The client
A health system with about 25,000 staff in 9 hospitals and 120 clinics. It hires about 3,200 nurses and 1,800 other clinical staff a year, and spends about $118M a year on agency nurses. Hiring runs through iCIMS, Workday, UKG, and symplr, and supply chain runs on Infor Lawson.
The engagement
The chief financial officer and the chief nursing officer sponsored one engagement across HR and supply chain, because the two shared a cost. Every nurse who started late was covered by an agency nurse, and supply chain paid the agency. Five workflows were in scope:
- Clinician onboarding: about 5,000 hires a year, each keyed into 5 systems, mostly by hand.
- License checks: 12,000 at hire and 40,000 renewals a year.
- Employee questions: 68,000 HR tickets a year, 71% of them on the same 20 topics.
- Agency invoices: about 27,000 lines a year from 14 agencies.
- Supply invoice price errors: about 88,400 a year, checked against contract prices.
What the pilot found
Four forward-deployed engineers ran a 4-week pilot with HR, credentialing, and supply chain. They studied 2 years of hiring records and invoices, and read the procedures and contracts. They also interviewed 34 people.
- Two start dates. Recruiters changed start dates in one system, but payroll used another. 17% of hires had dates that disagreed.
- Licenses expired before day one. 4% of hires had a license or certification expire before the first shift. With the date conflicts, 14% of hires missed orientation and started 2 weeks late, and agency nurses covered their shifts.
- Agency invoices were checked only against the agency's own timesheet. 5.2% of agency spend, $6.1M a year, was billed above contract. Supply chain recovered 9% of it.
HR's dashboard showed 12 days from offer to cleared. Counted from the accepted offer, it took 19. Onboarding cost $690 a hire, though HR counted only $260. A missed orientation cost another $3,240 in agency and overtime cover, in a budget HR never saw.
The redesign
An accepted offer now starts one record that follows the nurse to the first shift, across all 5 HR systems. The agent checks that the start date matches everywhere before payroll is set up, and checks every license against the first shift. The chief nursing office now signs off a file that arrives ready. In supply chain, every agency invoice line is checked against the contract and the hours worked before it is paid. Every supply invoice is checked against the contract price.
Before23 steps, 7 loops
19 days
After9 steps, 2 human decisions, 2 loops
6 days
- Manual step
- Agent step
- Person decides
- Rework loop
Process steps
- Before
- 23
- After
- 9
- Change
- 61% fewer
Offer to cleared for orientation
- Before
- 19 days
- After
- 6 days
- Change
- 68% shorter
Exception loops
- Before
- 7
- After
- 2
- Change
- 71% fewer
Hires cleared with no manual correction
- Before
- 31%
- After
- 79%
- Change
- +48 pts
Hires who miss their orientation cohort
- Before
- 14%
- After
- 3%
- Change
- 79% fewer
Onboarding cost per hire
- Before
- $690
- After
- $290
- Change
- 58% lower
| Before | After | Change | |
|---|---|---|---|
| Process steps | 23 | 9 | 61% fewer |
| Offer to cleared for orientation | 19 days | 6 days | 68% shorter |
| Exception loops | 7 | 2 | 71% fewer |
| Hires cleared with no manual correction | 31% | 79% | +48 pts |
| Hires who miss their orientation cohort | 14% | 3% | 79% fewer |
| Onboarding cost per hire | $690 | $290 | 58% lower |
4 weeks of discovery, then 4 weeks of deployment
- Weeks 1 to 4, discovery: the pilot above maps the process, interviews the team, and sets the baseline for every figure on this page.
- Week 5, build: the agents are built on the redesigned onboarding and invoice processes, in the health system's own systems.
- Week 6, shadow: the agents work live hires and invoices with read-only access, and their work is compared with the team's.
- Week 7, validate: the agents are tested on the same hires and invoices, and HR, the chief nursing office, and contracting sign off.
- Week 8, deploy: live for every clinical hire and every agency invoice, with every action logged.
- From week 8, train: the engineers stay on site to train recruiters, coordinators, and payables staff. License renewals, the HR portal, and supply pricing follow, 4 weeks each.
What the agent does
- When a nurse accepts an offer, the agent checks that the start date and certifications agree in every system.
- If something is off, such as a certification about to expire, it asks the nurse for the renewal and books a class.
- The HR coordinator confirms in Teams, and payroll, scheduling, and system access all move to the same date.
- When an agency invoice arrives, the agent checks it against the contract and the hours worked, and flags any overbilling for a contract analyst to approve.
Results
License renewals are now chased 60 days before expiry, and lapses that pull a clinician off the schedule fell from 2.1% to 0.4%. The HR portal now closes 45% of tickets on its own. Agency overbilling recovered rose from 9% to 88%. Supply price errors are resolved in 5 days instead of 18, at $10 each instead of $24, and overbilling recovered rose from 38% to 84%. Every figure is measured against the pilot baseline.
| Source | Annual value | How |
|---|---|---|
| Capacity released | $5.1M | 97,800 hours at $52 fully loaded, 63,500 of them in HR and 34,300 in supply chain and accounts payable |
| Agency overbilling recovered | $4.8M | 79 more points of the $6.1M a year agencies billed above contract |
| Supply overbilling recovered | $4.9M | 46 more points of the $10.6M a year suppliers billed above contract |
| Shift cover avoided at orientation | $1.8M | 550 hires a year who no longer miss their cohort, each saving 72 hours of agency or overtime cover at a $45 premium |
| Credential lapses avoided | $0.6M | 680 fewer lapses a year, each saving 18 hours of cover at the same $45 premium |
| Total | $17.2M | Against the $48.8M a year it costs to run the workflows in scope: about 270 recruiters, onboarding, credentialing, HR service, contract, and payables staff at $52, plus $2.9M of agency and overtime cover for missed orientations and lapsed credentials, and $16.7M billed above contract |
What stays with people
Agents keep records current, check invoices, and gather evidence. Every hiring decision, every pay rate, whether someone is cleared to work, clinical privileges, every contract award, and every payment stay with named people. Every agent action records the rule, the evidence, and the approval, and a wrong change is reversed in the system where it was made.
