Overview
Aspirus Keweenaw Hospital, a rural critical-access hospital in Michigan’s Upper Peninsula, faced challenges related to provider alignment, burnout, and inconsistent emergency department performance. The variation across employed clinicians and locum tenens made it difficult to maintain a consistent patient experience. In addition, it was hard to establish clear expectations across shifts.
Hospital leadership partnered with Wapiti Medical Staffing to improve consistency in patient experience. By 2024, the hospital ranked in the top quartile of ER patient satisfaction across the Aspirus Health System.
The Challenge
Like many critical access hospitals, Aspirus Keweenaw operated with limited staffing resources and an ongoing reliance on locum tenens providers. While this staffing model is necessary to maintain coverage, it introduces a vast variation in how care is delivered across shifts. Expectations were not always the same across employed clinicians and locum tenens providers. That made it harder for teams to stay aligned day to day and added pressure on nursing staff. Burnout from coverage gaps and uneven workflows made it more difficult to maintain a consistent patient experience in the emergency department.
Leadership needed an approach that could bring more consistency to care without adding complexity or the need for additional administration. Otherwise, it would create more work for the team.
Solution
Wapiti Medical Staffing partnered with hospital leadership to implement a Pay-for-Performance (P4P) staffing model designed for a rural emergency department.
First, the model aligned employed clinicians and locum providers under the same expectations from the start of each assignment. Next, a focused set of patient experience metrics, tracked through their internal patient experience platform, gave leadership a view into how care was being delivered across providers and shifts.
Rather than introducing a separate initiative, the team built these expectations into onboarding, scheduling, and daily operations. As a result, teams worked from the samr understanding of care delivery across every shift.
Results
As a result of these changes, the hospital saw measurable improvement in emergency department patient satisfaction.
- ER patient satisfaction increased from 60% to 73%
- Ranked in the top quartile across the Aspirus Health system
- Reduced variation in performance from month to month
- Improved collaboration across providers, nursing, and leadership
In practice, these improvements showed up in daily operations. Care became more consistent from one shift to the next. Expectations were clearer, and teams were better aligned in their work.
Performance improved because expectations remained consistent across all providers, regardless of role or assignment type. As a result, clinicians worked toward the same standard, which reduced variation between shifts and improved the reliability of care delivery.
In a rural emergency department, where teams often include a mix of employed and locum tenens clinicians, this level of consistency supports provider alignment and patient satisfaction.
Looking Ahead
For rural hospitals and critical access hospitals facing similar challenges, this case highlights how a structured approach to emergency department staffing can improve both consistency and patient experience. By aligning expectations across all providers and reinforcing those expectations through daily operations, hospitals can create a more stable care environment without adding unnecessary complexity.