A Critically Important Workforce in Healthcare Isn't on the Payroll

Editors: Justin Poulin and Jay McDonald  

Walk the floor of any major hospital on a busy weekday and you're moving through two overlapping workforces. One is yours. The other — surgical device reps, biomedical engineers, IT contractors, facilities vendors, pharmaceutical liaisons, rotating students — can number in the hundreds on a single busy day, in a single facility. Those are your third-party vendors.

They're in the same clinical environments as your employees, interacting with the same patients and staff. The difference is that your employees have HR. This group has a credentialing record, if it's current, and a badge.

The Lifecycle Nobody Owns

Healthcare has built a robust infrastructure around the employee lifecycle. Every step has an owner. Every expiration has a flag, from hiring and onboarding to performance reviews and exit interviews.

The third-party workforce gets something assembled from whatever pieces individual departments built, independently, without much coordination. Compliance credentialed them at some point. Security issued a badge. The OR set its own rules for surgical reps. IT manages contractor access under a separate workflow. Rarely does any single system answer who is cleared, where they're allowed to go, why they're there, and how long that access remains valid.

When something lapses, nobody finds out until someone is standing at the point of entry with an expired credential and a case about to start.

The Tracking Asymmetry

Healthcare is a documentation-intensive industry. Every medication, clinical order, and vital sign carries a timestamp, an author, and a location — because the stakes of not tracking are too well understood to ignore.

The same patients those records belong to are being cared for in environments where the vendor rep in the room, or the technician who serviced that device last week, may exist in a spreadsheet — or not at all.

This isn't a leadership failure. It's a category gap: the tools to manage a non-employee workforce at enterprise scale didn't exist in an integrated form until recently. They do now, which makes the gap harder to justify.

What an Unmanaged Population Looks Like

Without a vendor governance infrastructure, the work doesn't disappear. It gets absorbed by clinical and operational staff who weren't hired to do it — verifying credentials at the scrub sink, sorting badge conflicts at the front desk, chasing documentation that should have been confirmed before the visit was scheduled. Across dozens of facilities, that friction doesn't stay local. It becomes the operating model.

The data makes the stakes concrete. One health system, upon implementing structured vendor governance for the first time, found more than 400 vendors in its existing database with serious criminal offenses — individuals who'd been accessing facilities without anyone knowing. That's not a failure of effort. That's what an unmanaged population looks like.

You can't enforce access policies you can't verify. You can't improve operations you don't measure. Healthcare applies rigorous management discipline to its employed workforce because it understands the consequences of not doing so.

The third-party workforce — one that rivals the employed workforce in daily clinical interactions at many large health systems — deserves the same discipline. Not as a compliance exercise. As a basic condition for operational control.