Blog Post October 28, 2020 Physician Enterprise Integration: Successful Ambulatory Staffing Management Tactics Authors Rick Roesemeier, Jr. Alexander Muckerman As health systems continue to invest heavily in employed physician enterprises (PEs), organizational leaders are placing a greater emphasis on proactively managing PE expenses. Across most employed PEs, the second-largest operating expense bucket (after provider expenses) consists of support staff salary and benefit expenditures. This category alone represents approximately 25% of PE expense budgets and 40% of PE net patient revenue. Health systems that maximize the value generated from their PE investment deploy a support staff workforce that prioritizes patient care quality while optimizing the balance between capacity/throughput and the staffing cost.High-performing organizations that utilize a standardized staffing model (see figure 1) with consistent workflows across their PE can expect a greater ability to achieve the following: Lower Support Staffing Operating Expense: An emphasis is placed on each support staff member working at the top of their license. Then assigning operational workflows to appropriate positions ensures the lowest-cost resources support the related job functions.Increased Job Satisfaction and Decreased Staff Turnover: Appropriately balanced job responsibilities, reasonable work expectations, and a well-developed career progression framework promote a positive working environment that motivates staff to stay with the organization and have a meaningful and tenured career. This inherently leads to higher job satisfaction and greater staff retention. Fewer Operational Disruptions: A workforce deployment model that combines Lean staffing levels with flexible, on‑demand float staff pools reduces staffing shortages that can disrupt normal operations. Quality and Consistent Brand Recognition: Using a standard staffing complement and operational workflows across all clinic locations promotes a consistent consumer experience that patients and families then associate with the health system’s name.Executives, operational leadership, and frontline managers have critical roles in establishing and maintaining a standardized, high-performing support staff workforce. Optimal staffing deployment requires that these key stakeholders perform their duties effectively in concert (as depicted in figure 2). Not doing so places the PE at risk of failing to realize the full potential of its support staff. Figure 2: High-Performing PE Support Staff Management ModelI. PE Executives (CEO, COO, CFO)Participation of leadership from the PE C‑suite is essential for establishing the culture of how support staff are used and deployed across the organization. PE senior leaders: Define the organization’s staffing management strategy in relation to organization-level strategic goals and priorities.Oversee the definition of labor standards and alignment of organizational resources to deploy a common staffing model.Are accountable for overall support staff levels and expenditures.Oversee the design of regional and service line float pools.Support regional leaders when they confront resistance to system-wide staffing initiatives.Address performance feedback from the provider network (employed, PSA, affiliated, etc.), remaining steadfast when communicating and enforcing approved staffing policies and procedures.Pursue opportunities to deliver patient care through business and care delivery models that streamline the utilization of support staff (e.g., centralized billing, virtual care, contact centers).From an ongoing performance management and accountability perspective, PE executives should: Be informed about the execution of staffing deployment strategies.Regularly (quarterly, at a minimum) review trends in support staff and expense budget variance summaries.Foster a culture of accountability among both administrative and clinical leaders relative to labor productivity and expense management.II. Regional and Service Line Operational DirectorsRegional and service line operational directors are responsible for operationalizing the enterprise-wide staffing management strategy and ensuring all managed clinics follow standard staffing policies, procedures, and workflows. These directors: Establish clinic-specific staffing levels based on the system-wide standard staffing model.Support recruiting for open budgeted positions and maintain final approval of all new staff hires. Keep practice managers accountable for training staff and adhering to best practice operational workflows. Manage regional- and/or service line–specific float staff pools to backfill short- and medium-term resource needs.Communicate potential local and regional workplace improvement solutions to PE leadership and governance groups that could be implemented across the system to promote consistency.In order to sustain compliance with system-wide staffing policies and procedures, regional and service line operational directors should: Actively monitor regional and service line support staff levels and expense budget variance summaries.Conduct clinic audits to ensure adherence to standard roles, responsibilities, and workflows. III. Practice ManagersPractice managers are responsible for executing the organization’s staffing plan at the clinic level. They: Provide ongoing, on-the-job training of approved workflows. Notify recruiting personnel about staffing vacancies.Manage the interview process for recruiting candidates.Communicate with regional and service line directors about short- and medium-term resourcing needs that can be filled by float staff pools. Summarize and communicate all staff workplace feedback, proven grassroots staffing deployment, and workflow innovation ideas to regional and service line operational directors.Monitor and act upon variances in labor productivity and/or costs.In addition, practice managers ensure that staff complete necessary education and training courses, and they monitor staff compliance with system-wide standard workflows in day-to-day operations. IV. Why Support Staffing Management MattersA well-designed and properly executed support staff strategy can help organizations optimize clinical performance and achieve improved operating margins. Physician groups that continue to manage their staff in silos with minimal inter-specialty or -regional collaboration will struggle to realize the desired operational and financial economies of scale of a consolidated physician enterprise. Contact ECG to learn about our rapid assessment, which includes a customized roadmap for implementing a plan for a better-performing workforce. Contact Us Footnotes 1.  ECG 2019 Medical Group Cost and Infrastructure Survey.