Key takeaway: While most U.S. industries are pulling back on hiring, healthcare leaders are holding staffing steady and redirecting focus toward workforce orchestration, flexible staffing models, and retention. Health systems that treat flexible staffing as a budget decision will continue to face employee burnout, rising vacancy rates, and continued agency dependency.

Across U.S. industries, hiring is slowing. A Yale School of Management survey of CEOs conducted in December 2025 found that two-thirds planned to hold headcount flat or reduce it in 2026. However, the healthcare sector kept adding jobs: hospitals gained more than 16,000 positions in December 2025 alone, and clinical labor demand has not let up.

The CHROs shaping 2026 workforce strategy are not talking about adding more people, though. They are focused on deploying the people they already have more effectively.

From recruitment to orchestration

Freeman Health System’s CHRO Kristan Eaton told Becker’s that 2026 priorities center on “data-driven workforce planning,” skill-based hiring”, and “flexible staffing and compensation and incentive models.” Great River Health’s CHRO Michael Yost put it plainly: the system is focused on “maintaining core staffing levels and filling critical roles rather than expanding headcount,” driven by reimbursement pressure and the need to operate more efficiently.

Their peers at other systems are saying the same thing. The post-pandemic labor playbook of recruiting aggressively, accepting agency dependency, and managing costs after the fact cannot hold at current labor rates.

The average travel nurse bill rate peaked above $3,000 per week in 2022. Those rates have come down, but health systems that built staffing models around contingent supply at that scale still carry the structural weight. Float pools go underutilized. Scheduling runs in disconnected systems. External agencies fill gaps that internal staff could cover. Each of those is a predictable output of a workforce architecture built to react rather than plan.

What flexible staffing actually requires

Data-driven workforce decisions require unified data on FTE utilization, fill rates, and demand forecasts, however most systems today cannot pull that picture together. Workforce management tools were built for scheduling permanent FTEs. Contingent labor operates in a separate system or through an agency that controls the relationship, pricing, and reporting. Most system leaders know their staffing structure needs more flexibility, but few have the infrastructure to act on it.

Building that infrastructure requires technology and process changes that most systems are still in the midst of implementing.

Flexible staffing in healthcare means deploying internal and external clinical labor through a unified, data-connected system. Health systems that have done this report lower per-shift costs, higher float pool utilization, and less reliance on travel nurses.

The risk of stopping at cost reduction

Health systems that reduce flexible staffing strategy to a cost-cutting exercise tend to find out six months later what it actually cost them: burnout, rising vacancy rates, and pressure on care quality.

Nemours Children’s Health chief people officer Sean Baptiste described his system’s 2026 approach differently: retaining and developing existing staff, investing in culture, and building “a strong total reward strategy that gives employees the benefits they most value.” That is a workforce architecture decision.

The facilities seeing real cost efficiency are getting the labor mix right, utilizing core staff supported by a bench of per-diem and contingent professionals who know the facility, show up reliably, and fill gaps before they become crises. That mix is what keeps labor costs predictable. Flexibility, built into the workforce model from the start, is how you spend less on the expensive fixes later.

What health systems should build in 2026

Workforce leaders getting ahead of this are focused on three areas:

1.  A unified view of internal supply: Float pool utilization, FTE capacity by unit, and credentialing status across facilities are all accessible in one place. Multi-facility operators making workforce decisions without this picture are working with incomplete data.
2.  Direct access to vetted external clinicians: When internal capacity runs short, the gap gets filled somehow. Filling it through an agency means the agency controls pricing and the clinician relationship. A direct sourcing model puts the facility in control of both. That model is operationally viable now in a way it was not five years ago.
3.  Demand forecasting ahead of the census: The reactive cycle of a gap opening, an agency call, and a premium paid is the most expensive way to run contingent staffing. Systems that forecast demand by unit and pre-position internal and external supply spend less per filled shift.

Frequently asked questions

What is flexible staffing in healthcare? Flexible staffing in healthcare is a workforce model that combines internal float pools, per diem clinicians, and external contingent labor through a unified scheduling and sourcing system. Health systems with this model maintain direct access to credentialed clinical labor and use demand forecasting to match supply before shortfalls occur, rather than calling an agency after a gap opens.

Why are hospitals prioritizing workforce orchestration over hiring in 2026? Reimbursement pressure, rising labor costs, and residual agency dependency from the pandemic years are pushing health system leaders to extract more value from existing staff before adding headcount. CHROs at Freeman Health System, Great River Health, and Nemours Children’s Health all told Becker’s that their 2026 priorities center on retention, internal workforce flexibility, and data-driven planning.

What is the difference between workforce management and workforce orchestration? Workforce management covers scheduling and tracking permanent FTEs. Workforce orchestration covers the full labor picture: internal float pools, contingent sourcing, demand forecasting, and the technology that connects them. Health systems running workforce management tools typically lack visibility into contingent labor spend and cannot act on it proactively.

How does flexible staffing reduce agency dependency in hospitals? Agency dependency falls when health systems fill gaps through internal float pools or direct-access clinician networks before an agency call is necessary. That requires unified scheduling visibility, credentialed per diem access outside a traditional agency relationship, and demand forecasting early enough to surface shortfalls while internal options remain. Systems with this infrastructure report lower contingent spend per shift.

What role does technology play in healthcare workforce orchestration? Technology provides the visibility and coordination that workforce orchestration requires. Scheduling systems built only for permanent FTEs cannot surface float pool capacity or connect to an external supply. Workforce orchestration platforms bring internal scheduling, contingent sourcing, and demand data into one system, giving CNOs and HR leaders the information they need before gaps become emergencies.

Sources: Becker’s Hospital Review, Bureau of Labor Statistics Employment Situation, December 2025.

Medely helps hospital and health systems leaders build the infrastructure for workforce orchestration: direct access to credentialed clinicians, internal workforce visibility, and the data tools to align supply with demand.