When Trinity Health created its FirstChoice internal staffing agency, it wanted to offer employees, including nurses and other clinicians, greater flexibility to serve in short- and long-term roles in locations across the Livonia, Mich.-based system. The goal, as Gay Landstrom, PhD, RN, senior vice president and chief nursing officer, described it, was "to build it very differently than float pools of old."
"We wanted to create a culture within the system where our colleagues working in our hospitals and healthcare facilities — when they saw a FirstChoice person coming — that they were thrilled," Dr. Landstrom said. "That they knew this wasn't just somebody coming in as a travel nurse that they'd have to make do with, but rather, 'Here's the FirstChoice nurse coming. They're experienced. They know what is going on. They're some of the first trained when we make changes in clinical care, when we're making some of those continual improvements.'"
"We've really tried to get to our FirstChoice staff first, so they're knowledgeable, they help to spread innovation — they're really an essential part, not a float-pool fill-in."
Today, there are around 3,100 employees in the FirstChoice program that help meet staffing needs across 92 hospitals in 27 states.
In conversation with Becker's, Dr. Landstrom discussed FirstChoice's success and challenges, and shared advice for other health systems looking for innovative strategies to address workforce needs.
She noted that the program comes amid an evolution in what nurses and those in other clinical roles demand in terms of flexibility and control over their schedules.
"[W]e're really seeing that our caregivers — they absolutely are going to find a way to be able to better control their lives and their schedules — when they work, when they don’t, how they take time off and recover," Dr. Landstrom said.
"So, FirstChoice is really — it's our mobile option. Rather than just having traditional roles that are full-time or part-time, where you need to work every two or three weekends and half the holidays — those requirements typical of core [full-time equivalent] roles — it gives them options."
She added that while some people may assume these workers in the mobile workforce only provide day shifts on weekdays as their preference, there are plenty of offerings for nights and weekends. Some FirstChoice workers also enjoy variety, according to Dr. Landstrom.
"They like being in one hospital one day and another hospital another day, or staying with one of our organizations for three months and then even moving to another state to work in another one of our organizations," she said.
When asked about other metrics that highlight the effects of FirstChoice, Dr. Landstrom pointed to cost savings. She said the program has saved Trinity Health roughly $24 million annually by reducing contract labor expenses.
And, while the program started with nurses, it has expanded to include respiratory therapists, surgical technologists and healthcare professional travel positions.
As far as challenges with FirstChoice, Dr. Landstrom said, "[H]aving leaders let go of their mental models of float pools of old hasn't been a big barrier, but it has been a challenge."
"Leaders, sometimes — they've grown up within healthcare, and they have a picture of what these folks with a flexible schedule should be," she said. "They have a mental model of how they should work and try to exert control that is really not needed.
"Demand certain shifts and so many weekends — things like that. Things that we did in the past are just not needed with this workforce. And the more flexibility we offer — and the less we try to control their schedule — the more the FirstChoice colleagues will give us.
"So, sometimes, it's actually a leader who needs to let go of those old mental models and really work with this mobile workforce. That's been a little bit of the challenge, but we've been able to overcome that across our enterprise."
Dr. Landstrom also shared advice for other health system leaders who may be thinking about similar models: "Think big."
"This isn't just about nursing. While nursing is a very large part of the healthcare team, there are other critical clinical members of the team that also are some of that population workforce looking for flexibility in their lives as well. So, think big. Don't just think about nursing," she said.
Along those lines, she noted that the model's interim leadership arm has helped retain leaders who perhaps don't want to work 12 months per year but are not ready to retire. These experienced leaders are able to take on interim roles or special projects.
"Initially, that wasn't what we were building when we built FirstChoice," said Dr. Landstrom. "But we found it to be a platform that probably has much wider boundaries than we're even thinking of right now. So, my advice is — think broadly. Think about the changing workforce and what they need, and then balance it with what you need as a healthcare provider or as a system. And you'll find that there's some wonderful overlap there if you let go of old conceptions of float pools and mobile workforce."