How to Grow a Staffing Agency: What Building One Taught Me

I have spent the past decade in healthcare staffing, and most of it inside one company I watched grow up.

When I joined Uniti Med it was a small startup. Today I am President and COO of Uniti Med and GQR Healthcare and COO of Nebula, and revenue on our core brand has grown tenfold. Uniti Med ranked #3 on the Inc. Regionals list of the fastest-growing companies in the Midwest and was named one of Fortune’s Best Workplaces, and GQR, the company family Uniti Med belongs to, is listed on Staffing Industry Analysts’ Largest Staffing Firms in the US.

I share that so you know where the lessons come from, not because the numbers are the point. What follows is what I would tell any staffing owner who asked me how to grow, including the things that broke on us along the way. Before staffing I spent ten years in restaurants and then running sales and marketing for a brewery, so I came into this industry as a salesperson first. Some of these lessons are sales lessons. More of them are people lessons.

What actually grows a staffing agency?

A staffing agency sells two things at once. It sells a client on trusting you with an open role, and it sells a candidate on trusting you with their career. Every dollar of revenue depends on both of those conversations going well, usually on the same day, often handled by people who have been in the job less than two years.

That is why growth in staffing is less about a clever strategy and more about the people doing that work and how quickly they can do it. If your recruiters stay, get better, and move fast, and your account managers protect and expand the relationships you already have, revenue follows. If they leave every eighteen months, you are rebuilding the same desk over and over, and no amount of new business fixes that.

Why does recruiter and sales culture come first?

When the company was still small, the first leadership hire was not another salesperson. It was a Director of Culture. I wrote about that decision in Forbes, and I still think it was one of the best calls we made, because culture in a staffing firm is not a poster. It is whether a recruiter picks up the phone for the fortieth time on a hard Tuesday.

Recruiting and staffing sales are rejection-heavy jobs. A candidate ghosts after accepting. A client fills the role internally the day before your submittal. A nurse takes a contract with another agency for a few dollars more. The people who keep going through that are almost always the ones who feel that their leader has their back and that the work matters. When I teach on motivation, I use a framework called SPARK for exactly this reason: support, purpose, appreciation, relationships, and knowledge and growth are all things a staffing leader controls.

The practical test is simple. Ask whether your best recruiter would recommend your company to a friend in the industry. If the honest answer is no, fix that before you open another vertical.

How fast should a staffing agency submit candidates?

Faster than you are doing it now. In healthcare staffing especially, the best clinicians are talking to several agencies at once, and the client is often reviewing submittals from several vendors at once. The firm that presents a qualified, interested, fully prepared candidate first very often wins, and the firm that presents the same candidate a day later often loses to its own slowness.

Speed to submit is not about cutting corners. It is about removing the waiting that sits between steps: the callback that happens tomorrow instead of in ten minutes, the credential that gets chased after the submittal instead of before, the approval that sits in someone’s inbox. When we looked hard at where time went, most of it was in handoffs, not in the work itself.

I wrote more about this in AI for Recruiters: What Works, and What Backfires, because response time is the place where technology genuinely helps and also the place where it can quietly make a firm worse if it replaces the human conversation instead of speeding it up.

Why is candidate experience a revenue strategy?

Because in staffing your candidates are both your product and your customers. A traveler who has a good experience extends, comes back for the next contract, and tells three friends. A traveler who gets ghosted after a submittal tells more than three.

We took feedback seriously early, and it showed up in our Net Promoter Score. In our first year surveying with ClearlyRated, Uniti Med posted an 86.6 NPS, and I talked with their team about how we got there on the Survey Says podcast. The short version is that we did not treat the survey as a scorecard. We treated it as a list of conversations we needed to have, and we closed the loop on them quickly.

The habits that matter are small: calling candidates back even when the answer is no, telling them the truth about a role before they get there, and checking in during an assignment rather than only at the end of it. None of that shows up on a pricing sheet, and all of it shows up in your fill rate a year later.

How dependent should a staffing firm be on its biggest client?

Less than feels comfortable. One of the quietest risks in a growing agency is when a single health system or a single MSP program becomes a large share of revenue. It feels like success, and in a sense it is, until that client changes vendors, moves to a different tier, freezes contract labor, or renegotiates rates. Then a good year becomes a hard one overnight.

I do not think there is a magic percentage, and I would be wary of anyone who gives you one without knowing your business. What I would do is look at your top client every quarter and ask what happens to payroll, to your recruiters’ desks and to your margins if that account went away in ninety days. If the answer frightens you, the growth plan for the next year should include winning and expanding accounts that are not that one, even when the big client keeps asking for more.

Margin is the other half of that conversation. When bill rates tighten, the agencies that keep growing are the ones that know what each placement really costs them to recruit, credential and support, and price and staff accordingly. It is the subject of The Margin Squeeze: How Smart Agencies Are Still Winning, the panel I am on at TalentTrack 2027 in Omaha.

How do you keep your own recruiters and account managers?

Staffing firms spend their days helping clients with turnover and then often accept the same turnover inside their own walls. Every recruiter who leaves takes candidate relationships, pipeline and judgment with them, and the person who replaces them needs months before that desk produces again. When I think about what protected our growth, keeping strong people was every bit as important as winning new clients.

Most retention tactics are fences: bigger bonuses, longer non-competes, golden handcuffs. I made the case against that in Inc. in Stop Building Fences to Keep Your Employees. People stay when they are growing, when someone notices their work, and when they can see a version of themselves a year from now that is bigger than today. If you want to see what turnover is costing you in dollars, the employee turnover cost calculator is a useful reality check.

How do you build a leadership bench in a growing agency?

Start before you need it. The most common thing I see break in a fast-growing staffing firm is that the founders and first sellers are still doing everything, and there is nobody ready to run a team when the second and third teams arrive.

Our best leaders mostly came from inside. They were the recruiters the rest of the desk already went to for help, long before anyone gave them a title. I told the DisruptHR Kansas City audience this year that your best hire already works for you, and in staffing that is especially true. The person who already knows your candidates, your clients and your culture usually beats an outside hire who looks better on paper. Give them real responsibility early, coach them on leading people rather than just producing, and let them make mistakes while the stakes are still small.

Where does AI fit in staffing and sourcing?

In the places where it gives your people time back, not in the places where it replaces the relationship. Sourcing, matching, summarizing and first-pass outreach are real wins. I am also COO of Nebula, an AI talent sourcing platform, so I have a stake here and I will say it plainly: the tool is never the strategy. The firms getting results are the ones that redesigned how the work gets done, and then used technology to speed up the new process.

That is exactly the conversation I am joining at the SIA Healthcare Staffing Summit this November, on a panel about real-world innovation in healthcare staffing. The pattern I keep seeing is that layering software onto an old process mostly automates the mess. Fix the handoffs first, then automate. For more, the Staffing Show episode on leveraging AI in recruitment covers what we have learned.

How do staffing sales teams win hospital and MSP accounts?

By knowing exactly what each deal still needs instead of following up harder on everything. A hospital or MSP program does not buy because your rates are a little lower. It buys when the decision makers want what you offer, believe it will work in their facility, trust your team, can see what happens the week after they say yes, and understand what it costs them to leave the role open. That is the LOCKS framework I teach staffing sales teams: Love the product, Own belief, Confidence in you, Kickoff plan, and Stakes.

On the candidate side, the objections are just as predictable. “Another agency offered more.” “I need to talk to my spouse.” “I am not sure about that city.” Recruiters who jump straight to an answer lose people they should have placed. The LAARC method (Listen, Acknowledge, Ask, Respond, Confirm) gives them a way to find the real concern and check that it is resolved. If you want the broader picture of how revenue grew for us, I wrote that up in How to Grow Revenue Fast.

What breaks when a staffing agency scales?

Communication breaks first. When the whole company fits in one room, everyone hears everything. At fifty people, and then at a hundred, the same message has to be said on purpose, more than once, and by more than one leader.

Standards drift. Something small gets tolerated once, and then it becomes the standard. In a staffing firm that might be a late callback, a sloppy submittal or a candidate who never heard back. Leaders have to keep naming what good looks like, especially when they are busy.

The founder becomes the bottleneck. Decisions that one person could make quickly at twenty people slow everything down at two hundred. Growth requires handing decisions to the people closest to the work.

Back office falls behind the front office. Credentialing, payroll, compliance and onboarding have to scale with sales, or every new contract creates a new problem. Clinicians remember a late paycheck far longer than a great recruiter call.

Where should a staffing owner start?

Start with your own people. Sit down with your recruiters and account managers and ask what is slowing them down, what is making them think about leaving, and what candidates and clients keep telling them. You will learn more about how to grow your staffing agency in that one conversation than in any strategy deck, and you will walk out with a short list of things you can fix this quarter.

If you lead staffing teams and want to compare notes, the Healthcare Staffing Trends for 2027 article covers where I think the market is going next, and I talk about growth in more depth on the Killer Growth podcast and on Staffing Stories.