Tech-Enabled Staffing: The Catalyst for Changing Employment Models

Gig-style employment feels completely incongruous with the realities of healthcare staffing to most hospital executives, but with the right technology tools, it’s more than just possible – it’s a competitive advantage.

“It’s been the perfect storm,” explained Scott Watkins at the onset of our interview. “Care teams feel overtaxed from the burdens of COVID, the workforce continues to age, and those that remain are looking to make a change more than ever before, all of which make it increasingly more difficult to adequately staff. Health systems are starting to report their numbers for the first half of this year, and we’re all struggling with where this is heading.”

Watkins is the SVP of Hospital Operations at Norton Healthcare – a 5-hopsital system that has served the Greater Louisville market and beyond for more than 130 years. He’s spent more than 25 years with the system, giving him the perspective one needs to really conceptualize just how dire the situation is. “Pre-pandemic, we were spending maybe $10 or $11 million annually on contracted labor. Today, we’d love to only be spending that much. Whether you want to call it the Great Resignation or the Great Burn Out, the truth is that we’re going to be feeling its impact for a long time. I’ve seen rapid growth over the last 12 to 18 months in nurses’ willingness to take travel contracts, and those seeking traditional employment simply won’t be enough to fill any hospital’s needs.”

Joining Watkins was Isaac Ullatil, Co-Founder and CEO of Hallmark Health Care Solutions. Ullatil has worked in healthcare IT for the last 30 years, 20 of which were acutely focused on understanding and grappling with the realities of healthcare staffing.

“This is a problem that has been steadily growing for some time,” Ullatil said in affirmation of Watkin’s points, “and what we’re witnessing now is a stressed system reaching its breaking point. Consider this: the government specifically made it easier for nurses and physical therapists to come to the US through employer visa sponsoring, and even then, we’re nowhere close to succeeding with traditional staffing models. By 2030, we’re projected to be 2 million nurses short, and that’s not even counting other hard-to-fill positions like respiratory, lab, and radiology techs.”

Bringing gig work to healthcare

This massive gap between healthcare labor supply and demand was a key driver behind Ullatil’s mission with Hallmark Health Care Solutions’ Einstein II platform. Einstein II is a cloud-based workforce deployment and vendor management tool that helps dramatically reduce Providers’ reliance on premium labor by facilitating the creation of mobile enabled internal resource pools (IRPs). IRPs are an evolution of the float pool model, providing a group of genuinely contingent labor support to fill the gaps between traditional employees for just-in-time staffing, as opposed to simply being a group of FTEs willing to move between units in exchange for a higher rate. Einstein II layers atop a Provider’s core scheduling system, uses AI to intelligently, flexibly, and automatically predict volumes and manage the IRP, and most importantly, gives IRP members the ability to choose their own schedules the way they would working for a gig-company like Uber or Lyft.

For Norton, this means the ability to meet the shifting demands of today’s workforce. “The labor market on the whole is requesting more flexibility than ever before,” explained Watkins. “For your back-office roles, you can use a blend of remote and hybrid workforce strategies to meet that need, but it takes something more innovative and involved to do the same for caregivers, who will otherwise see staffing agency contracts as their only option. The days of relying predominantly on 12-hour shifts is over, and the sooner Providers embrace flexible staffing, the sooner they can compete with premium labor firms for the best and brightest.”

For Norton, this means the ability to meet the shifting demands of today’s workforce. “The labor market on the whole is requesting more flexibility than ever before,” explained Watkins. “For your back-office roles, you can use a blend of remote and hybrid workforce strategies to meet that need, but it takes something more innovative and involved to do the same for caregivers, who will otherwise see staffing agency contracts as their only option. The days of relying predominantly on 12-hour shifts is over, and the sooner Providers embrace flexible staffing, the sooner they can compete with premium labor firms for the best and brightest.”

“Outside of nurses that have completely changed professions, that’s where a lot of the available nurses disappearing from the full-time labor pool are going,” Ullatil chimed in, “because they want to be able to pick the shifts and days they work, and the rate at which they do it. Einstein II goes even further by helping healthcare match the pace of innovation we see in the consumer market by allowing all that selection to be facilitated through a mobile app.”

“It enables you to account for volume volatility using a flexible pool without overstaffing and risking underutilization of FTEs,” continued Ullatil, “and most importantly, it cuts out the wasteful middleman.” Ullatil is referring to contracted labor firms – none of which they are affiliated with, preferring to help clients from an uncompromised, neutral position – which he argued are significantly more responsible for the financial realities of staffing than some may realize.

“There’s this idea that the increase in rates is directly tied to how much nurses are making in these contracted positions, but if you look at their wages, that’s not entirely the case. They are making more, but what’s grown disproportionately are the margins of the staffing agencies that are taking advantage of the demand curve. Einstein II levels that playing field, dropping costs even if the per hour rate per nurse was left unchanged, and giving Providers the ability to find mutually agreeable labor terms directly with their talent.”

“There are of course some hurdles to manage,” explained Ullatil, “such as how that gets handled in a nursing population that’s unionized. But the same tools can be applied to any PEO arrangement to bypass those concerns and preserve all the financial, recruiting, and employee experience benefits.”

Modernizing the minutia

Einstein II provides more than just labor forecasting and gig-style shift selection, as the platform also contains a host of vendor management system (VMS) features. “There was no platform on the market when we started that could interface with an EMR, or platforms like ADP and Kronos, to manage all the scheduling, tracking, and contracting of the three primary labor groups: full-time, part-time, and contracted. This drove the creation and growth of the MSP market,” expounded Ullatil, “which we’ve removed the need for by automating all the benefits of one within the platform.” Rather than rely on an MSP, Einstein II enables Providers to create their labor orders, submit them agnostically to vendors and freelancers, and then examine the entire breadth of potential candidates ranked accordingly by hourly rate and other criteria.

Watkins took this opportunity to weigh in on what that means for an organization like Norton. “This gives us a range of operational benefits, such as streamlining not just selection, but contracting. All the contractual terms that you need to have consistent can be automatically included in requests that go out, saving our legal teams time and effort. It’s all standardized, and that’s decreasing the need for negotiations – what they see is what we’re offering. The platform also gives us daily analytics on how many contracts we have out, how many are signed, how many are pending starts, and it can all be stratified down across our hospitals. In fact, it’s been so effective that we’re expanding outside of just clinical roles to environmental services, dietary, and IT.”

Credential status, tracking, and reminders are automated as well, sending all affected parties regular updates. “The talent sourcing and management processes bot become easier,” added Ullatil, “because we’re taking all those smallyet- important pieces and automating them like they should be, so teams aren’t wasting precious manual effort. AI-driven tools like this will be critical as the care delivered, modes of working, and compliance requirements grow evermore complex.”

Taking the first step

“Contracting directly with labor has helped Norton cut overhead and labor costs, and we’re thankful for Hallmark Health Care Solutions’ support in making that internal agency a reality. It’s helped us meet employees where they’re at, and demonstrate our commitment to them,” continued Watkins, “but it’s not enough. We’re adapting to the market better than most, but we’re still spending more on labor than ever before, and will have to keep investing in healthcare innovations and technology to keep pace.” Ullatil agreed, stressing that Hallmark Health Care Solutions is just one of many tools that can work in harmony to help Providers rise to their ever-escalating challenges.

“Having the right tools is absolutely vital to succeeding,” explained Ullatil, “but equally important is having the right leadership mindset. Norton’s team has been very progressive in their thinking, and that’s the way you must look at it. You must see the changing tide of employee preference, and as a senior leadership team, accept that there’s no winning answer other than to reconceptualize work, scheduling, and technology’s place within them.”

“Then you have to be willing to put in the change management work, which is never easy,” added Watkins. “A lot of times, operators, administrators, and even senior leaders are hardwired to believe they know the right answer. They draw from their experience, and are guarded the second someone says there may be something better. The best way I know of to get everyone on the same page, and overcome that resistance, is to teach your leaders to listen. Listen to what your staff are saying, empathize with their desire for a better work-life balance, and shelve the noes in favor of, ‘how can we use technology to find a better arrangement?’”

Scott Watkins
Scott Watkins began his current role in January 2017 after serving as System Vice President, Operations, since April 2004. Prior to that, he served in operational roles at Norton Audubon Hospital and Norton Women’s & Children’s Hospital. Watkins began his professional career in 1992 with Eskew & Gresham in Louisville. After earning his certified public accountant (CPA) designation in 1995, he moved to Nashville, Tennessee, to begin his health care career with Columbia/ HCA, then the largest hospital company in the United States.

In 1997, Watkins returned to Louisville to work for Audubon Hospital. A year later, Norton Healthcare bought the hospital from Columbia/HCA, and he accepted a position with Norton Healthcare. He has had the opportunity to work at the facility level and system level during his time at Norton Healthcare. He enjoys getting to make a difference in his hometown and is extremely grateful to be part of the Norton Healthcare family.

Watkins holds a Bachelor of Science degree in business administration with a concentration in accounting from the University of Louisville and a Master of Business Administration degree from Bellarmine University in Louisville. He is licensed as a CPA in Kentucky. Watkins, who is a native of Oldham County, Kentucky, and his wife, Pam, have three children, Madison, Jackson and Luke. He serves as a board member for Christian Academy of Louisville and the Kentucky Derby Festival and is an elder at Northeast Christian Church in Louisville.

Isaac Ullatil
Isaac is a champion for merging strategy with technology to help healthcare organizations drive improvement and innovation in workforce management. Recognized by The Healthcare Technology Report as one of the Top 50 Healthcare Technology CEOs in 2022, he focuses on developing high-end technology solutions complemented by finely tuned business process reengineering. Prior to co-founding Hallmark Health Care Solutions, Isaac held senior consulting roles at ECG Management Consultants and PricewaterhouseCoopers (PwC), and he started several other healthcare and IT firms that quickly became multi-million dollar companies. These include Core3 Technologies, which was acquired by 3i Infotech (a publicly traded firm), and Team Health Care/Bion Healthcare, which he led in raising capital from hedge funds and private equity while expanding into multiple international markets in North America, Asia, Africa, and the Middle East. Ullatil has an MBA from Newport University, a master’s certificate in business management from the A.B. Freeman School of Business at Tulane University, and a bachelor’s degree in production engineering from the University of Pune in India, as well as a Lean Six Sigma Black Belt certification in health care. He has been published in multiple media outlets, including Forbes, and speaks regularly at national and international conferences.