Many — maybe most —  hospitals understand the need to incorporate a dedicated service desk within their IT operations. With the complexity of new EHRs and upgrades in other sophisticated systems, a poorly conceived and managed service department that provides haphazard help from over-burdened IT analysts is not enough to satisfy medical staff and other users. The demand for high quality support and quick response is snowballing in hospitals across the country, whether large systems or small rural institutions.

But service desk operations can become alarmingly expensive if not managed properly. Even in the annual budget analysis process, hospitals’ low-profile service desks tend to get little attention, except perhaps for generic requests: a 10% budget increase or decrease, depending on how the hospital’s financial winds are blowing. The end result of a perfunctory analysis can take an unexpected financial toll and thwart the purpose of systems service operations. At least three cost factors must be understood to budget for the total cost of all services provided by your service desk, and to make sure it is cost effective.

To understand what your hospital is actually spending on its service desk operations, the first step is to recognize and consider some important differentiations between:

• Immediate or “obvious” costs
• Frequently overlooked and less direct costs
• Indirect “hidden” costs

Obvious Costs of Service Desk

Salaries of Service Desk Staff: These costs include salaries plus fringe benefits. For most purposes, using the hospital-wide average benefit cost as a percentage of salary is a suitable approach.

Software Purchases: Ticket management typically is the most common expenditure. Exact pricing varies widely by vendor. If software is purchased as a one-time expenditure, it may be amortized over the estimated life of the software.

Software Maintenance: Usually a one-time annual cost associated with the ticket management software, this expenditure may be amortized over a twelve-month budget.

Hardware and Furnishing: Hardware will include desktops, laptops, monitors, servers, and telecommunication equipment. Don’t forget “small” items like headphones and mice along with chairs, carpeting, and other furnishings which have to be replaced frequently in a very busy service group. Service desk agents put them to hard use, creating surprisingly high costs. As these typically are capital expenditures, IT may not budget or report depreciation of furniture and equipment at the department level or in sufficient detail to impact service desk cost reports. To understood true costs, they should.

Communications Costs: This includes phone service and internet costs, along with security expenses. If other paid services such as remote hands-on troubleshooting, conferencing, etc. are used, these costs should be included.

Frequently Overlooked Costs

On-call and Overtime Pay: Many hospitals, particularly small ones, do not have a staffed service desk 24 X 7 in off hours.  IT service requests must be handled by on-site or on-call analyst staff. These people who are more highly paid (usually) than service desk staff, are paid a premium, either via overtime, or on-call pay.  If service desk staff are required to be on-call at home, they are typically paid overtime or an on-call premium that must be budgeted and reported.

Space or Rental Costs: In many budget analyses, space costs are ignored or taken for granted. Most hospitals are short on space and in many cases must rent space off-site. The areas used by the service desk are a meaningful cost, and typically require dedicated infrastructural spending. Electrical, heating, or air conditioning costs can be high because of continuous usage. For example, service desks commonly require additional air conditioning because of the large concentration of staff and equipment located in a relatively small space. These costs can be surprisingly expensive.

Training: Initial new hire training costs and ongoing training of service desk agents are necessary for high productivity and quality performance. Some of the costs may be direct, based on labor costs.  Insufficient training can create less obvious costs, in terms of unmet SLAs. Costly but essential certifications, such as ITIL (Information Technology Infrastructure Library) should be required of key staff; the necessary training (usually externally-sourced) and actual certification costs should be calculated.

Recruiting: Turnover can be high in service desks, partially because the agent’s job is an entry-level position and relatively low-paid. Burn-out is not unusual. Market demand for experienced healthcare service desk agents has increased. Managers must expect that turnover, as well as expansion of operations, will require recruitment of additional agents and supervisory staff, some of whom must have specialized knowledge. These efforts are normally made by the HR department without a direct allocation to the IT department. However, if a search firm is used, these costs are identifiable and should be covered in service desk costs.

The Hidden Costs of Wrong Problem Management

Self-Solution: It is normal human behavior for a hospital staff member to try to resolve his/her problem before seeking help. However, frequent and/or lengthy attempts at self-solution are costly — and also may be a signal that users do not have confidence that service desk will solve the problem quickly and well.

Involvement of Other IT Staff: IT staff other than the service desk, often become unnecessarily involved in problem resolution. Many medical staffers have their favorite “go to” people within the IT department, including IT leadership. When users  contact these favorites instead of the service desk, costs go up.  Analysts’ and CIOs’ salaries are substantially higher than service desk agent salaries. The above-described behaviors result in an unnecessarily high problem resolution cost, particularly if the problem would not have merited eventual analyst intervention.

Involvement of Other Hospital Staff: Co-workers of hospital staff other than IT staff are often pulled into IT problem resolution by a frustrated user. This can be a formal or informal approach. Some hospitals formally designate clinical department “super users” who are trained for problem resolution. This role is usually accommodated within budgets. On the informal side, hospital staff may identify co-workers as system savvy and consult them for problem resolution. These individuals typically have a higher salary cost than service desk agents, and their time “helping” is most likely not budgeted and a hidden cost to the hospital.

These hidden costs and their impact on the bottom line are illustrated in the diagram below:

Poor Usage of Service Desk Technology: Too many hospitals purchase expensive service software without utilizing modules or capabilities that directly impact agents’ performance and/or costs. This occurs when management doesn’t have a mandate to optimize usage of the software, or doesn’t understand how to work these features to their advantage. To do so, they must  complete needed training, utilize strong vendor support, and take the time for new process set up and management.

The Bottom Line:

Many hospitals’ financials are compromised unnecessarily by the costs listed above, whether management knows it or not. We recommend that you perform an analysis of your operations costs to learn exactly where your dollars are going. Such cost analyses may offer new internal solutions to reducing costs. Some hospitals that weigh expenditures and benefits carefully choose to move their service desk operations to dedicated hospital service desk outsourcers for cost savings, consistent quality and round-the-clock accessibility.

Download our Cost Estimation for Hospital Service Desk Operations report for detailed instructions and examples to guide your assessment and analysis of costs.

For information to consider outsourcing your service desk or patient portal service support, please contact us. We can help save service costs because we leverage our dedicated on-shore service desk team across many hospitals 24 X 7 X 365.