Building a Flexible Workforce: The Good, The Bad, The Truth

November 15, 2022 | Workforce Solutions

The past two years have been challenging for healthcare leaders, workers and suppliers. Healthcare systems and hospitals were short on staff, high on census and reliant on contingent labor. As healthcare leaders look forward to rebuild and strengthen their talent pools, it is vital to maintain flexibility for workers and health systems. Providing flexibility ensures good financial stewardship of limited resources for health systems and provides more employment opportunities to a wider pool of candidates.

In a recent webinar, Aya Advisory Solutions’ executive vice president, Jackie Larson, and Aya Healthcare regional vice president of program management, Cristal Mackay, discussed how healthcare leaders can build flexible workforces in their organizations.

Watch the webinar now or continue reading to gain its highlights.   

What is a flexible workforce?

A flexible workforce adjusts to census demand — growing when a system needs it to and returning to the baseline when increased headcounts are no longer necessary. There are many situations that can cause health systems to consider building a more flexible workforce, including:

  • Flexing down and sending employees home too often
  • Scrambling to meet peaks in census demand
  • Using excessive bonus shifts and internal premium labor
  • Having difficulty filling open shifts
  • Trying to manage burnt-out employees

While building a flexible workforce can help healthcare organizations overcome these scenarios, another main benefit of building a flexible workforce is staff satisfaction.

According to LinkedIn’s 2022 Global Talent Trends, workers today value flexibility and well-being. With a flexible workforce, healthcare organizations can provide a variety of opportunities to employees with positions for every type of worker. By offering different shifts, lengths of shifts, scheduling options and employment types, flexible workforces can provide a solution for organizations looking to accommodate a wide variety of lifestyle choices while increasing their labor pools — whether their workers are on the verge of retirement, looking for more flexibility or transitioning from travel nursing.

Emerging Workforce Models

Building a flexible workforce is not without its challenges, though. The vacancy levels in healthcare are still alarmingly high. According to the 2022 NSI National Health Care Retention & RN Staffing Report, hospital turnover increased by 6.4% and currently stands at 25.9%. Many emerging models and technology solutions are coming into the market to overcome this workforce challenge.

Undoubtedly, technology helps make scheduling and filling open shifts more manageable and more efficient. For example, the scheduling manager or unit manager creates an open shift on their scheduling software, and the worker receives an open shift notification from their smartphone, accepting or declining the shift request. Direct communication via technology platforms can save time, but technology alone will not solve healthcare’s workforce shortage. Given the current 200,000 direct hire RN openings indexed by Liquid Compass, hospitals experience challenges in marketing open positions and recruiting qualified talent. Unfortunately, many technology solutions entering the market are direct sourcing applications that do not provide adequate recruitment support and can place health systems at risk through the misclassification of healthcare workers. It takes a combination of technology, strategies and best practices to overcome healthcare’s workforce challenges.

Developing a baseline for your flexible workforce

Every organization and market operate differently, and there’s not a single solution. The right solution considers the unique needs of an organization. Using data and analytics to understand the organization’s current state, healthcare leaders can formulate workforce optimization that work for them.

The following points need to be assessed at the individual unit level to develop a baseline for your workforce:


Are there certain times of the year when the census is considerably higher? A unit with a higher census in November through February every year will need greater flexibility in its workforce than a unit with no seasonality.

Staffing Ratios

What is the unit’s nurse-to-patient staffing ratio? An ICU unit that typically staffs at 2:1 will experience changes to staffing needs at almost every change in the census. A unit like this will require a much more flexible workforce than a unit that staffs at a 6:1 ratio which has the potential to absorb additional patients with existing staff.

Weekly/Daily Census Variation

How much variation does the unit experience daily or weekly? In some units, the census can be at 20 but double the following week to 40. These units require a lot more flexibility to adapt quickly. Other units have variations by weekday. For example, in surgical units, the census may rise Monday through Thursday and drop later in the week as those patients are discharged. These units may require different staffing levels across weekdays.

Open Staff Positions/Leaves

How many open positions does the unit currently have? Nationally, it takes 65 to 70 days to hire a permanent staff RN. An organization needs a deep enough bench to be able to backfill open positions and/or leave vacancies without going into a premium labor expense category. Understanding your organization’s trends is important for proactive planning.

Full-Time Employee (FTE) Erosion

Are staff working to their fully budgeted hours? FTE erosion occurs when employees work fewer hours than their FTE commitment. This can negatively affect an organization as they hire more individuals or pay premium labor costs to compensate for the lost hours.

Build A Flexible Workforce with Aya Advisory Solutions

Data drives good decision-making, so it’s a natural start to begin with a thorough workforce data analysis before building or refining an organization’s flexible workforce strategies. If you want to take a data-driven approach to develop a flexible workforce, contact Aya Advisory Solutions for an assessment at [email protected].

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