Alternative Staffing Arrangements

Many organizations have found staffing benefits or cost savings through outsourcing, offshoring, and partnerships with vendors. But each has its downside.

Outsourcing has somewhat unfairly earned a bad reputation in recent years, but nevertheless, it has made its mark on the American business culture and in hospitals, which are finding that there are benefits in augmenting employed staff with contract workers.

The right outsourcing arrangement will boost efficiency, cuts costs, and be beneficial for everyone involved—but these arrangements must be planned strategically.

Hospitals Likely to Outsource ICD-10 at Launch

Sometimes, it's a question of finding a temporary employee through a staffing organization, or creating a managed services agreement tailored to a hospital's needs. Other times, hospitals benefit from more traditional outsourcing agreements, like teleradiology or telemedicine.

Vendor Partnerships
One strategy is to develop an exclusive relationship with an organization that is willing to tailor an agreement to a hospital's needs—whether in terms of staffing, consulting, equipment, or all of the above.

"I wouldn't consider it to be outsourcing," says James V. Rawson, chairman of radiology at Georgia Regents Medical Center (GRMC) in Augusta, a 478-bed academic medical center. GRMC has a managed services agreement with Philips, which assumes ownership, management, and maintenance of medical technologies used at GRMC and also manages, trains, and supplies many of the employees who use it.

"This is a great way for us to get different perspectives. Some might look at this as more of a tech deal, but it's really about people," says Rawson. "While I have a lot of high tech equipment in my department, the greatest benefit of this partnership is the people."

In addition to employees who operate the equipment, GRMC has also been able to take advantage of Philips' consultants, who advise on topics ranging from training to strategic planning to process improvement. GRMC's agreement with Philips is valued at about $300M and is contracted to last for 15 years.

Therein lies one downside to such long-term agreements is contract length: Fifteen years is a long time to be exclusively linked to a single vendor. Another downside: the potential for workplace problems when some workers are hospital employees and possible union members, and others are contractors or employees of a partnership organization. And managing workers who are not employees can create friction, especially regarding benefits, time off, or pay.

At the two-year mark, Rawson says that the deal has saved GRMC about seven million dollars.

An additional benefit to bringing in outside-contracted employees can be exposure to the knowledge and skills an outsider can bring to the table. One of the greatest perks of GRMC's agreement with Philips has been the ability to bring in well-trained workers who can teach their skills to hospital staff, says Rawson.

Even for organizations that would shy away from managed partnerships, there are options for more short-term arrangements. "Many travel nurses have been able to pick up a ton of best practices," says Bill Heller, president of RN Network, a travel nurse staffing company headquartered in Boca Raton, FL.

In fact, some hospitals intentionally hire temporary healthcare professionals specifically for a certain skill set, says Heller. "Forward-thinking organizations can tap into [travel] nurses," he says.

Some look for nurses who have worked at prestigious hospitals, then ask them about their experiences there. "Just ask, 'how did they do this at Johns Hopkins?' Let's say you just got a new piece of equipment in— find out from a travel nurse how do to get most out of it." He has also seen travel and temporary nurses help train incoming nurses and share their decades of experience. However, a few hospitals have noted issues with workers provided by staffing agencies, and it is important to keep an eye out for staff quality issues.

Outsourcing and Offshoring
And then, there are the benefits of offshoring entire processes or jobs to remote workers living abroad.

"There's a whole sector of teleradiology called 'nighthawking,'" says Bruce Carothers, vice president of workforce technology at AMN Healthcare, a healthcare recruiting firm. "They find US- licensed physicians who live overseas who can look at images on weekends and at night."

Some hospitals find that this is a good way to ensure all radiology results are in by Monday morning, and it's also an area where hospitals can cut costs by employing foreign workers, often at a fraction of the cost of US employees.

One potentially big downside of both outsourcing and offshoring this kind of work: The quality of the work must be monitored and patient privacy and data security must be safeguarded.

Coordinating Care Through Physician Outsourcing

Sometimes outsourcing doesn't have to be to a far-away land—most telemedicine and virtual care providers are based in the United States. Telemedicine work is growing in popularity as an option among older clinicians with decades of experience and wisdom behind them who are in the process of winding down their professional lives. It is likely to gain traction as licensing laws help it become an option for more hospitals, especially in remote parts of the country where there just aren't enough clinicians to go around.

Outsourcing and offshoring and partnerships with vendors are options, but it's important to evaluate the potential effects on workplace culture and cost savings, and to determine whether alternative staffing is the most efficient solution. Before committing, make sure there isn't a better solution closer to home.