Becker's Hospital Review

28 CHRO Care is shifting to outpatient settings: How CHROs are scaling roles By Kristin Kuchno A s more care shis outside hospital walls, health system leaders are rethinking how they plan, staff and structure their workforces to support a rapidly expanding ambulatory footprint. Outpatient services accounted for 57% of hospital revenues in 2024, up from 52% in 2020, according to the American Hospital Association. e AHA's Sg2 forecasting model projects outpatient volumes will grow another 17% over the next decade. At the same time, many health systems are accelerating ambulatory investments in 2026 to support financial sustainability and expand access closer to home. Against this backdrop, Becker's spoke with human resources leaders from three health systems about how the shi is reshaping workforce strategy, from pipeline development and staffing models to evolving roles and care team design. Changes to workforce planning, staffing model Coeur d'Alene, Idaho-based Kootenai Health's workforce planning approach has become more proactive and pipeline-focused as it expands its ambulatory footprint. e system has implemented an ambulatory nurse residency program to ensure a consistent flow of trained and practice-ready nurses, according to Cyndy Donato, PhD, chief people and culture officer. Kootenai Health has also invested in growing its own talent through medical assistant apprenticeship programs, supporting both access and retention by developing employees internally, Dr. Donato said. "In addition, we've adopted forward-looking hiring strategies, including hiring ahead of need when we anticipate growth, onboarding new providers, or identify upcoming staffing gaps. is helps us stay ahead of demand rather than reacting to it," she said. "We are intentionally shiing from reactive hiring to a sustainable, forward-thinking workforce model built on internal pipelines, early investment in talent and alignment with future growth." As Fairfield, Calif.-based NorthBay Health continues to invest in outpatient care, it has rethought its workforce planning and deployment to better align clinical, operational and strategic priorities across the care continuum. A key advancement has been the implementation of service line dyad vice president roles, which pair physician and nursing leaders to drive performance, growth and care delivery, Chief People Officer Jim Andersen said. "Overall, our focus is on building a scalable, flexible ambulatory workforce that can meet growing demand, optimize access, improve efficiency and consistently deliver a high-quality patient experience," he said. Roles gaining importance amid outpatient shis As systems invest in greater ambulatory footprints, leaders said several roles are becoming more critical to recruit and retain. At NorthBay Health, primary care physicians remain the cornerstone of its ambulatory strategy, serving as the main entry point into the system and supporting patient attribution, continuity and downstream specialty utilization. Advanced practice providers are increasingly central to NorthBay's model, Mr. Andersen said, as they expand access, strengthen team-based care delivery and improve cost efficiency. NorthBay is also prioritizing ambulatory leadership and practice management talent to operate in increasingly complex outpatient environments. "ese roles are foundational to scaling ambulatory care effectively," he said. "ey also play a critical role in standardizing care delivery, expanding patient access, and enhancing the overall patient experience. As ambulatory care becomes a larger share of the care delivery model, strong leadership and operational expertise in these areas are increasingly important." At Kootenai Health, medical assistant roles are among the most critical — and challenging — to recruit due to training requirements and relatively lower earning potential. e system is also seeing increased difficulty recruiting for specialized clinical roles, such as those requiring cardiac-specific experience. "ese positions are harder to fill because there are limited opportunities externally for candidates to gain the specialized experience needed, which narrows the available external talent pool," Ms. Donato said. "ese challenges reinforce the importance of building internal pathways and development programs to grow both entry level and specialized talent." Miami-based Jackson Health System sees opportunity for licensed practical nurses to grow in ambulatory and primary care, where the system is expanding its footprint, said Anna Fababeir, associate vice president of human resources. Leaders are evaluating how LPNs could complement medical assistants and other roles to create more efficient care team models, while maintaining a steady recruitment strategy for correctional facilities. Ms. Fababeir also said the system is exploring how nurse practitioners can support its ambulatory facilities, including assessing market supply and determining the right skill mix to scale care delivery more efficiently. Medical assistants are another key focus in its ambulatory and primary care strategy. Connecting inpatient, outpatient strategies Aligning ambulatory and inpatient strategies is a key focus at NorthBay, supported by its dyad leadership structure, which creates shared accountability across care settings within each service line. "is alignment supports smoother care transitions, strengthens referral pathways, and enhances coordination across the continuum," Mr. Andersen said. "Ultimately, it enables us to deliver a more connected experience for patients." NorthBay also prioritizes connecting patients to primary care, linking those without an established provider to community-based clinics before or shortly aer discharge and following up within seven days to support continuity of care. "At the same time, we've expanded specialty services such as behavioral health and addiction medicine to better support vulnerable populations while reducing readmissions," he said. "Ongoing collaboration across our hospital, population health and ambulatory teams ensures coordinated, high-quality care and helps keep patients engaged within our system." n

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