Over the last two decades in the healthcare industry, IT has evolved from a back-office utility to a frontline strategic asset. Most would agree that its strategic importance will only continue to grow. Whether enabling virtual care, securing patient data, modernizing infrastructure, or supporting clinical decision making and care protocols, health system IT departments are now essential to the realization of strategic staffing imperatives, and mission-driven, outcome-oriented care delivery.
At the same time, financial challenges are significant, stemming from reimbursement pressures, inflation, and sharply climbing labor costs and related concerns. Many health IT teams and roles are facing wage inflation in excess of 5% annually, workforce demands for fully remote or hybrid work arrangements, and high turnover. Large scale outsourcing — once seen as a simple cost fix — overlooks the ever growing strategic importance of IT in healthcare. In this environment, relying on static staffing models is no longer viable.
To remain agile and financially sustainable, a health system’s whole IT staffing mix needs to be dynamically managed, constantly solving for the right balance of:
- Full-time employees for strategic continuity
- Contractors for project-based needs
- Outsourcing or co-sourcing partners for scalable, cost-stable operations
This kind of staffing audit isn’t just smart management — it’s a leadership imperative.
In Jim Collins’ classic book Good to Great (2001), he argued that the first priority in building a great company involves getting the right people on the bus. That principle still holds true — but in today’s health IT landscape, it’s equally important to ask: do we now need more than one bus?
A modern IT strategy requires not just the right people, but the right types of roles, moving in the right vehicles. Strategic leaders belong on the permanent, mission-driven team bus. Contractors may ride a temporary project shuttle. Outsourcing partners operate their own well-oiled fleet, focused on consistent delivery. The job of IT leadership is to coordinate all of them — ensuring the right people are on the right bus, for the right stretch of the journey.
Why Static Staffing Models Fall Short
Many health systems have fallen into the trap of “set it and forget it” staffing. But IT demands shift constantly, driven by clinical priorities, regulatory changes, mergers, and technology lifecycles.
All-internal staffing models leave organizations overexposed to rising salaries, rigid capacity, team burnout, and the nearly impossible task of effectively managing team utilization. They often result in teams that are overbuilt during low-activity periods, understaffed during high-demand projects, and marked by inefficient task allocation.
Fully outsourced models, on the other hand, create disconnects between IT and the broader mission. Offloading too much control limits an organization’s ability to innovate, respond quickly, or embed digital transformation into care strategy. Worse, the word “outsourcing” often evokes fears of job loss, offshoring, and degraded service.
What’s needed is a flexible, blended model. This isn’t a novel concept, but what is novel, is the notion of a regular review, audit, and assessment period. It takes discipline, and there are many behavioral, cultural, and structural traps that undermine objective strategic decision-making when it comes to labor resourcing. It’s imperative that IT leaders ask: Where are we overinvested? Where are we stretched too thin? Where can we gain scale, stability, quality improvements, cost savings, and cost predictability – without losing flexibility or giving up control?
The Right Roles for FTEs, Contractors, and Partners
A successful staffing strategy isn’t just about numbers — it’s about fit for function. Each labor category plays a distinct role:
Full-Time Employees (FTEs)
Use FTEs for strategy, governance, architecture, and high-value planning roles. These individuals carry institutional knowledge, lead long-term initiatives, and guide partner alignment.
IT Contractors
Contractors provide project-specific, time-limited support — ideal for surges like EHR upgrades, cloud migrations, or new site activations. They offer flexibility without long-term payroll implications and help maintain momentum when internal capacity is maxed out.
Outsourcing/Co-Sourcing Partners
Best suited for operational, repeatable functions:
- Help desk/Tier 1 and 2 support
- Desktop and field support
- Application support and maintenance
- Infrastructure and network monitoring
- Cybersecurity operations (SOC, patching, monitoring)
These partners bring economies of scale, standardized service levels, and cost predictability. Co-sourcing models in particular preserve internal oversight while delivering scalable results — often with far lower annual rate increases compared to 5%+ for direct hires and the avoidance of significant indirect costs.
Make the Audit a Leadership Discipline
Just as clinical operations are subject to continuous improvement, so too should IT staffing be continuously evaluated. A regular staffing audit can uncover opportunities to cut waste, improve service delivery, and protect internal bandwidth for strategic work. A productive staffing audit might include:
- Role by role cost to value analysis
- Full time employee utilization rates
- Contractor utilization rates and ROI
- Partner SLA performance reviews
- Forecasts of upcoming project demands and internal capacity gaps
To be most effective, an audit should involve IT, finance, HR, and clinical leadership — ensuring that staffing strategy reflects both fiscal responsibility and mission fulfillment. The audit isn’t just a cost exercise — it’s a method to align labor with purpose. Even modest adjustments in staffing mix can yield significant returns, not only in cost savings, but in speed, quality, and resilience.
Conclusion: Strategic Staffing Requires Strategic Review
In today’s health system, IT is inseparable from innovation, access, safety, and experience. That’s why staffing decisions can’t be left to inertia or legacy assumptions.
The smartest organizations don’t just invest in people — they invest in the right mix of people, partners, and plans. They staff for what only insiders can do, partner for what external experts can scale, and flex when project demands require fast adaptation. And they revisit those choices regularly, using audits as a tool for discipline, clarity, and alignment.
Staff for strategy. Partner for delivery. Flex for demand. Budget for all three.