Health systems by and large have realized that advanced practice providers are essential to meeting growing patient demand. The challenge is no longer about just hiring enough APPs to fill the staffing needs; it is about building organizations that allow them to perform at their highest level.
Many health systems still evaluate APP success by vacancy rates, staffing ratios or wRVU/encounter volume. Those metrics answer whether positions are filled but not whether the workforce is generating its full operational value. Moving forward, the organizations that outperform are those that design high-performing APP organizations rather than simply expanding APP staffing.
Organizational design drives performance
The difference between workforce expansion and optimization is significant. Expansion deals purely with numbers and bodies. Optimization asks the following questions: Are our APPs functioning at top of license and education? Is there a consistent physician-APP team structure? Is there a path of growth and support for the APP workforce?
Barriers such as unclear role expectations, physician-dependent utilization and siloed operations, inconsistent onboarding and fragmented APP leadership can prevent systems from answering these questions in an affirmative way. Two identical-size teams will have dramatically different outcomes depending on their organizational structure, and these outcomes will have direct effect on patient care and business metrics.
4 building blocks of high-performing APP teams
High-performing teams are intentionally built around systems that are reproducible, teachable and measurable. A practical framework for creation of a high-performing APP team involves four primary building blocks: role optimization, team-based care, continuous professional development, and a strong leadership structure.
Role optimization means APPs practicing at the top of their license and education, with standardized role expectations. Those expectations should be matched to each APP’s individual experience level. This also involves elimination of unnecessary administrative workload; for instance, utilizing ambient AI scribes and authorization or coding/billing specialists where appropriate.
Team-based care is furthered by a clearly defined physician-APP partnership, with shared patient ownership and standardized workflows. Clear communication of expectations and responsibilities is paramount. Continuous professional development includes mentorship, specialty education, and retention through career growth. Leadership pathways and succession planning are also vital in this area.
Strong leadership structures are evidenced by local operational ownership, clear accountability and an appropriate span of control for each level. This also should include a dyad partnership model with physician leadership, one in which responsibility and accountability for decisions are shared for their respective areas or service line.
Focusing on these four building blocks will allow the organization to truly maximize their APP workforce. Organizations that purposely build these systems will consistently experience a more productive, more stable and happier APP workforce.
Measuring what actually matters
Health systems have gotten very good at measuring traditional productivity markers. EHRs have become repositories of millions of pieces of data that is trackable, searchable and can easily be put into spreadsheet format. That data includes RVUs, encounters, room utilization, wait times and case start times. But much of APPs’ contributions do not fall into easily tracked or searched data, and it rarely fits into a spreadsheet cell. That includes activities in areas such as:
Access: New patient availability across the team, appointment lag
Team capacity: Increased physician productivity and procedure throughput
Quality: Readmissions prevention and compliance
Patient experience: Satisfaction and continuity
Workforce: Retention, engagement and onboarding
Operational performance: Care coordination, discharge efficiency and reduced delays
The highest-value APP work often occurs outside the RVU framework but directly contributes to organizational performance. Organizations should develop pathways to evaluate and recognize these nontraditional markers of productivity that experienced APPs contribute to the operational value. Utilizing an invisible operational labor tool not only identifies these contributions but allows those metrics to be formally recognized in compensation, bonus and performance conversations.
Developing APP leaders multiplies organizational impact
As APP teams grow, leadership frequently becomes a limiting factor. To combat this, organizations must develop a systemic APP leadership structure with solid succession planning and a ladder of increased responsibility and contribution.
Specific areas that should be addressed at varying levels include operational management, finance, quality improvement, change management, coaching and strategic planning. Investing in APP leadership creates organizational leverage far beyond any individual clinician’s productivity.
5 questions executives should ask about APP organization
Organizational leaders need to have a thoughtful, consistent, purposeful plan for APP utilization moving forward. For that to happen, leaders should be able to answer the following questions about their APP workforce.
- Are our APPs consistently practicing at the top of their education and licensure?
- Do we have a scalable leadership structure to support future growth?
- Are physician-APP partnerships standardized across service lines?
- Are we measuring APP value beyond RVUs?
- Does our APP strategy align with the organization’s long-term workforce goals?
From workforce asset to strategic advantage
Health systems that simply hire more APPs in the future may improve staffing. However, systems that intentionally develop high-performing APP teams will improve so much more: access, physician capacity, workforce retention, patient experience, operational efficiency and financial performance.
The next evolution of APP strategy is not adding more providers. It is creating leadership structures, operational systems and performance frameworks that enable APP teams to become a durable competitive advantage for the health system. That adds up to significant operational value.
John Lahr, PA-C, is the director of advanced practice for the Orlando Heath Jewett Orthopedic Institute and the Orlando Health Neurosciences Institute.
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