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Leveraging size while remaining nimble with a workforce management strategy. Case Study: Advocate Aurora Health

By: Margaret Gavigan, MSN, MBA, RN, NEA-BC; Jane Dus, DNP, RN, NE-BC; and Mary Beth Kingston, PhD, RN, NEA-BC

Having a staffing vision promotes optimal response to patient surges.


  • Shared governance and an infrastructure to support collaboration between a system and individual sites paves the way for creating a multidisciplinary group to anticipate equipment, resources, and staff needed for patient surges.
  • The system-based nursing education and professional development team can provide support from the system and site perspective.

Developing a robust, flexible nursing workforce over the past 6 years has positioned Advocate Aurora Health (AAH) to proactively manage uncertainty in an ever-changing environment, particularly during the COVID-19 pandemic. By improving staffing processes, the system’s leaders have developed workforce management strategies to respond to change and build powerful organizational resilience. These qualities, in turn, have provided a stable foundation throughout the crisis.

AAH is one of the 10 largest not-for-profit integrated health systems in the United States, serving nearly 3 million patients annually in Illinois and Wisconsin across more than 500 sites. The system’s purpose is to “help people live well” during times of crisis and calm, fully embracing a whole-person health focus and commitment. Leaders have leveraged the size of the system while moving with speed and agility to navigate the changes created by the pandemic.

Workforce management: A foundation for organizational resilience

Improving patient health, safety, and satisfaction while also improving team member satisfaction and ensuring an optimal work environment have been key AAH goals. To meet them, leaders have implemented best practices, developed a robust infrastructure, and identified tools to help plan and deploy clinical labor resources to best meet patient needs.

One initiative is the Effective Staffing Vision, which is driven by a commitment to get five key things right: the right nurse, at the right time, with the right competencies and credentials, at the right cost. Three critical success factors for achieving this are shared governance, metrics, and standardization. (See Ecosystems unite stakeholders in staffing decisions.)

Ecosystems unite stakeholders in staffing decisions

Advocate Aurora Health (AAH) uses two key strategies to ensure effective staffing: ecosystems (multidisciplinary and interdisciplinary teams) and engaged frontline nursing teams. The ecosystems are used to create structure, change processes, develop sound staffing plans, and track key metrics at the system and local site levels.

To avoid silos, AAH has standardized staffing and scheduling practices across the system, creating consistent job descriptions for all flexible staff and staffing offices, and synchronizing scheduling time frames. Scheduling software* has been leveraged to implement optimal care models. In partnership with finance, nursing budgeting principles have been developed, and both site and system multidisciplinary teams have been formed.

Responding to COVID-19

With a strong workforce management strategy already in place, AAH was positioned to quickly and effectively respond to the COVID-19 pandemic. The creation of a virtual system labor pool command center was a key workforce strategy. Co-led by the vice president for talent acquisition and nursing, the command center includes team members from human resources (HR), HR analytics, ambulatory, and the system float pool, along with a project manager and the contingent labor director. Working closely with each site’s labor command team, the command center developed a 24/7 online pro­cess for sites to request and reassign staff. The system command center team helps optimize the use of all available, qualified staff. Success strategies include:

  • allowing team members to volunteer for reassignment
  • hiring more than 100 zero-assigned nursing students; nurses; and respiratory therapy, environmental services, and hospitality staff (all managed through the system labor pool) to support site needs
  • partnering with contingent labor companies to hire and onboard agency nurses
  • leveraging the relaxation of licensing requirements at the state level to send nurses between state lines
  • reassigning more than 5,000 team members to new roles
  • matching prior work experience with work-from-home or furloughed team members to meet site needs
  • conducting twice daily system calls to address immediate and anticipatory staffing needs
  • redeploying team members with medical restrictions to nonclinical areas, such as managing department of health data requests
  • creating a database of all available team members for potential staffing support.

This collaborative approach to meeting patient care needs was highlighted in the system’s response to a surge in patients requiring extracorporeal membrane oxygenation (ECMO) at one of the hospital sites. To simultaneously support up to 30 patients on ECMO at a single facility, highly qualified staff from throughout the system stepped up to help, with some staff staying in local hotels during the surge.

Shared governance and an infrastructure to support collaboration between the system and individual sites paves the way for creating a multidisciplinary group to anticipate equipment, resources, and staff needed for patient surges. The system and site labor command center teams met twice daily to respond to staffing demands; the system is now developing a standard approach to any new surges based on lessons learned. A database of furloughed, newly hired, and volunteer staff is instrumental in helping with reassignments, including new roles such as visitor and staff screeners or site-based testers.

Ensuring nurses have the support they need for reassignments is a priority. The system-based nursing education and professional development team provide support from the system and site perspective. From the system, the team developed a virtual surge orientation staffing and critical care program that focuses on helping furloughed nurses from the OR, post-anesthesia care unit, and clinics return to the med-surg unit or ICU bedside for clinical reassignment. Over 3,500 nurses participated in these online programs. The nursing department also moved the orientation and new graduate residency program to a virtual format for more than 3,000 nurses. The system team created COVID-19 educational videos, which have been viewed over 37,000 times, and regularly updates personal protective equipment (PPE) guides, which have been downloaded 35,000 times.

The site-based teams help share new daily information and updates, provide support for proper PPE donning and doffing, and, in many cases, provide direct care staffing or are reassigned to areas of high need such as employee health. An educational program supports implementing a team-based nursing model and helps reassigned nursing education and professional development staff feel comfortable in their new roles. In partnership with nursing practice, these staff have implemented more than 300 practice changes to cope with the pandemic’s unique challenges.

In addition to standard communication processes, daily communication updates provide information about quickly evolving practices, policies, and procedures. Site metrics and issues are shared through daily huddles. Precise, targeted communication, along with robust, innovative educational and clinical support systems, are essential for taking care of staff during these very difficult times.

The Effective Staffing Vision provides the infrastructure for creating the resiliency needed to quickly manage the pandemic in two states with very different challenges at different times The ability to expeditiously share knowledge and resources, as well as move patients and staff quickly to different care sites, makes it possible to meet everyone’s needs. (See Balancing metrics, meeting goals.)

Strength for the future

The system and site leadership team plans to make the most of the lessons they learn during the pandemic. Instead of narrowly focusing on the pandemic’s financial impact, a balanced workforce management strategy that leads to excellent patient care and staff engagement has been maintained. AAH’s response to COVID-19 requires a flexible workforce, and staff experiences are being evaluated for ongoing implementation, especially regarding a system approach to labor pools. Leaders also are identifying opportunities to sustain new skill sets learned during reassignments. The more than 300 practice changes that have been implemented during the crisis reflect the importance of listening to frontline staff and inform the next steps in implementing change. The shared governance structure in inpatient, ambulatory, and home care assists in gathering this important feedback.

The pandemic response also has helped strengthen relationships with staff, providing an opportunity for leadership to show they care and reinforcing the priority of nursing career development. In reassigning staff, nurse leaders are listening to clinical nurses and considering their skills, interests, and educational needs. Nurses in every area are welcoming to those orienting to different care settings and respectful of their current skills and expertise. Leaders and educators are coordinating the process and are instrumental in building trust, ensuring that clinical nurses have the training and support required for new assignments. Providing excellent care during the pandemic is a unifying goal, and nurses in the inpatient setting appreciate their colleagues’ help.

In addition to the system labor pool and clinical nursing support, special innovative payment models have been initiated by creating two different COVID-19 pay models:

  • Continuity pay. This is identified by trigger factors such as census and COVID-19 prevalence in the community. If the triggers are met, team members receive an increase in hourly rate based on role.
  • COVID-19 pay. This applies to the emergency department and units where more than 50% of patients have COVID-19. An increase in hourly rate is provided based on role.

Feedback from the nursing team is that the combination of staffing initiatives, pay incentives, and transparent communication are essential elements supporting nurses during this challenging time. Ongoing innovation during the pandemic has fostered resiliency and will position the organization for other unexpected challenges in the future.

Mary Beth Kingston is system chief nursing officer (CNO), Margaret Gavigan is regional CNO and system vice president for clinical operations, and Jane Dus is regional CNO and system vice president for nursing education and professional development at Advocate Aurora Health in Downer’s Grove, Illinois, and Milwaukee, Wisconsin.

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

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