Ballad Health

The Spark

Ballad Health operates 20 hospitals across a 29-county footprint in the Appalachian Highlands—an area that is almost entirely a child care desert. When pandemic-era turnover collided with a long-projected nursing shortage, the system was losing nurses at unsustainable rates—not to competitors, but to the workforce entirely. Many were young women who couldn’t find or afford child care and simply stopped working. Ballad Health was spending heavily on contract and traveling nurses to fill the gaps. Leadership conducted its own regional capacity assessment and found 12,000 child care slots missing across the footprint. If Ballad Health wanted to solve this, they would have to build the capacity themselves.

The Solution

Ballad Health’s board authorized an investment to dramatically expand child care capacity across the region. In three years, the system went from operating three centers serving about 250 children to nine centers serving roughly 700—with additional expansion underway. Every Tennessee center is at or near capacity with a wait list.

Not a single center was built from scratch. Ballad Health repurposed underutilized facilities across its footprint: former medical office buildings, a vacant grocery store in Norton, a round education building on the Tusculum University campus in Greeneville, and an existing child care facility at East Tennessee State University (ETSU) in Johnson City that had closed. Each renovation was tailored to meet state licensing requirements while maximizing capacity. In Kingsport, the team worked around a two-level hillside building by creating two ground-floor entrances to satisfy Tennessee’s single-level rule.

Enrollment is split roughly 50/50 between Ballad Health’s team members (who receive priority) and community families. Team members get a 30% discount per child. The centers operate from 6 a.m. to 7 p.m., Monday through Friday, every week of the year, closing only on Christmas Day and Thanksgiving Day. A dedicated corporate staff member helps families navigate the state child care subsidy process. Quality is not an afterthought. Ballad Health uses a state-endorsed curriculum focused on kindergarten readiness through exploration and play, and the child care program is led by Amy Doran, Ballad Health’s corporate director of early care and education, who came to the system from Kingsport City Schools, where she led their early childhood programs. That background ensures the centers operate with the rigor of a public early learning system, not just an employer perk.

Ballad Health’s scale helps. Its corporate infrastructure gives the child care team access to dedicated finance, grants, HR, and facilities departments that no standalone provider could match. But Todd Norris, Ballad Health’s Chief Population Health Officer, is clear about what makes the model sustainable: it’s a three-legged stool. Families contribute through tuition. State and federal governments contribute through child care subsidies and grants. And the business sector contributes, in this case, through facility and operating support and discounted tuition. No single leg holds the weight alone. The business sector, Norris says, has sometimes been too absent from the equation, but treating employer investment as a silver bullet for child care isn’t realistic either. The system works when all three legs are in balance.

The Results

Ballad Health has gone from 250 children in three centers to approximately 700 across nine in three years. Every Tennessee center has a wait list. Combined with other workforce investments, the system reports dramatic improvements in nurse retention and recruitment, directly addressing the crisis that triggered the initiative. The human impact shows up in individual stories. One single mother—a nurse in an oncology unit—had been burning all of her PTO on snow days and holidays because her previous provider closed whenever schools closed. Ballad Health’s extended hours gave her the ability to save her PTO. She used it to take her four-year-old to Disney World, the first vacation they’d ever been able to take. At a park recently, Amy met a former Ballad Health cardiovascular nurse who had left after her second child because she couldn’t find child care. She’s planning to come back.