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A workforce management strategy that builds organizational resiliency. Case study: Sanford Health

By: Diana Berkland, PhD, RN, FAAN, and Meghan Goldammer, JD, RN

Technology used wisely can help balance staff and patient needs.


  • Workforce management infrastructure should be built on the foundation of a supportive environment that meets staff needs in normal circumstances and enhances performance during emergencies.
  • System-wide workforce management technology to all managers and leaders to ensure best practices are in place throughout the organization.

A solid workforce management structure has been a stabilizing force at Sanford Health amid the uncertainty and chaos created by the COVID-19 pandemic. The system, which consists of six large medical centers and 40 critical access hospitals, is located primarily in South Dakota, North Dakota, and Minne­sota. A merger in January 2019 with the Evangelical Good Samaritan Society added 158 skilled nursing and rehab sites across 24 states, home health agencies, senior housing, and home- and community-based services.

The region served by Sanford Health is home to several meat-processing and packing plants and long-term care facilities where outbreaks occurred in the early days of the pandemic. Although the numbers of COVID-19 cases have varied across Sanford Health, the system’s data, flexible staffing, enterprise workforce management, and technology infrastructure have enabled a coordinated and strategic response.

Workforce management success factors

Four workforce management factors contribute to building stability and resiliency and serving staff and patient needs over time.

  1. Sanford Health firmly believes that resiliency starts with the care unit directors and managers. They’re viewed as the chief executive officers of their departments with fiduciary accountability and responsibility for maintaining the appropriate staff numbers and skill sets to serve patients.
  2. These unit leaders must be committed to cross-training staff so they can be flexible, confident, and comfortable providing care on other units when needed.
  3. Central nurse resource pools at the local and regional levels provide flexibility with cross-trained skills that go beyond an employee’s single specialty, whether they work in med-surg, women’s, children’s, or critical care units.
  4. The system-wide nurse resource pool provides an internal travel agency for the organization, which spans more than 400,000 square miles and can help local and regional central nurse resource pools when needed.

Underpinning this workforce management infrastructure is a supportive environment that meets the needs of staff in normal times and enhances their ability to perform in emergencies. As a result of actionable and visible data and a focus on staff well-

being, the organization has experienced a 12% decrease in agency use and a 2% decrease in RN turnover from 2019 to 2020. (See Using culture to cultivate commitment.)

Using culture to cultivate commitment

Sanford Health’s mission is to improve the human condition at every stage of life through exceptional care, spiritual enrichment, innovation, and discovery. The system’s operational framework is centered on several core values, including calling, courage, family, community, service, resolve, and advancement.

This nursing leadership philosophy—Humanbecoming Paradigm—is based on the work of nurse theorist Rosemarie Rizzo Parse, PhD, RN, FAAN. It creates a “more alike than different” culture that calls on leaders to:

  • promote mutual respect and trust
  • encourage collaboration
  • welcome diverse perspectives
  • focus on quality of life from each person’s perspective.

Listening with a “willingness to be influenced” helps new team members feel valued and appreciated when mergers and acquisitions occur.

Leading with respect

Sanford Health nurse leaders believe their success is largely related to operational implementation, adoption, change management, and change leadership within the work environment. To achieve this, they must be committed to a clear vision, and they must support their staff with reverence and respect.

A guiding premise for the leadership team at Sanford Health is recognizing that if the staff feels valued and supported in their work, the financial outcomes will follow.

Enabling staff to achieve work-life balance is key to helping them feel appreciated. Unit managers and directors must be well versed in the workforce technology to enable consistent staffing with minimal chaos. Calling staff every afternoon to work without foresight is a failure of leadership that may compromise their well-being; it’s a form of leadership malpractice. The staffing and scheduling committee is called the “Work-Life Balance Committee” to emphasize its importance.

Critical to that work-life balance is creating a solid and detailed succession plan, and giving everyone opportunities to grow. Providing positive coaching and extensive competency training, along with having crucial conversations, creates the stability needed to ensure staff success in providing excellent patient care.

Proof of concept

Proof of the positive impact of this leadership philosophy can be seen in staff engagement and patient outcomes.

  • One hospital within the system has successfully achieved four Magnet® designations and another has achieved three.
  • In organizations that receive Magnet designation, nursing staff engagement, as measured by the Practice Environment Scale, indicates staff experience at or above the mean for comparable organizations.
  • Nurse-sensitive indicator outcome data indicate low numbers of falls, pressure injuries, central line infections, and catheter-associated urinary tract infections.
  • Clinical comparative data indicate a statistically significant improvement in overall rankings in most domains for the past 18 months.

The role of data and governance

Workforce data are essential to operations. Using system-wide workforce technology* provides information to local managers and directors, resource pools, and executives to ensure leading practices are in place throughout the organization.

A holistic approach to workforce management requires that all disciplines (not just nursing) use the same platform. Integrating information—such as predictive and descriptive analytics based on volume, turnover, length of stay, leaves of absence, and other metrics—completes the holistic picture. We created dashboards in response to COVID-19 and the accompanying medication, medical supplies, and personal protective equipment (PPE) supply chain challenges. This allowed us to be nimble and accurate with supply-and-demand calculations. These data were instrumental in allowing leaders to make data-driven decisions to ensure patient and staff safety.

Workforce management governance is comprehensive and takes two forms: the system workforce governance structure and the nurse executive council.

System workforce governance

The system workforce governance structure includes all stakeholders and content experts, such as payroll administrators, finance officers, nursing informatics staff, nursing officers, and information technology staff. This group provides oversight and monitors the workforce management system, ensures standardization of nomenclature and system technology, decides which disciplines and units will use the system, and determines implementation timelines.

The system workforce governance structure also decides the best use of workforce management technology and has oversight for ensuring one consistent, leading practice standard throughout the organization. Staffing and scheduling software is used in areas other than nursing, so everyone must be represented as the technology is designed and developed.

Nurse executive council

The nurse executive council’s respectful, appreciative, trustful model ensures that everyone has a voice and consensus is obtained. The council determines staffing standards, skill sets, and hours per patient day across the organization and aligns these standards within the workforce management technology.

Sanford Health currently has five workforce management optimization projects: predictive/prescriptive data analytics (which includes several interactive calculators), staffing standards, governance, position control data standardization, and workforce management technology. The goal is to create an environment in which people can do the work they’re called to with the resources they need to accomplish it.

Coming together during the pandemic

In early 2020, staff needed to feel valued, safe, and supported as Sanford Health navigated the turbulent first weeks of the COVID-19 pandemic. Guidance about the virus changed frequently and required clear, concise communication and trusted leadership. This was accomplished, in part, via existing modalities, including the nursing governance structure, the nursing senate, various nursing governance councils, daily safety briefs, and short weekly surveys to all staff. In addition to these regular interactions, the enterprise and regional incident command structure provided daily standardized, succinct, and transparent communication (including vertical and horizontal communication from point-of-service staff through executive leadership) to ensure proper information flow.

The organization quickly posted a Facts over Fear page on the intranet, and daily Town Hall sessions were recorded so all shifts could hear the most current information from leaders. In addition, weekly Facebook Live sessions, hosted by leaders, were well attended by thousands of team members. Guiding this work was a philosophical belief that point-of-service staff needed to feel safe and secure while providing care. To that end, a PPE and supply-chain dashboard was created to allow leaders to make data-driven decisions based on supply and demand. (Learn more about how to support staff here.)

The cross-training that’s been in place at Sanford Health’s flagship hospital in Sioux Falls, SD, for 20 years provided a foundation for ensuring staff training, education, and competency when caring for patients with COVID-19. In addition, the system’s well-established local and enterprise float pools consist of staff who are enthusiastic about floating and confident in their skills.

Early in the pandemic, when patient volume in some units (including ambulatory care) was low, Sanford Health used the time for training and advancing skills and competencies to ensure staff could confidently take on challenges and be even better prepared for the future. Expert nurses were paired with novice nurses as volume surge plans were implemented, and upskilled ambulatory nursing personnel were prepared to work with expert nurses to ensure enough skilled staff would be available for the projected surge in patients with COVID-19.

Concern about the financial impact of a disaster tends to dominate in stressful times. Examining how decisions about finance affect patients, caregivers, and the success of the organization is important. Sanford Health takes a balanced approach to measure success, with a focus on clinical outcomes, financial metrics, patient experience, and healthcare worker experience.

Innovations for the future

Innovation is important for healthcare systems, but it should add to, rather than detract from, the workplace environment. Innovations should be viewed through the eyes of the staff. For example, mobile workforce management technologies are important because this is how millennials operate and we need to work within that world. These technologies include applications that are available via mobile devices and functions such as work schedules, available shifts, and time card corrections and approvals that can be completed remotely.

Data analytics and artificial intelligence should be aimed at taking work out of the system and providing support for leaders and end users, not making work more complicated. As innovation occurs, everyone on the team should acquire the skills needed to ask the right questions and extract meaning from the data.

Sanford Health has achieved consistency, excellence, and equilibrium amid many chaotic events. We’ve used a sophisticated workforce management system to synthesize technology and the work environment to balance staff and patient needs. Leaders are responsible for creating a workplace environment that engages competent staff who can provide excellent patient care. Thanks to a rich and robust professional nursing culture, clear vision, and solid succession planning, Sanford Health is nimble and well-positioned for future tidal waves of change.

*Workforce Management Solutions by API Healthcare, now a part of symplr

Diana Berkland is vice president of nursing and clinical services and Meghan Goldammer is chief nursing officer at Sanford Health in Sioux Falls, South Dakota.


Parse RR. The Humanbecoming Paradigm: A Transformational Worldview. Pittsburgh, PA: Discovery International Publication; 2014.

Supported by an educational grant from API Healthcare, now a part of symplr

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