Contract spend is a symptom, not the root problem
Many hospitals and health systems are under pressure to reduce spend on travel and contract staffing. Leaders often focus on rate negotiations and contract caps, but overlook the upstream cause: misaligned permanent hires that don’t stay, don’t thrive, or don’t fit the unit culture.
Research on organizational culture in healthcare shows that positive culture and work satisfaction are associated with reduced turnover, better teamwork, and improved work performance. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout)
When permanent staff repeatedly leave due to poor culture fit or misaligned expectations, organizations cycle back to contract labor to fill the gaps—driving up costs and destabilizing teams.
What culture-aligned hiring really means
Culture-aligned hiring is not about hiring people who “look like us” or think identically. It is about deliberately matching clinicians to the realities of the unit: acuity, pace, communication style, leadership norms, and patient population.
Studies of organizational culture and staffing suggest that when employees are placed in environments that fit their values and work preferences, they are more engaged, more satisfied, and more likely to stay. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout; Nursing Staffing and Patient Outcomes – various staffing and culture analyses)
In healthcare settings, that alignment affects not only clinician retention, but also teamwork and patient outcomes. (Nursing Staffing and Patient Outcomes – multiple nursing staffing and quality studies)
What most organizations get wrong about culture and hiring
1. Hiring for resume only
Many hiring processes overemphasize years of experience and certifications while underestimating how a clinician will function in a particular team and culture. Yet evidence consistently shows that organizational culture and work environment strongly influence satisfaction, engagement, and retention. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout)
If you recruit solely based on technical skills and then drop people into mismatched units, you increase the likelihood of early turnover—and with it, increased contract use.
2. Treating “culture fit” as vague and subjective
Culture is often discussed in vague terms, but research describes it as the “social glue” that shapes engagement, communication, and decision-making. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout; PMC – Exploring the Influence of Organizational Culture on Evidence-Based Practice Adoption)
Without a clear, documented understanding of each unit’s culture—communication norms, pace, conflict style, feedback patterns—culture-fit conversations easily slide into bias or gut-feel.
3. Ignoring culture’s link to patient outcomes
Evidence ties staffing levels and healthy work environments to better patient outcomes, including fewer adverse events and higher patient satisfaction. (Nursing Staffing and Patient Outcomes – multiple nursing staffing and quality studies; various nurse staffing and outcome reviews)
When culture-aligned hiring leads to more stable, engaged teams, those teams are better positioned to deliver consistent, high-quality care—reducing errors, rework, and costly downstream complications.
Kace Premier philosophy: culture as a clinical and financial lever
At Kace Premier, culture-aligned hiring is treated as both a workforce stability and financial strategy.
We align with a growing body of research demonstrating that supportive, well-defined cultures improve satisfaction, retention, and performance. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout; PMC – Exploring the Influence of Organizational Culture on Evidence-Based Practice in Healthcare)
In practice, that means:
• Taking time to understand the cultural realities of client units: leadership style, communication norms, patient mix, and pace.
• Screening candidates not only for skills and credentials, but also for how they prefer to work, communicate, and collaborate.
• Helping clients articulate the culture they have today—and the culture they want to build—so hiring decisions move them toward that desired state.
Practical implications for healthcare leaders
1. Define culture in operational terms
Translate “culture” into observable behaviors and expectations:
• How do we handle conflict?
• How do we give and receive feedback?
• What does a “good teammate” look like on this unit?
Research suggests that aligning employees’ preferences and values with the organizational culture contributes to higher satisfaction, engagement, and retention. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout)
2. Build culture-aligned screening into your process
Incorporate structured behavioral questions that map to your culture. For example, if your unit is highly collaborative and fast-paced, ask for specific examples of working in teams under time pressure.
Evidence from organizational culture and performance research indicates that when people are placed in roles that fit their strengths and work styles, performance and commitment improve. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout; PMC – Exploring the Influence of Organizational Culture on Evidence-Based Practice in Healthcare)
3. Track the impact on contract spend
Once you begin hiring with culture alignment in mind, track:
• Early turnover (0–12 months).
• Repeated vacancies in the same roles or units.
• Contract hours and costs by unit.
As stability and retention improve, you should expect contract reliance to gradually decrease in well-managed units, reflecting fewer backfill needs and more consistent staffing. (Nursing Staffing and Patient Outcomes – multiple studies linking staffing and stability to stronger performance)
If your organization is focused solely on cutting contract rates without addressing why you need so many contract hours in the first place, you are attacking the symptom, not the cause. Research shows that culture and work environment are central to satisfaction, retention, and performance. (PMC – Exploring the Link Between Healthcare Organizational Culture, Employee Well-Being and Burnout)
Kace Premier Medical Talent can help you implement culture-aligned hiring so each permanent hire is more likely to stay, contribute, and reduce your long-term reliance on expensive contract labor.
