When Angela Pulcini stepped into the role of Director of Provider Services for Parkview Health, she knew locum tenens hiring was a priority she wanted to focus on. With nearly a dozen different locum tenens vendors and no standard process for locum tenens hiring, it was challenging to have visibility into Parkview’s locums usage systemwide. It was an opportunity for improvement she couldn’t pass up.
Identifying the problem
Parkview Health serves the northeast Indiana and Northwest Ohio region with a network of 11 hospitals and over 100 clinics with a multi-specialty network of about 1,200 providers. The system covers a large rural region that stretches across 11 counties.
Pulcini was working in human resources at Parkview when she first recognized how chaotic locum tenens hiring had become. “When departments needed to hire a locum tenens provider, sometimes they would come to me, sometimes they would go to physician recruitment, and sometimes they didn't know how to get a locum,” Pulcini says. “On the other hand, sometimes they would just call up whoever they wanted and sign a contract.”
“I would hear the aches and pains from our credentialing folks or our Med Staff people about getting last-minute notification on a locum starting. I knew I could make some improvements by hardwiring some processes in,” Pulcini says.
Tackling the challenge of locum tenens centralization
Pulcini worked with a physician dyad partner to try to fully understand the current locum tenens landscape and develop a standardized process. Both Pulcini and her physician dyad partner have been trained in lean management, and they also had access to an internal lean team for consultation.
Together, the duo started by interviewing internal stakeholders to get a clear sense of the overall locum tenens picture before they tried to put together a new process. “We wanted to get our arms around the current state to figure out where we wanted to be. That really was challenging,” she says.
Additionally, Pulcini asked CHG Healthcare for advice on how other healthcare organizations had centralized their locum tenens hiring process.
Creating locum tenens process efficiencies
In the end, the Parkview team decided to narrow the vendor pool by selecting a primary locum tenens provider and two secondary providers.
“We recognized no one was going to be in favor of going all in with just one company,” Pulcini says, “but we also knew that we couldn’t keep working with all these different vendors who had never been properly vetted.”
The network decided on CHG Healthcare as its primary provider and then worked with CHG to develop a standardized process.
In addition, Parkview Health decided to hire an internal locums specialist who would be solely dedicated to handling locum tenens. “So, now we have one person who understands the credentialing process and who can create efficiencies with our medical staff,” Pulcini explains. “When a department needs a locum, they're going to deal with one person who will know what they want, make sure they get it, and make it as easy as possible.”
Making the case with data on locum tenens usage
Locum tenens usage and spending typically gets scrutinized at budget time, according to Pulcini, and it can look like a big line item that’s ripe for a reduction. But without good visibility into locum tenens usage — what you are spending and why — it can be easy to fall back into the same old patterns.
Now, with fewer vendors and a centralized process, Pulcini can clearly see where locum tenens spending is happening, why those services are needed, and then connect it back to the bottom line. Bringing in a locum tenens provider often allows facilities to bill for services and capture revenue that would otherwise be lost if there was no one to fill the gap.
Detailed reporting has also enabled Pulcini to showcase the progress they’ve made as well as highlight where they think more improvements can be made. “It makes it a whole lot easier for me to get buy-in and get changes done than if I’m just hoping people voluntarily decide to jump on board.”
Advice for getting started
Pulcini’s advice to other healthcare organizations that want to centralize their locum tenens hiring is to get leadership buy-in. “They need to see how centralizing locum tenens hiring can improve usage and reduce costs,” she says. “There’s always a case to be made. You just have to get the data behind it and be able to show it.”