Confronted with spending millions of dollars persuading nurses to work overtime, an Indianapolis hospital administrator had a novel thought: Could a computer program let nurses "bid" on which shifts they wanted and how much they should get paid? It would be like eBay in reverse — the nurse who bid the lowest salary would get the shift, and those who wanted to earn more could try for unpopular hours.

The Clarian Health Partners executive asked tech entrepreneur Ian Chaplin whether it could be done. Chaplin turned the idea into a company.

Since Chaplin founded San Diego-based BidShift Inc. four years ago, the software company has signed contracts with more than 90 hospitals and expanded to 35 employees.

But along the way, Chaplin discovered that BidShift required more than one innovative concept to succeed. The company's growth — and future — has required BidShift's executives to enlist their clients as idea laboratories that nurture the company's creativity cycles by suggesting new products and solutions for navigating healthcare's bewildering bureaucracies.

"Every new step we take is really driven by the requests and ideas of our customers," said Scott Bechtler-Levin, BidShift's vice president of marketing and client services. "When in doubt, we just give new products to the customer and let them tell us what we should do next."

Such symbiotic relationships between companies and clients aren't new. But they are becoming more common as companies look for new ways to compete. Corporations such as consumer goods giant Procter & Gamble Co. and Palo Alto, Calif.-based design firm Ideo have tried to spur creativity by asking employees to approach clients with questions rather than solutions.

"A lot of companies worry that by giving customers incomplete products or admitting there is something they don't know, they are damaging that relationship," said Lisa Gundry, a professor at DePaul University's business school. "But if clients understand that they are participating in developing something new and feel like their frustrations are guiding new prototypes, they tend to become even more loyal to the finished product."

In the case of nursing, hospital frustration is intense.

Nationwide, nursing shortages are reaching alarming proportions.

For hospitals, those numbers have translated into spiraling costs. According to the U.S. Department of Health and Human Services, the average nurse earned a base salary of $57,784 in 2004, the last year for which statistics were available. But nursing shortages have forced some facilities to spend as much as $30,000 more a year per nurse in overtime and administrative costs.

For instance, an administrator at Tucson Medical Center, a hospital that adopted BidShift's technology in 2004, estimated that before working with the company, nursing managers spent about 60 percent of their time phoning staff to fill vacant shifts. When that didn't work, the hospital was paying temporary workers 20 percent more to work alongside more experienced permanent staff.

Problems like those spurred BidShift's creation. The company's Internet-based application is modeled on software used in the airline industry. Hospital staff members log on via the Internet from any computer to bid on shifts, and administrators can personalize preferences for specific employees. Certain shifts can be limited to nurses with particular skills or seniority, and financial incentives can be customized to make some shifts more attractive to certain workers.

But simply creating the BidShift software was not enough for the company to succeed. After working with Clarian Health Partners, BidShift executives approached other hospitals and discovered that, regardless of how useful the system, bureaucratic obstacles to purchase existed. So they asked their first clients to suggest solutions.

The result was a subscription model that lets hospitals buy the BidShift service on a monthly basis, avoiding the large financial contracts that require board approval and can take months to complete. What's more, BidShift executives learned that nursing staffs hated competing for attention from hospitals' technology departments whenever something broke down. So BidShift keeps the data on its own servers, where it can perform immediate upgrades and maintenance.

Those and other creative ideas originated with clients but were quickly embraced by BidShift.