Key takeaways
- Over 90 days at a health system in Illinois, the incentive paid on an open shift rose as the start time got closer, from $9.67 an hour a week out to $15.00 an hour inside four hours. Yet the fill rate fell the whole way, from 38% to under 2%.
- Incentive pay works. It filled more than one in three shifts posted with a week of runway. Inside 24 hours it stopped working, either because the shift was no longer reaching enough people in time, or because a fixed incentive policy did not allow enough flexibility to find the offer that would.
- Pay and lead time are two dials, not one, and each shift needs its own setting.
Every operator has increased the bonus on a shift nobody was picking up. Sometimes it works. What almost nobody has done is line the bonuses up against how far ahead each shift was posted and ask where the money is actually buying coverage. A health system in Illinois did that across three departments and 1,389 shifts.
The two dials
Each row is a group of shifts posted for the hospital’s own staff to pick up, sorted by lead time. The incentive is the average paid per hour, on top of base, on the shifts that filled.
Posted before start | Shifts posted | Filled | Fill rate | Incentive paid |
Less than 4 hours | 108 | 2 | 1.9% | $15.00 an hour |
4 to 12 hours | 170 | 29 | 17.1% | $12.77 |
12 to 24 hours | 71 | 9 | 12.7% | $13.89 |
1 to 3 days | 210 | 62 | 29.5% | $9.76 |
3 to 7 days | 406 | 123 | 30.3% | $11.07 |
7 days or more | 357 | 136 | 38.1% | $9.67 |
Nobody intended this outcome. It is what happens when managers do the sensible thing shift by shift: a gap opens late, nobody bites, the offer goes up. Repeat it a thousand times and the hospital can end up with an incentive structure that deserves a second look, one where the highest rate is paid on the shifts least likely to fill. The four-hour shift paid 55% more per hour than the week-out shift and filled at one twentieth the rate.
What the money buys, and when
Read the bottom of the table first. With a week of runway, a $9.67 premium filled 136 of 357 shifts. That is incentive pay doing exactly what it is for: making a shift worth taking for someone who has time to take it.
Now the top. Inside four hours, the hospital paid its highest rate and filled two shifts out of 108. Two is a thin base for the $15, so read it as a signal rather than a rate card, but the signal is the same one the rest of the table sends. The rate may not be the only problem. The internal pick-up at $15 an hour is still the cheapest cover available: on a 12-hour shift at the median RN wage, the incentive is $180, the overtime premium on the same shift is about $281, and an agency order is more. What likely failed was reach: a shift posted at 0540 for a 0700 start reaches whoever the charge nurse can get on the phone, and most of them cannot be in the building by seven.
So the two rows are telling you two different things. With more runway, a shift may respond to incentive. In the urgent window, incentive still matters, but the hospital needs better data to know what level is likely to change behavior, and it needs enough reach to get that offer in front of the right people quickly. Pay without reach can miss the window; reach without the right offer may not be enough either.
Across the 90 days, 309 of 349 urgent shifts went unfilled internally, about 24 a week in three departments, and every one of them was covered at overtime or agency rates instead. Compensation is 56% of hospital costs. This is one of the few pieces of it an operator can move without a negotiation.
Finding the setting
The wrong lesson from the table is that incentives do not work. The right one is that each shift needs a different setting of the two dials, and most hospitals only have a feel for one of them.
Post known gaps early and the pay dial does most of the work at a modest rate. For the shift that surfaces late, turn the reach dial first: get it in front of every qualified person at once, and then pay what that shift needs to fill, which is usually less than what the phone list was paying. The goal is not less incentive or more. It is the incentive that fills the shift, offered to enough people to take it.
That balance is not something a manager can hold in their head across a thousand shifts. It has to be measured. Fill rate, time to fill, and incentive paid, by lead time, by department, every week. At this system, fill rate ran from under 2% to 38% depending on when a shift was posted, and none of that was visible until someone tracked it. Once it is visible, a change to pay or posting becomes a test with a result instead of an argument at budget time. Speaking as the person on the other side of that argument, results are easier to fund.
Where we come in
Gigly is how the Illinois system turned the reach dial. Your own employees see open shifts on their phones and pick them up, before those shifts turn into overtime, incentive pay, or agency. Every eligible person sees the posting at once, and the system learns which shifts need a premium to fill and which just needed to reach more people, so the incentive lands where it converts.
If you want to see your own table, pull 90 days of posted shifts, group them by lead time, and set the fill rate next to the incentive paid for each group. We are glad to walk through what the urgent rows are costing against your actual overtime and agency rates.
Frequently Asked Questions
Does this mean incentive pay does not work?
No. In this data, incentive pay filled more than one in three shifts posted with a week of lead time. What the table shows is that the same tool loses effect inside 24 hours, when the shift is not reaching enough people in time. Pay still matters there. It has to be the right offer, in front of the right people, fast.
Why is the incentive highest on the shifts that fill least?
Nobody sets it up that way. A shift opens late, nobody takes it, and the offer goes up. Repeated across a thousand shifts, the hospital ends up paying its highest rate on the postings least likely to fill. Seeing that pattern requires lining incentive paid up against lead time, which most hospitals have never done.
Is an internal pick-up still cheaper than overtime or agency at a $15 premium?
Yes. On a 12-hour shift at the national median RN wage, a $15 an hour incentive is $180. The overtime premium on the same shift is about $281, and an agency order runs higher. The internal fill is the least expensive cover even at the top of the incentive range.