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Reducing Costs & Increasing Efficiency with an Internal Resource Pool

Filling open roles at hospitals – particularly among clinical staff – has been a major challenge for health systems since before the pandemic. In some places, vacancies and staff shortages have hit critical thresholds, forcing health systems to cut service lines and close locations. Worse, understaffing can lead to a vicious cycle where the burnout induced by overworking understaffed teams leads to even more nurses quitting or becoming travelers, where they can better control their schedule and workload.  

To ease this pain, many hospitals turn to a tried-and-true staffing tactic: the internal resource pool (IRP), sometimes also known as a float pool. Specifically, most hospitals and health systems use an IRP to help fill open needs among clinical and, sometimes, non-clinical staff. This approach to managing hospital float pools can help the system or facility to flexibly fluctuate when the census demands it, minimizing the use of agency resources and achieving healthcare labor cost savings. 

However, most resource pools do NOT fulfill the labor goals they were intended to support.  

“Typically, every health system already has its float pool from which they are deploying resources, but they're using a manual process that limits the size, appeal, and productivity of their float pool,” says Bill Reau, Chief Operating Officer and Principal at Hallmark Health Care Solutions. As a result, their resource pool programs fail to meet intended objectives: 

  • They don’t meet the support levels demanded by the census. 
  • They’re misaligned to the organizational labor initiatives. 
  • They’re underutilized.  

Why Most IRPs Fall Short 

Most healthcare organizations typically face dual problems in building and executing their IRP programs. First, they manage their IRP manually, thus losing the efficiency benefits that come from having their resource pool. Manual management—with nothing but spreadsheets and in-person phone calls—is an inherent constraint on the effectiveness of any IRP. It limits program scalability, hinders staffing optimization in hospitals, and makes it less likely the program will successfully free the health system from six-, seven-, or eight-figure annual agency costs.  

Second, administrators design the pool to appeal to the hospital rather than to the workforce they’re trying to attract. In other words, if the IRP is built on a foundation of “This is what we want from the nurses,” you’ll struggle to attract a sufficient number (and quality) of nurses to participate. National Nurses United, the largest union of RNs in the U.S., argues the current staffing problem isn’t a shortage of nurses at all; rather, the issue is “a shortage of nurses who want to work under current conditions.” Reau agrees: “The agency business is just consistently booming because they're the ones that engage the freelance workforce.” Thus, in building an effective IRP, one key question that needs to be asked is: What do the nurses want? 

Making the Most of Your IRP 

Consider the nurses who are considering leaving their current employers—particularly younger nurses—citing the need for flexible scheduling as a chief driver. Simultaneously, “a whopping 36% of employed Americans identified as independent workers in 2022, up from 27% in 2016.”  

In other words, a gig economy approach to nursing is rising in popularity—among nurses! 

So, to start attracting the next generation of flexibility-oriented clinical staff, the IRP program must be technology-driven, and offer the freedom and flexibility of a freelancer or an agency model. That means your program must offer flexible work models for nurses and be designed to attract the 30-35% of nurses who are not interested in any of your current jobs and who need maximum flexibility with no strings attached.  

To do that, organizations need to be able to offer automated nurse scheduling, immediate communication of open needs, instantaneous availability updates, and simultaneous confirmation scheduling. Spreadsheets can’t manage that level of functionality, but dedicated IRP technology can. 

“I came from an organization that had an internal resource pool of 30 nurses when we started,” says Matt Dane, Senior Vice President at Hallmark Health Care Solutions and a former Chief Nursing Officer. “After partnering with Hallmark and its workforce management platform, we grew that pool to over 200 nurses in just eight months.” 

He explains that the implementation of a dedicated IRP technology platform catalyzed two changes. “First, we built a contingent employment model that resonated with what those applicants wanted in a work-life balance.” Then, the Hallmark platform enabled the organization to connect directly with IRP participants and allowed them to procure shifts or employment when, where, and how they wanted to—all through their own devices. 

His organization wasn’t alone in experiencing rapid growth and utilization of its IRP program after implementing IRP-specific technology. For example, one Tennessee-based health system tripled its resource pool size in just 3 months after adopting IRP technology. Another Michigan-based system added 450 additional nurses, which enabled them to expand the program to 120 ambulatory sites. 

Enabling Easy, Efficient, and Effective Administration of the IRP Program 

Just getting the nurses onboard isn’t enough; any IRP program needs to be easily and efficiently manageable by hospital administrators. With robust and purpose-built technology, healthcare organizations can secure this growing labor force segment without adding additional employees or departments or relying on external staffing firms. 

Scheduling software isn’t the solution. It may handle the core staff of full- and part-time nurses, but it lags at managing and communicating with contingent resources who float across a lot of hospital locations. That requires dedicated IRP technology like the platform that Hallmark offers. The Director of Nursing at a New Hampshire-based health system agrees: “If we’d tried to do everything in the current scheduling system, we’d probably only get a tenth of the amount of actual productive hours.”  

She cites the ability to communicate with staff members automatically and to match up skills with needs, shift timing, and credentials while making it easy for nurses to enter what and when they want to work. “It wouldn’t be possible without Hallmark to run our program the way we do.” 

In turn, that has yielded tremendous cost savings: an estimated $6.5 million just during the first 18 months. 


Ultimately, the right IRP technology allows HCOs to “plug into” the gig economy and avoid losing nurses and other clinicians to agency staffing, and it can offer enormous operational and financial benefits, including the ability to: 

  • Predict upcoming staffing needs. 
  • Provide care to a larger patient population (and, consequently, to generate higher revenue) 
  • Lower clinician-to-patient ratios (leading to better overall health outcomes).  
  • Increase employee satisfaction (and thus improve retention and recruitment).  
  • Decrease vacancy rates and speed up fill rates. 
  • Enhance hospital staffing efficiency through smart automation. 

In the end, the market may give most health systems no choice: the only way to avoid dependency on premium labor costs with the agency, OT, and incentive pay—or risk facing high vacancies and an inability to recruit/retain staff—is to work toward changing current practices and engaging the available workforce today. The endgame always is that every hospital needs to attract, retain, and engage more resources. But to do that, you have to adapt to meet the realities of today’s nursing workforce: 

  1. You need a productive resource pool with proper employment offerings, aligning with the impact of IRPs on nursing, and 
  2. You need a tech-enabled automated engagement platform to successfully interact with that workforce.