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3 Ways Creating an Internal Agency Improves Quality Outcomes

May blog header

The transformation of the float pool model at hospitals and health systems into a more fully functional “internal agency” can do more than improve the ability to meet operational and financial imperatives. Specifically, improving procurement of contingent staff through a gig-style system controlled internally can not only help lower labor costs and improve service lines, but it can also measurably boost patient experience and outcomes.

As hospitals look to rein in their labor spend, the question is whether using gig-style staff will lead to decreased employee engagement and quality of care. Fortunately, an internal agency often has the opposite effect: improving quality so much that it can measurably move the needle on measures like employee satisfaction, Press Ganey scores, and even award nominations.


What do we mean by an “internal agency?”

Imagine you have an open role that you want to fill with a qualified nurse. You typically have a variety of options, but none are ideal. You could go through a Managed Staffing Provider (MSP), but you'll pay a significant premium, and it will take them time – often a long time – to fill that role. Alternatively, you could pay members of your core full- or part-time staff overtime or some other form of incentive pay, but that's also expensive and increases the risk of burnout and dissatisfaction among core staff.

Here's a better way: by implementing a single, smart platform to manage your internal resource pool, you solve your primary pain points. You can better attract staff who want more flexible work options, creating a robust “internal agency” of qualified, credentialled talent that you can call upon at need. In turn, that means health systems can fill more open roles faster at a lower cost.

But there are more gains than just staffing improvements and labor cost reductions, especially in quality. “These quality impacts aren't necessarily your initial priorities,” says Matt Dane, DNP, MBA, RN, Senior Vice President of Business Development at Hallmark Health Care Solutions, “but they end up having powerful positive effects.”

Case in point: a Tennessee-based health system, one of the country's largest not-for-profit systems, jumped from Tier 3 to Tier 1 in patient satisfaction results and gained 8+ Daisy nominations after implementing the Einstein II platform to grow and manage its internal agency. “Ninety-nine percent of our Daisy Awards come from the patients and family members for the care that we provide to them,” says their director of nursing, who oversees their internal agency. “I just love it because it gives me a good insight into what my staff is achieving. This shows they’re truly serving our patients.”

But how exactly did they produce these improved quality outcomes? What connects the dots between creating an internal agency and improving quality outcomes?


How can an internal agency improve quality?

1: Higher throughput as a result of improved staffing

The immediate benefit of an internal agency is an improved ability to meet organizational staffing objectives. For example, one of the nation’s leading academic medical centers, based in Michigan, hired 450 new nurses and has grown its own internal agency by about 100,000 hours per year since its inception. Another, serving millions of patients annually across nearly 100 hospitals, more than tripled its float pool size and achieved a 97% fill rate.

For its part, the health system in Tennessee saw a 540% growth in float pool size within three years, including 100 new nurses hired in just the first 100 days of the program. In turn, improved staffing has had tangible quality impacts. For example, the system was behind in its MRI procedures by 80+%. “Radiology, with MRIs in particular, were having the same kind of staffing struggles and couldn't complete procedures, which then held everything else up,” says their director of nursing. This wasn’t a department that used its internal agency initially but, given the need, added it. “So now we consistently staff them every day of the week with extra staff.”

The result is that they were able to use their internal agency to deploy high-quality clinicians, increase their ability to flow patients through the hospital and make sure patients get the treatment they need to recover faster, and sooner, with fewer complications or problems.

2: Reduction in turnover, which enhances continuity and consistency of care

Beyond the ability to grow their contingent workforce, health systems with high-performing internal agencies tend to find that turnover decreases as well. That’s because offering flexible work options can catch nurses who might otherwise leave altogether by giving them more control over their work schedules. Even if they’re no longer working full-time, they can keep them working shifts here and there. The Tennessee-based system, for example, has nearly halved its previous turnover rates and is now at 12%, below the national average: “They can take a break when they are burnt out without leaving the nursing profession or leaving us at our facility, so they can still help fulfill the needs that we have.”

That facilitates greater continuity and consistency of care; the same nurses stick around. That helps cultivate trust and comfort with patients, which helps with quality outcomes. It can also preserve institutional knowledge because constant rotations of new nurses don’t have to figure out how things work in a brand-new area or position.

3: Ability for clinical staff to grow in their roles with an improved ability to get advanced practice degrees or to have more cross-training opportunities

Notably, not all turnover is bad turnover, and a more robust internal agency can create opportunities for nurses to “turn over” in ways that benefit the organization. “This program has allowed people to get advanced practice degrees to go on,” says the director of nursing. “I have 10 to 15 nurses off the top of my head that have obtained their nurse practitioner, for example. We've had people transition into head nurse roles on units or manager roles in our facility. So, they've continued to grow once we got them in the program.”

The health system has also been able to use the program to facilitate a lot of cross-training opportunities. For example, the health system can compare the nurses’ competencies against areas of opportunity and assign them to areas where they can increase their overall skillset. “It makes them a more valuable nurse, increasing the ability of our facility to use them in more ways. Even better, it increases their satisfaction in their role too.”

In short, the staff starts in a flexible work program that offers them the ability to train further and gain new degrees and credentials, and then grow into leadership and more advanced practice roles, where they can deliver increasingly better service.

Ultimately, transforming your health system’s float pool into an “internal agency” has more benefits than just faster, more cost-effective clinical staffing. It can drive quantifiably improved quality – including reduced lengths of stay and improved patient experience – with results like happier patients and staff, a stronger reputation, higher Press Ganey scores, and commendations like the Daisy Awards.

To learn how to design and implement an internal agency in your health system, visit for more information.