With the unprecedented growth of the healthcare travel industry over the past decade, hundreds of companies now vie for institutions' supplemental staffing contracts. Choices have grown proportionally and selecting a firm, or contracting with multiple agencies, as is the case for most acute care facilities, is no longer simple. This level of competition necessitates that nurse administrators and hospital directors carefully evaluate-and re-evaluate-travel companies and the services they provide. One way executives can determine which agencies are best suited to meet their current needs is through the request-for-proposal (RFP) process.

Today, a growing number of administrators are encouraging staffing firms to submit bids in response to calls for supplemental healthcare personnel. By utilizing the RFP process, they can weigh companies' strengths, determine efficiencies, and verify strict adherence to institutional, industry, and legal guidelines. With this knowledge, managers more easily make informed decisions, solve staffing issues, and ensure the delivery of quality patient care.

Joining the ranks While many individual facilities still routinely recruit their own supplemental staff, the RFP system is increasing in popularity, especially among large, multi-hospital systems and state alliances. A number of institutions have begun to consolidate these efforts to contain costs. More and more networks, for example, now have a single point person charged with soliciting travel company proposals.

The same concept applies to hospital alliances. By joining forces, facilities strengthen their economic leverage, often setting caps on supplemental staffing costs. "Over the past few years, there has been reduced competition among hospitals, even within large systems," explains Donna Ramey, MSN, RN, CNAA, director of nursing for RNNetwork, located in Boca Raton, Florida. "Healthcare networks and alliances hope to achieve greater buying power and, therefore, get a better rate."

"The purpose of an alliance is to lower bill rates," agrees Kathy Taylor, national contracts administrator for Bridge Staffing, headquartered in Mobile, Alabama. "It puts staffing companies on an equal playing field since member facilities set the pay rates. As a result, other factors-such as housing and the agency's profit-become issues for consideration. In the case of Arizona, New Mexico, and South Carolina, agencies wishing to place nurses within member hospitals must follow alliances' procedures, which almost certainly include an RFP. Travel companies that do not submit proposals will likely not do business in those states."

RFP usage among community hospitals is more sporadic. Many times, supplemental staffing decisions are made based on previous experiences with travelers, and administrators opt to work with the same companies time and time again. "For the vast majority of these facilities, we simply send our contracts and rates," says Ms. Taylor. "There is a lot to be said about long-term relationships. Clients appreciate and reward agencies that provide good customer service."

"Existing partnerships with travel companies add a sense of comfort," states Susan M. Hallick, MHA, BSN, RNC, chief nursing officer of Geisinger Health System and chief administrative officer for Geisinger Medical Center in Danville, Pennsylvania. "We contract with one or two traveler agencies more than others, but we continue to look at additional organizations to stay on the cutting edge. Price and competencies make it a competitive market."

Sending out the call Whether interested in maintaining established relationships, assessing services offered by veteran companies, or evaluating those new to the marketplace, facility executives can more accurately gauge performance levels and make comparisons through the bidding process. "We use RFPs to determine the quality of an agency, as well as to perform comparative pricing," explains Ms. Hallick. "To ensure we receive highly qualified nurses and services that match our needs, we ask travel companies to submit proposals once or twice a year."

"As the market shifts, facilities may be doing themselves a disservice if they do not revisit the offerings of agencies with which they contract," admits Ms. Taylor. "Not every company is the same. Some may have more nurses available and/or provide a better selection of interested travelers."

For those institutions that utilize the RFP process routinely, how do calls for bids originate? Notes Ms. Ramey, "Usually, it is the person first in line for bringing travelers to the facility. Most often, human resources personnel or nursing directors who participate in contract negotiations initiate the RFPs. But, in some cases, this could even be the responsibility of those in the finance department." Comments Ms. Taylor, "With county, city, and government facilities, it is frequently purchasing personnel who play this role. At larger hospitals, requests may come from materials management directors, as well."

Some experts feel that HR and nursing professionals are the most qualified to make travel company selections because they understand the clinical demands better than employees in other departments. "There are certain requirements, questions, and criteria that apply to nursing," asserts Ms. Taylor. "When those outside of the clinical realm develop RFPs for supplemental nursing staff, they may overlook important mandates, such as those provided by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). We have seen a number of nurse recruiters and chief nursing officers taking responsibility for more traveler contracts. Addition-ally, patient services may be involved."

Just as the personnel responsible for soliciting RFPs differ between institutions, so does the timing of requests. "We tend to see more inquiries during cer-tain months," explains Ms. Ramey, "such as June or December, depending on hospitals' fiscal cycles." The method of issuing RFPs varies, as well. Some facilities post notices on their websites and, in turn, receive bids electronically. Other organizations might call their contacts directly or send out mass e-mails, and yet others may simply ask for proposals when contacted by travel companies.

Staffing firms often are not aware of agencies receiving the same request, given that private hospitals do not have any legal obligation to reveal who is competing for available contracts. Government-run facilities, however, are bound by the Freedom of Information Act to post those firms invited to submit proposals.