Q&A with Dr. Randall Wilson, Jobs for the Future

Investing in the frontline workforce is a strategy that holds great promise for both employees seeking to advance and employers who need to recruit and retain dedicated workers to provide great patient care. The CareerSTAT initiative, a project of Jobs for the Future (JFF) and the National Fund for Workforce Solutions (NFWS), promotes investment in frontline worker training and education through employer-led advocacy. In this interview with Dr. Randall Wilson of the JFF’s Building Economic Opportunities Group, we hear what makes for a successful frontline workforce development program and how employers can make the business case for investing in their employees’ advancement.

Could you tell us a little about the impetus for developing your new report, CareerSTAT: A Guide to Making the Case for Investing in the Frontline Hospital Workforce?

The Guide grew out of a couple of insights. One, there are dozens, if not hundreds, of hospitals and other health care providers out there who are supporting the learning and career advancement of their workforce at all levels—the nurse aides and housekeepers as well as the doctors, nurses, and other licensed professionals. We see them, and the partnerships they’ve built with educational organizations and with other providers, as part of a movement. The question is: how do you build this movement and get other providers, as well as policymakers, to recognize the value of investing in their workforce? The second insight is that employers can make the most persuasive business case to other employers about the value of this investment.

We think these investments are especially important because education of the first-rung workers in health care is still the exception, not the rule. Many individuals working at the entry level, in hospitals, nursing homes, community clinics, have ambition and skills but didn’t receive a strong education the first time around. They may not be aware of the pathways open to them, or they may not have access to the kind of mentors and advisors that professionals had. And that’s a loss for them, because it limits their earning potential and their ability to apply their skills fully in giving care. But it’s also a loss to providers, their patients, and the community at large.

Here at Jobs for the Future, and the National Fund for Workforce Solutions, we’ve developed relationships with many of the leading providers who invest in their frontline workforce – by starting up demonstration programs, bringing practitioners together, and offering technical assistance. We reached out to a core of them – from hospitals and partnerships in Boston, Rhode Island, Baltimore, and other places – and created a “leadership council” for a new initiative, also called “CareerSTAT.” The core idea behind CareerSTAT – the initiative and the Guide – is that advocates for frontline worker investment need tools to make their case: concrete metrics of how training and advancing your workforce pays off. With advice from the leadership council, and financial support from the Joyce Foundation, we researched the metrics that leading hospitals were using to measure the impact of workforce development. The CareerSTAT Guide is the product of that research.

The National Fund for Workforce Solutions and Jobs for the Future, both of which focused on building job skills and not just on health workforce specifically, sponsored this guide. Could you speak a bit to what is unique about the field of health care and the promise it holds out for those who are seeking a career that can support a family?

Health care is distinctive in several ways. As a field, it offers many entry points for people starting a career or looking to expand their talents. Jobseekers aren’t limited to one position or pathway. They can choose clinical or technical pathways, but they can also go in the direction of business and administrative occupations. There are also good opportunities in community health education, social work, or case management with patients. And with the growth of electronic health records, people with clinical AND computer skills will be especially competitive. Because of this variety, health care offers both ladders and lattices – vertical and horizontal movement – for people entering the field. In many cases – think of licensed practical nurses or RNs, surgical techs or lab techs, etc. – people can attain a decent income by earning a certificate or degree with less than four years of college education.

Another facet of health care is the service mission. Institutions still have to meet their bottom lines, of course, but they also have explicit or implicit goals as caregiving entities to serve their patients, families, communities and other stakeholders. And they can’t do that without the contributions of everyone on the care team. So that creates a built-in argument for investing in everyone on the team.

With health care in the business of serving people, it is deeply anchored in local labor markets. Most of the work is not going offshore.

Finally, this is a field that is in the limelight – not only because of the Affordable Care Act, but because of all the other trends converging there: controlling costs, treating an aging population (and replacing an aging workforce), improving the quality and the coordination of care. You can’t ignore it if you are serious about workforce development.

Do you find that employers are seeking out advice on how to attract and develop workers? Is this something that needs to be sold to them based on direct organizational benefits?

We do receive those requests for advice, from employers but also from education and training partners looking for effective models. But there is also a lot of selling that needs to happen. The decision-makers in the “C-Suite” of hospitals are dealing with a million things, and making talent at the lower levels, versus buying it from outside, isn’t necessarily at the top of their minds. And since the recession, there isn’t the same pressure to develop talent from within or to recruit from non-traditional populations. We don’t have the same scarcity of labor that we saw five or ten years ago. So you’re correct, it’s necessary to make the case with reference to a number of organizational benefits, not just filling vacancies.

What characteristics marked hospitals that excelled in developing these types of programs?

They had champions, or visionary leaders, at the top who saw the benefit and supported it for the long haul. But they also created new roles –“workforce directors,” coaches, and the like – and new HR policies and practices that live on even when the champion departs. They are also willing to experiment and learn from mistakes; starting small and then scaling up. You might see a pilot with a little grant money to train unit clerks or lab techs. Then it’s expanded to more departments or functions. To do that, leading hospitals also had to be smart and strategic about resources. They partnered with their competitor hospitals and lowered the cost of community college courses. They supported these partnerships with a mix of public and private (foundation) grants, and they made sure that every partner hospital had skin in the game, too. Most importantly, their partnerships were brokered by smart nonprofits – social businesses or “intermediaries” in our jargon – that understand how to meet employers’ needs and workers’ needs equally.

How can healthcare facilities measure the success of their investments in workforce?

First and foremost, they need to define what they value. What kind of value are they looking to create by training their workforce, or supporting them to go to college? Only then can they measure successes. In the interviews for the CareerSTAT guide, we found that most of what providers value in their investments fall in several broad categories: addressing human resource challenges, such as labor shortages or overtime costs; improving employee morale and engagement – motivating them by making them feel empowered through knowledge and skills; improving performance by upgrading skills; and meeting organizational mission – to be an employer of choice, to serve the surrounding community, to be a true “teaching hospital” for every employee. Once they are clear about the broad case for making investments, then there are specific metrics that fall out in each case. If you are documenting the value of training to address labor market problems, you would monitor vacancy rates in critical positions, measure your overtime costs, replacement and recruitment costs. There are standard ways of surveying the workforce on issues of engagement and motivation, and some hospitals track attendance (or absentee rates) as a proxy for this value. When your goal is to upgrade performance, you may want to track patient satisfaction, error rates, readmission, or any number of key metrics of quality.

Different hospitals need different degrees of rigor to make the business case, and that determines the metrics and methods for measuring successful investment. We see CEOs and VPs for human resources at one end of the spectrum who will say “show me a few data points” about promotion from within, lower turnover, and satisfaction scores. At the other end, there are CFOs and other executives that need hard financial evidence of return on investment. This is a much higher standard of evidence, and it requires a strong internal team with good capacity for choosing the right things to measure – what we value – and making the right comparisons. To do an ROI (return on investment) analysis, they might build this capacity in-house, as Children’s Hospital Boston is planning, or engage an outside firm, as hospital partners did in Cincinnati’s Health Careers Collaborative did.

Could you tell us about a few of the successful programs you identified?

Good Samaritan Hospital in Baltimore has enjoyed impressive results with its pipeline programs to develop talent from within. Their use of RNs from agencies (and the associated costs) fell dramatically over a five year period, as did their use of respiratory therapists from agencies. This is a program that not only supports worker education financially, but has created an infrastructure for coaching and navigating people through their career development.

Norton Health Care, in Louisville, Kentucky, is another good case. They have a very well-developed program, “Norton Scholars,” that enables current and prospective workers to pay off college tuition debt by working at the hospital. At the same time, they’ve created an in-house system for tracking employee-scholars’ educational progress and measuring the business impact of this investment. They found recently that employees who completed the scholar program turned over at far lower rates (5%) than non-scholar participants (31%), controlling for various characteristics. RNs trained in this program had considerably lower termination rates than other RN trainees – saving Norton over $5 million.

Cincinnati’s UC Health System has been making serious investments in workforce development since 2004. Participating in the Health Career Collaborative’s return on investment study, they found that career pathway programs for workers earning certificates and associates degrees had a return of 12%, or a $1.12 for every dollar invested.

What are the next steps in getting the word out about this effort and moving it forward? Which audiences do you most want to reach?
We are looking to expand both the Leadership Council of CareerSTAT and its network of partners, which includes non-employer entities such as workforce agencies and colleges. Members of the council, along with JFF and NFWS staff, use opportunities to speak to health care audiences about the benefits of using metrics and making frontline workforce investments. We are especially concerned about reaching health care trade associations. To that end, I’m especially excited about our panel coming up at American Society for Healthcare Human Resources Administration in September, which will feature a discussion with three of the leading employers, from Youngstown, Ohio, Providence, Rhode Island, and Cincinnati, Ohio.

How can hospitals and other organizations that have frontline workforce programs or initiatives share their examples with you and with each other?

Please contact us at JFF and NFWS through the information listed in the guide, and also seek out the employers featured there. Business to business contact, as I said, is the most compelling way of learning about this.

Randall Wilson, Jobs for the Future, can be reached at rwilson@jff.org or 617-728-4446.
Fred Dedrick, National Fund for Workforce Solutions, can be reached at fdedrick@jff.org or 617-728-4446.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.