Flexibility Isn’t One-Size-Fits-All: Building a Workforce Strategy That Works

Highlights

• Predictive planning helps organizations act before coverage gaps emerge. Maternity leaves, leaves of absence and changes in patient demand give leaders time to plan ahead.
• Different workforce layers serve different purposes. Float pools, per diem staff, internal agencies and travelers can work together to address different staffing needs.
• Data helps leaders match workforce options to actual needs. Census, patient complexity, sick calls, historical patterns and community events can shape those decisions.
• Flexible staff are part of the care team. Shared training and strong partnerships help float pool and contract clinicians provide high-quality care.
• Workforce strategies need ongoing adjustment. Technology can reduce manual work, but leaders still need to listen to their teams and adapt as patient needs and workforce expectations change.

Healthcare organizations do not need one workforce model. They need a strategy that can respond to changing demands.

That was the focus of a panel discussion at Aya Ideas Retreat 2026 featuring healthcare leaders from Michigan Medicine, Northwestern Memorial HealthCare and UC San Diego Health. Moderated by Brienne Sandow, associate vice president of operations at Saint Luke’s Health System, the conversation explored how health systems are combining internal teams, float pools, per diem staff and contract clinicians to create more flexible workforce strategies.

The discussion surfaced five practical actions leaders can take: plan ahead, build layers around workforce needs, use data to guide decisions, make flexibility part of the care team and keep adapting.

Move from reactive coverage to predictive planning

Michelle Bero, nursing services senior director at Michigan Medicine, described how her organization is moving beyond just-in-time staffing to a more proactive approach.

Michigan Medicine’s supplemental staffing department supports four hospitals, including a children’s hospital, and has grown to more than 800 employees. In the past, the focus was often on getting through the day and keeping beds open. Now, through a departmental restructure, closer communication with units and partnership with Aya on a labor and delivery birth surge, the team is planning coverage for known needs such as maternity leaves and leaves of absence before they become urgent.

Build layers around different workforce needs

At Northwestern Memorial HealthCare, Kate Colfer, director of workforce planning, described a strategy that combines several staffing layers.

Local float pools can address short-term needs. Regional pools provide coverage across a broader area. The internal agency supports longer-term vacancies, while external per diem teams can add specialty support in areas such as labor and delivery and neonatal intensive care.

The value comes from understanding how these layers fit together across the system.

“We are able to see it all at a balcony view,” Colfer said. That system-level perspective helps Northwestern leaders pinpoint the right workforce option for each need.

At UC San Diego Health, Leah Adrid, senior director of operations, described a similarly layered approach that includes internal per diem staff, travelers, a local registry pool and weekend-only staff. Each layer serves a different primary purpose. Internal per diem staff support overflow areas and some callout coverage. Travelers support vacancies and long-term leaves, while the local registry is used primarily for daily callouts.

Use data to improve workforce decisions

Effective flexibility depends on more than internal staffing data.

At UC San Diego Health, Adrid tracks sick calls, census, patient acuity, length of stay and local events. She also considers broader trends that could affect workforce availability, including major concerts and marathons in the community.

During the COVID-19 pandemic, she began tracking infection rates in other parts of the world. When rates rose in Europe, she noticed that changes often reached the East Coast and then the West Coast months later. That information helped her plan for contract labor before the need became critical. Adrid now uses available data to forecast traveler needs six to nine months ahead.

Colfer described another example. Northwestern worked with Aya’s Advisory Solutions team to determine the right size and structure for its medical-surgical internal agency. By analyzing census variation across units, the team identified where flexible staffing would have the greatest impact.

The lesson is simple: Averages are not enough. Workforce planning needs to account for the specific patterns that shape each organization.

Make flexibility part of the care team

Flexible staffing strategies work best when float pool and contract clinicians are treated as full members of the care team.

At Michigan Medicine, supervisors meet regularly with units to stay current on changes in education, equipment and patient care. Float pool staff receive training aligned with the units they support and maintain the competencies needed for changing patient populations. Bero also described a cultural shift. Float pool employees had sometimes viewed themselves as “extra,” a label that minimized their value.

“They’re never extra,” Bero said. “They’re critical to our team.”

UC San Diego Health also builds flexibility into traveler assignments by allowing travelers to submit requested time off at the start of their contracts.

“I treat them just like any career nurse,” she said.

Some travelers eventually transition into permanent roles, giving UC San Diego Health a way to build its permanent workforce through relationships developed during contract assignments.

Keep adapting to what your workforce needs

The panelists were clear that there is no final version of a flexible workforce strategy. Organizations need to keep learning from their data, their teams and the patients they serve.

Technology can reduce manual work and identify patterns leaders may not have time to find themselves. Colfer described a future in which scheduling becomes more of a validation process, freeing the nurse leaders responsible for scheduling to spend more time with patients and staff.

But technology alone cannot determine the right workforce strategy. Leaders still need to understand their organization’s goals, listen to their teams and make decisions based on patient needs.

For Bero, that means being patient during periods of change and listening to what employees want from work. For Adrid, it means being willing to experiment and adjust quickly.

The takeaway is simple: Flexibility is not a fixed model. It is an organization’s ability to adapt as patient needs, employee expectations and priorities change without losing sight of quality, safety or the people delivering care.