While taking risks and embracing challenges can be quite scary for smaller businesses, it paid off big time for Stability Healthcare, a Pasadena-based health care staffing firm which topped the Business Journal’s 2023 list of fastest growing companies.

“It’s absolutely a tribute to the men and women here that have built this company up over the last several years,” Jason Casani, chief executive and co-founder of Stability Healthcare, said.

Stability, which is responsible for recruiting registered nurses and other health care professionals and matching them with hospitals around the country, has satellite offices in Franklin, Tennessee and Scottsdale, Arizona.

The agency has experienced tremendous levels of growth, as illustrated by a 733% increase in revenue from 2020 to 2022.

For Casani, the growth of Stability can really be broken down into two ladders: the launch of a new technology and, believe it or not, Covid-19.

Stability, which was founded in 2009 and began as a traditional recruitment agency, took a pivot in 2017 when it released its own technology platform.

“We took a big risk in developing our own platform,” Casani said. “We decided that we wanted to get away from the traditional staffing model and really build our own technology platform.”

Stability created an internal tool for sifting through candidates, consisting of applicant tracking systems and candidate management software, with the purpose of streamlining all fronts of the staffing process, as well as increasing efficiency.

“For us and for the industry, it’s about speed,” Casani said. “These hospitals have a need. They need to get these nurses in as quickly as possible, and the faster you can get them in, the happier the nurses and happier the facilities are.”

One of the main points of differentiation of the platform was Stability’s transparency when it came to posting jobs.

“We were the only company in the industry to actually post pay packages, the actual amount of money the nurses were going to be making,” Casani said.

For him, that up-front pay transparency was “fundamentally” important. He wanted this new tool to be first and foremost a nurse advocate, rooted in customer support and quality service.

“The whole goal was for us to take what normally may take a typical recruiter or agency several days to find a nurse and then to place the nurse to do that within hours,” Casani said. “That was the fundamental shift for us, from a technology perspective.”

Embracing challenges

When Covid hit and many businesses suffered from unprecedented challenges, Stability’s pre-established technological model allowed its business to thrive.

“It allowed us to scale much faster than our competitors who had to hire and bring in recruiters and have them work in a centralized location,” Casani said. “I moved most of the recruiters in the staff out and allowed them to work from home.”

In embracing remote work, the company skyrocketed – its employee count jumped from roughly 35 to about 180 – and suddenly Stability had workers in 35 states across the country.

“We didn’t have to worry about finding the best talent in Pasadena or downtown Los Angeles,” Casani said. “We could look everywhere for recruiters, for salespeople, for back office, clinical support.”

“The moment you open a company’s pool of applicants to remote work, you attract high productivity workers across all geographies,” Sayantani, staff economist at UCLA Anderson School of Management, said. “In a way that leads to higher returns from increased productivity.”

Learning curve

While fast growth can mean great things for a company, it can oftentimes come with particular challenges too. For Stability, the biggest challenge was trying to keep up with its own pace of growth.

“While we had scalable technology, there’s still a lot of processes that need to change when you’re growing that quickly,” Casani said. “It’s kind of like the old adage, fixing an airplane when you’re flying. We’re trying to build and enhance and make an airplane better, but we’re mid-flight. And not only mid-flight, we’re on takeoff through Covid.”

Stability’s technology was intended to grow significantly since its initial launch, but making sure the company overlaid the right processes, internally, was a challenge, said Casani.

To get through the hurdles, Casani highlighted the importance of communication.

“Listening and working with people within your company to make those shifts, to make those changes and adapt as quickly as possible as you’re growing through it (is key),” he said.

“And on the flip side of that, I think things also change on a dime,” Casani added. “And if the business environment changes, if we’re going into Covid or going into a recession, you have to be able to make tough decisions quickly. And the faster you make those decisions, whether on the way up or the way down, the better off you’re going to be.”

Rate normalization

Another challenge Stability faced – this one on Covid’s comedown – was figuring out how to achieve an ideal point of efficiency, which was ultimately reflected by some internal layoffs.

“We went up to 180 employees,” Casani said. “We’re under that now. We’re probably at 150. It was part of adapting to the changing market.”

“Sometimes the economic factors that are conducive to the fast growth that’s happening may not be permanent,” Sayantani added.

The demand for nurses skyrocketed during Covid’s onset with the surge in patients seeking care. But as vaccines were introduced and Covid’s threat subsided, hospitals tried to navigate staff rate normalization. Stability did too.

“We were overstaffed,” Casani said. “We had to be overstaffed for Covid. We created roles and functions that were needed to grow quickly but weren’t needed coming out of Covid. We’ve become much more efficient. We’re very well balanced right now.”

“We have this idea in economics called economies of scale,” Sayantani added. “When you have economies of scale, you have the long run average costs decreasing as the output increases. And then you have diseconomies of scale, which is a point at which the more you produce output, your average costs are actually increasing. So, it may not be a good idea to really keep functioning at that level of output production.”

Settling in

While Stability’s revenue increased an astounding 733%, the company has remained fairly humble in distributing this extra income.

“We’re still continuing to invest in our platform,” Casani said. “We believe there’s a lot more to be done on our platform, a lot more efficiencies that can be gained on the back office.”

The company launched a live chat feature for nurses to be able to message recruiters, has continued to enhance its technology to be more intelligent by introducing automation, and even acquired a smaller health care firm at the beginning of this year. And while the remote model allowed Stability to thrive, Casani recognizes there are cons associated with the phenomenon as well, stating that the agency may be looking to open another hub office to encourage more face-to-face interaction.

“We love the hybrid (and) remote work environment. We think it allowed us to grow, it provides flexibility to our employees,” Casani said. “But there’s something that’s lost with company culture that we miss.”

Overall, Casani is optimistic about the continued demand for health care staffing and eyes future growth opportunities in the industry.

“(Health care) is a very exciting, very rewarding sector within staffing,” Casani said. “I’m excited for our growth. I’m excited to see what we can do for the next five to 10 years and what we can build for the opportunity, not only for us internally, but also for our clinicians and for the communities that we service.”