How Healthcare Teams Plan Around Roles They Can't Fill

Imagine having the perfect cake recipe in front of you. All the ingredients are laid out, and you’re ready to bake. And then you realize you have no eggs in the house, and now the whole thing falls apart. No baking, no cake. Why would anyone mention cake in this article? This situation is a great example of how many healthcare plans look. It all looks great ‘on paper’. And then you realize a key role (nurse, a specialist, tech, etc.) is missing. And because of that, the entire timeline doesn’t work anymore.

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In healthcare, everything depends on people actually being in the room, whether it’s the timeline, the schedule, or the patient care – it’s all dependent on having the right person right there. And to an outside observer, you’d assume every role would be filled easily. But the reality is that healthcare is actually chronically understaffed.

193,000+ openings for registered nurses are projected each year through to 2032. – Association of American Medical Colleges (AAMC) / U.S. Bureau of Labor Statistics

So what do teams do to make it work anyway? They expect gaps and plan around them. Read on to see how, because it’s pretty nifty.

What Happens to Timelines When Key Roles Are Missing

As mentioned, the healthcare sector in the U.S. is facing a workforce shortage, but that doesn’t mean that hospitals and clinics simply start working. When it comes to healthcare projects, most of them start with the assumption that they’ll be able to fill out every role. They build the timeline around the perfect scenario, but what usually ends up happening is that a role here and there is missing, and the timeline starts to crack immediately.

Here’s exactly how that plays out:

Launch Dates Slip — Sometimes Significantly: Launch dates are pushed back (sometimes by weeks or even months), and projects that were supposed to be fully open at once are forced to open in phases. And some services may not end up opening at all because you can’t find the right people to do the jobs.
Critical Roles Create Bottlenecks That Freeze Everything Downstream: A large part of this comes down to what’s referred to in the industry as ‘critical roles’ — positions that block everything else. If no one is filling such a position, nothing else in that chain can move forward. It doesn’t matter that all the equipment is set up and that the rooms are ready. Even your budget makes no difference.
Teams Are Forced Into an Impossible Choice: There’s basically a hard choice to make — either delay the entire project until every role can be filled (nobody really wants to do this), or continue with serious limitations. Neither is ideal. For the most part, teams will start with what they can until they can hire the full staff, focusing only on basic services first. The goal becomes getting it up and running, even if it’s in a limited capacity.
Entire Departments Can Remain Closed Indefinitely: The pediatrics department might stay totally closed for the time being because pediatrics physician jobs aren’t filled. Surgeries might not happen indefinitely because no surgeons are available. It’s a huge issue — and the scale of the problem is significant:

8,000+ additional pediatricians are required in designated shortage areas across the entire U.S. – HRSA Data Warehouse

Day-to-Day Operations Take a Real Hit: The impact shows up in the day-to-day: expensive equipment sits packed in boxes because there’s no one on payroll trained to use it, and coordination becomes nearly impossible as everyone is forced to constantly adjust to who’s available and who isn’t.

What To Do If You Can’t Hire in Time?

You need people, but the hires aren’t coming (fast enough). The solution? Well, you can’t really sit around and wait (hoping for the best) because you’ve got patients that are counting on you. You can’t wait for things to be perfect; you have to figure out what can be done with what and who you have right now at this moment.

Here are a couple of strategies that are proven to be effective in these types of situations.

They Cut Back What They Launch

This is usually the first step, and it makes total sense. If you can’t have all spots filled, you open what you can because that’s the only thing that’s realistic. Not every service is going to be ready on day one, but it is what it is. Some things get delayed because there aren’t enough people to run them safely, and this way, the work still moves forward. Sure, there’s no big, flashy healthcare launch that everyone might’ve hoped for, but at least you’re up and running, and that’s something.

Change the Order of How Things Usually Work

The original checklist would have been ideal, but right now, you have to find a way to make things work with what you’ve got available. This basically means that the usual procedure doesn’t work and you’ve got to shuffle things around a bit. Change up the order/sequencing of how things are (usually) handled.

Maybe you’ll set the rooms up, handle paperwork, train on basic systems, or whatever else you can until that one key person has been secured. The stuff that absolutely can’t happen without that key person gets pushed down the list. This sounds simple, but in practice, it’s not. Teams constantly have to shift gears and always reassess what can happen today and what has to wait until… Who knows.

They Build Talent From Inside

Sometimes, the best way to move on is to look at the people you have and see who can fill the gaps and how. So teams turn in and train current staff so they can step into new roles. For example, a nurse gets extra training and lands a lead position, or a tech moves up into a position that would normally go to someone from the outside.

Don’t mistake this for a quick fix because training takes time and patience. This method can build something truly solid. You end up with people who already know the place and the patients and who care about getting things right, because why would they bother otherwise? It’s slower, and that’s a downside, but it’s more reliable in the long run.

Short-Term Help/Solutions

This is basically a hiring manager’s Band-Aid. You’re basically relying on a rent-a-staff-member-type of solution. What you can do is hire temps, such as travel nurses, locum tenens doctors, etc.

Approx. 90% of hospitals rely on contract/temp staff in order to fill workforce gaps. – American Hospital Association

This is only a solution you can go for until you can secure a permanent solution for the problem. The problem with this is when this short-term solution becomes a semi-permanent solution simply because you aren’t able to get someone to fill the position. This solution is far from ideal because of a couple of things – it costs more, plus you’re losing consistency and reputation.

No one really wants to come work in a business that has staff members coming in and going repeatedly (high staff turnover rates). But, again, if you’ve got no other choice, this is still better than doing nothing.

They Spread the Work Across the Team

When all else fails, there’s no other choice but for the people who are here to do more. The staff takes on more responsibilities than they should and even do jobs they weren’t hired to do. A nurse will pick up what a tech would usually handle, and a manager steps in to help with direct care when things get too tight. This is the last resort, and nobody likes it when things get to this point, but it keeps the doors open, and that’s a priority.

The downside is that this means people do not get tired but are absolutely exhausted. The result? Work slows down because everyone is doing (way) too much. When you stretch people that thin, they’re more prone to making mistakes and suffering burnout.

Over 40% of U.S. healthcare workers reported feeling burned out either ‘often’ or ‘very often’ – Centers for Disease Control and Prevention (CDC)

Conclusion

Missing roles are often viewed as an HR concern — and in many industries, that’s where the impact stops. In healthcare, however, the consequences extend far beyond recruitment. Staffing gaps directly affect project timelines, service availability, team performance, and organizational budgets. Every operational decision bends around who is present and who isn’t. When a team is strong and resourceful, they will find a way to move forward — but the weight of that effort is felt across the entire organization.

They won’t wait around for the perfect conditions; what they’ll do is figure out what they can do so they get the most out of the situation right now. And while there are trade-offs, some of which are significant, they’ll accept them because it needs to be done. The good thing about all this is that there’s a Plan B in place, and this is to think about all these gaps from the get-go. Sure, this won’t magically fill all the positions or fully reduce all existing stress levels, but it’ll definitely help move things a bit more smoothly. And that’s a good start.

How Healthcare Teams Plan Around Roles They Can’t Fill