated, it turns out the company handbook is mute on the subject and it’s up to manager discretion. This would have been different if we were consultants or if we were bonused on billable hours, but we weren’t. Needless to say, there was a fair amount of turnover under the new manager (me included).

The negative impact it would have on my health. Too much airport food and booze and not enough sleep or exercise.

How a travel-heavy job would negatively impact my health. The inability to exercise on a sustained and regular basis, sleep deprivation, constant exposure to sick people on airplanes and buses, and constantly being expected to lavishly entertain clients with lots of alcohol all contributed to a pretty rapid decline in overall health and fitness.

Join an airlines club like American Admiral. if your employer won’t pay for it, you can usually use miles. When your flights get scrambled, the club staff will get you re-routed faster and with preference.

It makes it very hard to have a normal social life in your home town. When you travel all week, you tend to want to stay home on the weekends. If you don’t have a strong local social circle, this can make it tough to meet local friends. It also makes it hard to participate in community events or take weeknight classes (i.e. personal enrichment classes). I left a strong social circle in my 30s and moved to a new town on the opposite coast just when I started traveling full time for work, and 10 years later, I have thousands of frequent flyer points (and some fabulous global travels) but not one new friend in my new town. Something to think about.

As a business traveler, the last thing I want to do on weekends is travel some more. It has affected my desire to do weekend getaways, camping trips, and weekends away with the guys way more than I would have ever expected.

A travel-heavy job really reduces your ability to be involved in the community, be it board involvement, local government, or coaching a kids’ sports team. Getting involved is a lot easier if you are home every night of the week.

Sometimes an existing job you took without much travel can later turn into a job with heavy travel expectations, so apparently flexibility is just expected if you want to keep your job.

The travel T&E policy, in detail. Preferred vendors. Expectations about traveling on Sundays and holidays. Coverage for airplane WiFi. Will I be carting executives around with me all the time? Can I get executives or experts to come with me when I need them?

How tough it is on your body as you age. Back problems waiting to happen.

When I was in my 20s and fresh out of graduate school, I took a travel-heavy IT healthcare job that was exciting, challenging, and fulfilling. It was at the inception of the healthcare IT industry in the 1970s and everything we did was new. This lifestyle did not promote the ability to carry out personal relationships in an ideal manner. I was focused on my career and did not consider the long-term ramifications of not having met “Mr. Right.” Eventually I did meet and marry the right person, but by this time I was in my 40s and not able to start a family. We have been happily together now for 25 years and I recently retired from the healthcare IT industry. During this entire time, I continued weekly travel with the exception of a few positions I held as a direct employee of a healthcare system. The travel takes its toll, but the chance to work with many different organizations and people throughout the USA and Canada was very rewarding. My husband used my weekly Monday through Thursday absences as an opportunity to complete his PhD and he continues to work as a professor for a well-known online university.

What I Wish I’d Known Before … Going to my First HIMSS Conference as an Exhibitor

I knew HIMSS was a big conference, but I didn’t realize that the impact would be that it is just hard to move around and accomplish a lot. You never really get to see the whole exhibit floor or do a lot of things because it just take so long to get there. Food lines are long, there’s no place to sit. It’s a complete workout. The startup pavilion has some of the more interesting companies and the big vendor booths are very impersonal. Then, when it is all over, you wonder what you really accomplished or learned and if it was worth all the trouble.

Wear really, truly comfortable shoes.

That my exhibitor badge gets me into educational sessions as well. Someone more experienced at these events helped guide me in finding helpful sessions for my area of expertise.

Very long hours on your feet. I have a pair of super supportive shoes I call “my HIMSS shoes” and I am never without them.

HIMSS is all about making and strengthening business relationships. But on the floor, you literally have about 30 seconds to get someone’s attention and earn the right to have a meaningful conversation.

As an exhibitor, it can devolve into a party atmosphere, quickly. Pace yourself.

Wear comfortable, not necessarily stylish, shoes.

Wear comfortable shoes!

The exhibit hall is like the Caribbean, full of ports (booths) and buyers are like cruise ship passengers. The enthusiasm doesn’t always stick once they get home and visitors will confuse ports/vendors. Give them something memorable (in good way) and be prepared to present again after HIMSS if you want them to truly remember anything you showed them.

Be careful about scheduling meetings first thing in the morning after the first day. Last day first or last are the worst times for any real business to happen.

Stop at two drinks. Period. It’s possible, even likely, that key people in the industry are around you at all times, even 1 a.m. in the hotel bar. Remember that this is your career and you’re making an impression even after exhibit hours are done.

Make reservations for every anticipated meal, even if for two people, as everything will be packed. And, if invited to a meal by a vendor, verify that that vendor has a reservation inclusive of all invited attendees. I attended a breakfast at a previous HIMSS with a vendor where the rep from the vendor did not make reservations for an intolerably crowded joint and eight executives huddled around a bar-height bistro table for two in the hallway of the casino discussing the strategic direction of our partnership.

How your message gets lost in the noise and the value proposition is questionable, unless you are one of the larger vendors.

The amount of time you will be on your feet. I have HIMSS shoes, comfortable, dressy shoes half a size too big with the most cushioning insoles I could find and hiking socks.

Establish scheduled meetings before or during HIMSS if you are looking to sell (vs. touch current customers, develop business development relationships, or perpetuate your brand). It is not worth pulling anyone off the floor to learn about your product anymore since, unlike in the early days, most of the folks walking the floor are fellow vendors.

HIMSS is in a conference that companies in the healthcare information technology industry must attend even, if the value for doing so is minimal. Pulling out is a public red flag that there is a problem or at least a big change in the company. So we go and represent with minimal expectation of value, but it can be fun for the team selected to the representing.

What I Wish I’d Known Before … Taking a Job Selling Software to Hospitals or Practices

I wish I would have known that the company had a policy of customizing the application to whatever they thought the prospect needed. Functionally what we wound up doing was demoing vaporware, and there was no way the clients would ever get that content without customizing. It’s entirely unethical. I was gone within a few months.

As someone who has started two small HIT software companies (both acquired by larger HIT companies) and was responsible for designing, selling, and implementing the systems and overall customer satisfaction, a couple things I would want to know:

What is the main value that customers get from the system?

What percent of the customers get that value? (Software companies love to highlight their reference sites, but what is more important is what benefit do the majority of the customers derive from the software. Reference sites are nice, but even a blind squirrel finds a nut once in a while.

Can you quantify the value?

How does the value stack up against the investment?

How long does it take to get the software installed and how long before the customer starts receiving the value?

How much work is it going to take by the customer to get the software running and keep it up and running and is that amount of work and cost part of the return on investment analysis?

Why would a prospect buy the competitors’ products rather than the product we are selling?

What is the customer retention rate, and don’t include the customers that have to renew because they are in a multi-year agreement. I would want to know what percent of customers renewed the last 2-3 years that had the option to turn off the system.

Do Epic and Cerner have a similar offering?

What is my quota and how have the current sales team done with respect to that quota over the last two years?

What is the retention rate of the sale staff over the last 2-3 years?

How long has the sales leader been in the role?

Can I live in San Diego?

Do I have to wear a tie to client meetings?

Most of the people you talk to or not meaningfully involved in the decision-making process.

The people who are using your software are often not at all involved in the decision process, which injects hostility once purchase and deployment happens.

Don’t sell your software without the client having a strong change management plan in place. The sale is usually worth less money than having your name dragged through the mud later if adoption is poor.

You should aim to sell one client multiple things over the course of a long relationship more than trying to get clients.

Take your estimate of the sales cycle and double it.

Old-fashioned networking and being able to discuss specific use cases that resulted in success are the best methods for selling. Healthcare is not very impressionable by social media, content marketing, email campaigns, or other more modern marketing tactics.

How lonely the job can be.

For five years in my career, I sold an EMR to physician practices. Looking back, I wish I had understood better the degree to which physicians lacked the appreciation of the overall efficiency and throughput of their practices (which they usually owned) versus their role within the practice. Most thought only in terms of themselves and their own time, and these were the ones that struggled or refused to modernize their practices (also usually the ones with full waiting rooms of frustrated patients). Those I worked with that recognized that they were a part of a larger system embraced changes to their practices supported by EMR, they flourished, and tended to have happier patients with shorter waits for appointments.

How difficult it was going to be to accurately forecast when the sales would close.

My job is a hybrid, or at least it’s supposed to be. I have a half dozen clients that I am responsible for their satisfaction as well as a quota for each client. However much our company likes to say “It all comes down to satisfaction! Keep your clients happy!” and even with tying a portion of our compensation to client satisfaction surveys, it’s obviously all about selling. Leadership would rather you sell whatever you can, however you can, even if you piss off everyone in the process. It’s a very short-sighted model, but with how the direction this company is moving, I’m not very surprised. If you have any ounce of empathy, or like to forge client relationships that focus on more than dollars and cents, selling may not be for you. (If there are companies we can work for that actually give a hoot about clients beyond what they buy quarter to quarter, please share!)

That some of the “function and features” are pure vaporware. They haven’t been tested or met compliance in any setting other than the developer’s environment. This obviously causes major concerns from the client at go-live. I end up selling future versions that a user will not experience until 12-24 months later.

In no particular order or rank, here are a few of the things I wish I’d known before getting into the HIT sales field.

The training for salespeople is very limited and you’ll hear, “We don’t want you to train them, just sell it.” My product training for my first job included watching two demos of the application by my manager, one of which was provided while we waited for our plane at the airport. EHR software is complicated enough that vendors should either sufficiently train sales reps or use product specialists for all demos.

You’ll want to ask a lot of questions about your territory (how often does it change, how successful were previous sales reps, what is the turnover in this territory, are there any/many happy customers in my territory, etc.) to try and figure out if you really can make your numbers. Sales managers like to pretend that all sales territories are created equal, but they are not.

To truly provide a demo that shows a provider how your software works for their workflow, you will need to do a discovery with the provider or someone who truly understands the workflow. In the ambulatory physician space, it can be very difficult to get face time with the doctor and critical staff, so you know this beforehand and be able to prepare sufficiently to show them what they want/need to see. This discovery isn’t or shouldn’t be done to use smoke and mirrors and trick the staff. It’s no different than a doctor not being able to accurately diagnose a patient unless they’ve had sufficient time to do an assessment and evaluation before they prescribe the correct treatment. Salespeople should really refuse to do demos if they don’t get this time, but as long as they have quotas, they will do it.

Many physicians and their practice staff won’t bother to complete the requisite pre-work before their implementation, which further compromises their ability to optimize the expensive software they just bought. It is time-consuming, but it’s usually a question of “pay me now or pay me later.”

Not sales, but working in HIT for 16 years for companies that sell commercial software to doctors and nurses. I wish I’d known about the stress of being morally compromised on a daily basis as keeping my job (and thus my ability to pay my rent and buy food) requires either doing things I know are the wrong thing to do, or not doing things that are the right thing to do (way more of the latter than the former, fortunately). I’ve seen some very dark instincts on the business and technology “leadership” side of the house. If you ask why I stay, the only answer I have is: if I leave, that’s one less person banging the drum for what is right.

How often solutions aren’t fully baked before companies try to package them as GA.

Does the product actually work? Can the company actually implement and deliver it? Can they support it? Do they have any idea who will actually buy it? And who pays for it? Too many healthcare software companies I’ve worked for/with think that “if it treats patients better” or “makes the organization better” or “makes clinicians better” or “makes patients safer” (etc.) their product will fly off the shelves. All you, Mr. Salesperson, have to is bust your hump, get in front of the right people, and do your sales magic. Healthcare sales today is ALL about compliance or cash. C-Levels are only buying that which they HAVE to have, will save them money, or make them money (hard ROI).

Who are the competitors who are investing in the same product line?

While software is 100 percent margin, software companies in healthcare don’t want to pay as much as other technologies and their products are usually late.

I was in a sales support position, demonstrating application software. I suppose I was naïve to think that I would have to stretch the truth about the functionality of said software. Salespeople would provide me with what my response should be to certain questions. To which I stated, “That’s when I turn to you, because I won’t lie.” Ultimately, I transferred to another department within the vendor company to training so that the end user would find out how the system really worked. I would hear, “But they said [that being the salesperson] the system could do that.” To which I replied, “I know what they said, but I’m here to tell you the truth.”

What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

That technical dress rehearsal issues would get ignored or not addressed before the go-live. Wasn’t that the point of the TDR?

I wish I knew ahead of time that the EHR vendor outsourced their support to a third party. This arrangement created speed bumps to getting real support answers relayed from the EHR vendor through the support vendor.

I wish I knew how effective running a mock clinic was for training providers, especially physicians. An EHR analysts plays the role of a mock patient and gets checked in, roomed by the MA or nurse, seen by the doctor, and checks out. Ideally, the provider completes common orders, does a note, and charges. Any system problems can be caught by the analyst and a trainer can be at the elbow of each users. It is a little labor intense, but the clinics come back up to full speed much sooner. We had one ophthalmologist seeing 87 patients a day within one week of go live. His partners that didn’t do the mock clinic took weeks to get back up to full speed.

To what degree provider productivity would be negatively impacted and how that would impact the productivity-based comp plans of physicians and administrators. There’s a reason CIOs have a hard time surviving an EHR implementation, first among them messing with peoples’ pay checks.

How to generate sincere engagement for the implementation with the clinicians and staff as beneficial to their patients and care delivery. And helping all to make the project not just about the billing.

We learned after the CIOs and people allowed in the room had chosen Epic just because, that all non-Epic apps that were to integrate into the EMR had to have a test environment, or else integration was denied. Even apps with fewer than five users. Go-live was pushed back months, there no budget for this, and rebuilding non-Epic apps took time away from learning and building the actual future EMR and getting certified.

Focusing on optimizing physician workflows and making them as efficient as possible is absolutely important, but the same amount of effort must be made for the other roles on the ambulatory clinical care team: nurses (especially nurse triage), medical assistants, in-house laboratory and radiology, as well as all other ancillary services provided by the practice. Ensuring that the physicians are happy should not come at the expense of everyone else in the practice.

What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based System

You still have to work at the application’s care and feeding – you can’t just “dump it in the cloud” and expect all the problems to go away. Some of them will, but not as many as you think.

The Internet gets slow and breaks more often than you think, especially when vital services are at the other end. Downtime procedures are even more important.

Do the research to figure out what all the pieces you will or might need are. Once you’ve done the big deal, you have very little pricing leverage until you have big money to commit again. Example: a full-copy test environment. With one well-known CRM vendor, those environments are priced as a percentage of total licensed product. That makes sense in a way, because a full copy is just that — a full copy. However, that also means that the cost of the environment goes up when you add more products or add-ons to your list of licensed things.

They seem to track their application only up to the point where it leaves their data center or Cloud Source. Anything else between their address and my user location is left up to me to figure out if there is a problem with the application and my users. We have had to go to other third-party products to get the health of the Internet between the SaaS source and our end users. Yet they (the SaaS source) blame our internal network setup for any end response issues at play. Very tired of hearing “none of our other users are having that problem” when the problem lies in the health of the general Internet and not our last mile.

Was the solution architecture design for the Web and cloud, or was it client-server front-ended by Citrix?

If it’s your first time down this path, your internal HIPAA team or legal may end up having no idea what to do with it based on their standard vetting process. You might have to take additional time in the implementation for back and forth with the vendor to while they jump through whatever hoops are placed in the way to get a green light to implement or even sign a contract.

I’ll have to pay to get my data back.

The importance of not just a DR plan, but a business continuity plan. You are not in control of when down applications will be available, but you still have patients to care for and business functions that must continue. Always have a plan and have it readily available for staff.

You won’t necessarily have full access to the database or software maintenance tools. Ask in advance and put a plan in place on how when data will be accessed / software changes will be completed.

You will spend a lot of time explaining your business operations. Analysts go from those making configuration changes to someone who needs to partner and fully understand business processes and operations. Vendors will not successfully function as your systems analysts.

This was 15 years ago. I wish we had known the true cost of going to the cloud. Verizon charged us a ton to install a redundant pathway to the Internet after questioning why we wanted to do such a silly thing.

Wish I’d required more detail in how my data will be turned over to me at contract termination. Our outgoing ambulatory EMR vendor refuses to hand over our contractually mandated export until the day *after* our account is turned off, giving us zero opportunity for smooth migration to the new vendor.

I wish we better understood and negotiated standard maintenance windows and patch load times for production issues. We sometimes have to wait weeks for patches and get a nine-hour window, any time during which the system could be brought down to install the patch. I also wish we had better prepared ourselves for the challenges of offshore support. They only want to talk via the ticket system and you have to try hard to get them on the phone or a WebEx. It really exposed now poor our internal support was since every issue required going through this painful process with the vendor support.

What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System

That our hospital’s Time and Attendance policies were not being applied throughout the organization equitably in all departments.  We found a lot of departments that were providing extra incentive pay to nurses in order to boost their salaries. Other departments were making up their own on-call pay programs for their personnel.

That employees were getting around showing up late by not punching in and then later stating that the system must not have worked when they “clocked in.”

Anything that directly or indirectly to do with payroll is EXTREMELY sensitive. Expect people to freak about any test results that don’t match the result of the existing system in payroll, down to the penny.

If your facility is non-union, and has been working to stay that way despite onslaughts by SEIU and others, expect to deal with lots of very complex pay premiums. Don’t be surprised if disgruntled employees and/or organizers try to make something sinister out of the system change.

Place time clocks in areas with enough room to hold all the employees standing around waiting to clock in in the morning and clock out in the afternoon.

If your internal sponsor is the HR director, make sure that you reassure that person early and often that the system change won’t accidentally result in pay changes.

Hospital pay rules are more complex than any other industry, sometimes exceeding the capability of non-healthcare specific payroll systems to handle them. It was shocking to find how many departments were running their own unapproved overtime, call time, and bonus programs in direct contradiction to hospital policy. It takes a lot of time and finesse to find these exceptions and then some HR backbone to bring those departments into compliance instead of building rules just for them.

If your implementation involves installation of hardware, allow lots of time to make it happen. Hospital construction can be very tricky from a permitting standpoint.

Plan to run tests through month end and end-to-end with payroll to make sure everything is perfect before you agree to a cutover plan.

Don’t let Procurement sunset the contract with your existing vendor until you are absolutely confident in your cutover dates.

Policy over technology. Users run in the door and swipe at 8:14:59, then get ready for work, and out the door at 4:45:01.

Pay attention to the choice of letting employees clock in by telephone and limit that to in-house phones.

Expect managers to express shock and indignation that it’s their job to review time clock reports against reality. And to look the other way if they’re worried the offending employee might quit over being paid accurately rather than generously.

I wish we had understood the complexities of overtime, the number of salaried employees that are required to clock-in/clock-out even though their pay doesn’t change (and the frequency with which they forget or delay their swipe), and I wish it was understood exactly how much manual overriding would be needed over the first four payroll cycles to make sure employees were appropriately paid. I also wished we had budgeted for all of the overtime required for staff that were perpetually on call to handle these and other issues during the transition period. In short, I wish we knew everything since what we actually knew was nothing, and our vendor was complicit in helping us fail pretty spectacularly during the process.

Will employees be able to access accrued PTO in their current paycheck (leaving a zero PTO balance) or will their pay be docked even though they have PTO remaining? This “feature” has to be manually overridden by our HR personnel with management approval.

How difficult is it for employees to enter multiple days off in a row. Do they have to do every single day as a separate entry or is the multiple-entry feature seamless and user-friendly?

That a focus on staffing workflow impact is equally or more important than the specific technology. That includes integration with upstream and downstream systems.

Don’t underestimate the creative nature of employees clocking in and out. Before we got wise and changed it, some would stop and clock in and or out at our remote locations (30-45 minutes away) and then drive in to the hospital. We noticed a spike in overtime. Also we noticed an incredible number of time sheet edits by non-management folks who had the authority previously. Their role went away and the authority moved to managers (some of whom argued it wasn’t their job?) Every management level now had to sign off for their areas. The number of edits decreased but it took a long time and a lot of oversight.

A story about a payroll system. I don’t recall the name but it was a Mom & Pop vendor (Mom was the CEO and Pop was the techie) selected by the HR division. On January 31 with no other option, we had to mask out the SSNs on a couple hundred (or more) printed W-2s, then run them through the printer as blank sheets with a correctly placed SSN cell from Excel. We moved on to a new vendor and the company was gone the next year.

They were in negotiations to be acquired by a competitor and there equipment would be sunset within the year.

It’s not the system that causes issues. It’s the clock in/out & OT calculation policies & procedures.