Advance practice provider workforces have grown dramatically in size, complexity and strategic importance. Yet many health systems still manage them through antiquated departmental structures.
Typically, these structures lack components crucial to a true enterprise utilization of the APP workforce. Lack of consistent role definitions, variable compensation structures and fragmented performance metrics are just some of the hallmarks of these antiquated systems. At scale, APP management becomes workforce architecture. Health systems need to move from managing an APP workforce to designing an APP operating model.
Why departmental management breaks down
Departmental management means APPs are managed in “local” units, teams or service lines, often with no true insight into the true strategic asset APPs can become under an enterprise model. These management systems fail in four main areas: fragmentation, variation, limited visibility and workforce planning.
Fragmentation means the organization has no clear, consistent definition of APP roles and expectations. Variation means there are different productivity expectations, compensation structures, career ladders and physician-APP models for each unit with no consistent picture across an organization. Limited visibility is shown by organizational leadership that has no true understanding of APP capacity, value or workforce needs.
Finally, workforce planning has become reactive regarding APP deployment and utilization. These employees are added when a department has a problem rather than as part of an enterprise strategy.
The 6 components of an APP operating model
An APP operating model is the integrated system of governance, workforce design, clinical deployment, measurement, talent development, and workforce economics used to strategically manage and maximize the value of APPs across a health system. Only by addressing all these components in a systematic way can an organization truly optimize their APP workforce.
Here are six components of an APP operating model:
1. Governance and accountability: Who governs APP strategy?
The APP executive is not the answer by itself. While that person provides enterprise leadership, APP strategy must be integrated with true physician dyad leadership, operations, finance, human resources and clinical service lines. Organizations need to think along the lines of enterprise strategy but with local execution.
2. Workforce and role architecture: What work should APPs perform?
Operating models need standardization across an organization: role definitions, scope of practice, competencies, team-based care models and career pathways for progression.
3. Deployment and clinical integration: How are APPs deployed?
The goal is not centralized APP management, it is centralized APP architecture with local clinical execution. The enterprise establishes the framework, but specialties retain clinical autonomy.
4. Measurement and value: How is APP value measured?
Traditional value metrics are important, just not enough by themselves. Organizations that measure only visible clinical production risk overlooking the operational, relational and workforce-development contributions of experienced APPs. This is invisible operational labor, true value performed by APPs that is rarely measured or recognized.
5. Talent and career architecture: How are APPs developed and retained?
A scalable APP model must treat APP development as an enterprise talent strategy rather than a departmental responsibility. Recruiting, onboarding, career development, retention, succession planning and leadership development must all be considered and planned for.
6. Workforce economics and strategic planning: How should the organization invest in and continuously redesign its APP workforce?
Workforce planning should move beyond determining how many APPs are needed to determine what work should exist, who should perform it, and how the team should be structured. This should include not just the current economic picture but also a continuous workforce redesign, considering changing healthcare systems, technology innovations and future workforce needs.
How should an organization build an APP operating model?
Organizations can use a five-step action plan to create an APP operation model. They should view this evolution as a progression from departmental APP management to enterprise coordination, to standardized infrastructure, to integrated workforce planning and ultimately continuous strategic redesign.
Step 1: Inventory the current APP system. Assess the numbers of APPs, the roles and reporting structures. Look at the current value measurement tools being used. What is the leadership structure like, from the local to the organizational level?
Step 2: Identify variations and gaps across the organization. Which structures are intentional versus just accepted ways of doing things? Which departments are making progress and which ones are lagging behind?
Step 3: Define the future state, using the six components listed above. What goals does the organization want to move toward to truly optimize its APP workforce?
Step 4: Build the model. Looking at all six components, design the organization’s APP structure. Take into consideration not just where the organization is now or where you want to go, but how you want to get there.
Step 5: Implement and continuously redesign. A true operating model is not something that gets finished and checked off the list. Organizations must continually measure, assess and redesign their model to adapt to the changing healthcare economy. The model itself builds in the abilities to do just that.
The most mature health systems will not simply employ large APP workforces. They will design APP operating models capable of adapting to the clinical, financial and workforce needs of the organization.
The question for health systems is no longer whether they need more APPs, it is whether they have designed an organization capable of getting the full value from the APP workforce they already have — and the one they will build next.
John Lahr, PA-C, is the director of advanced practice for the Orlando Health Jewett Orthopedic Institute and the Orlando Health Neurosciences Institute.
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