developing your own pioneer program

Developing Your Own Pioneer ProgramIMPLEMENTATION TOOLKIT

A PROJECT OF THE HITACHI FOUNDATIONJANUARY 2013

PIONEER EMPLOYER HOSPITALS: Getting Ahead by Growing Your Own

The Pioneer Employer Initiative is based on the idea that employers who do

good, do well. It is an effort to discover and promote the next generation of best

practices in workforce management, with a particular focus on health care and

manufacturing. Pioneer Employers are companies that strategically invest in

their own lower-wage workers to benefit their customers and/or shareholders.

They go beyond typical ideas about “great places to work,” and demonstrate how

organizations can deliberately align the interests of employees and management

to create better results for companies and their employees.

O U R P A R T N E R S

Advocate Lutheran General HospitalPark Ridge, Illinois

Bassett Medical CenterCooperstown, New York

Beth Israel Deaconess Medical CenterBoston, Massachusetts

Faxton-St. Luke’s HealthcareUtica, New York

Good Samaritan Hospital Medical CenterWest Islip, New York

Group Health CooperativeSeattle, Washington

Northwestern Memorial HospitalChicago, Illinois

Providence St. Peter HospitalOlympia, Washington

Thompson HealthCanandaigua, New York

UNC Health CareChapel Hill, North Carolina

Virginia Mason Medical CenterSeattle, Washington

PARTICIPATING HOSPITALS

A Letter from the Hitachi Foundation’s President

Most hospitals are excellent employers – and haveto be to compete. Health care is after all a serviceindustry, and the quality of your people ultimatelydetermines success. But a tipping point is approach-ing, led by a demographic shift and the implemen-tation of health care reform. Hospitals that want toremain great need new strategies for hiring andretaining staff, and implementing effective staffingmodels. One way or another, the new models mustbe leaner, yet more effective.

This toolkit will help you develop such staffing mod-els. It takes the most crucial lessons from a selectgroup of innovative, high-performing health careproviders – what we call the Pioneer EmployerHospitals – and distills them into steps that you cantake today in planning your own hospital’s workforcefuture.

The Pioneer Employer Hospitals are diverse in manyways – they are large and small, rural and urban,union and non-union. What unites them is that theyall saw their own frontline staff as underutilizedassets, and decided to invest in them. Not simplybecause it’s the right thing to do, but because theyrealized these employees are critical to their organi-zations’ future. And they have taken unusually con-fident steps in developing these employees into amore integrated part of the care team.

To understand the focus on frontline workers, it mayhelp to look at a tipping point in a very differentindustry. In the book Moneyball, Michael Lewis

depicted the unlikely rise of the Oakland Athletics, atthat time the team with the second-lowest payroll inbaseball. Despite money woes, the A’s made theplayoffs for three years running with players every-one else overlooked and underrated.

How did they do it? The A’s found their own under-utilized assets: through statistical analysis, they iden-tified players whose skills went unnoticed by the restof Major League Baseball, and they put those play-ers in a position to shine. However, the advantagewas not one they could keep to themselves indefi-nitely. The book tipped off a revolution within thefront offices of baseball teams, and changed theway that players have been evaluated and devel-oped ever since.

While health care is undoubtedly more complexthan baseball, the same core business rule – makingthe most of underutilized assets – remainsextremely relevant. And like baseball, the singlemost important resource in health care is people.We believe the Pioneer Employer Hospitals are likethe Oakland A’s –because they’re championship cal-iber, the game is changing, and they’re out in frontof it. This toolkit puts their playbook in your hands.

Barbara DyerPresident and Chief Executive OfficerThe Hitachi Foundation

IMPLEMENTATION TOOLKIT Developing Your Own Pioneer Program 1

The Pioneer Employer Initiative is based on the idea that employers who dogood, do well. It is an effort to discover and promote the next generation ofbest practices in workforce management, with a particular focus on healthcare and manufacturing. Pioneer Employers are companies that strategicallyinvest in their own lower-wage workers to benefit their customers and/orshareholders. They go beyond typical ideas about “great places to work,” anddemonstrate how organizations can deliberately align the interests of employ-ees and management to create better results for companies and theiremployees. More information about the Pioneer Employer Initiative, includinglinks to all of its products, can be found at www.pioneeremployers.com.

This Implementation Toolkit is based upon in-depth case studies of 11 PioneerEmployer Hospitals selected for their diversity and the quality of their pro-grams to develop the careers of their frontline workers. It is designed to helpexecutives who anticipate facing specific workforce challenges to:

■ Quickly identify the type of Pioneer Employer Hospital program that couldhelp (Chapter 1 – Implementation Guide);

■ Understand how other organizations have approached similar programs(Chapter 2 – Menu of Key Program Elements);

■ Learn how to work effectively with post-secondary education institutions(Chapter 3 – Roadmap for Collaborating with Education Partners);

■ Answer questions peers may have about the program (Chapter 4 –Frequently Asked Questions); and

■ Delve more deeply into models and theories surrounding this work(Chapter 5 – Recommended Reading).

Researchers from the University of North Carolina’s Institute on Agingdesigned the qualitative research methodology to collect data from participat-ing hospitals. These included more than 100 key informant interviews andextensive organizational surveys focused on both quantitative and qualitativedata. The research team analyzed the data and wrote the case studies. Moreinformation on the methodology can be found in the Summary Report.

INTRODUCTION

Implementation Guide . . . . . . . .2

Menu of Key Program Elements . . . . . . . . . . . . . . . . . . . .8

Roadmap for Collaborating with Education Partners . . . . . .14

Frequently Asked Questions . .23

Recommended Reading . . . . . .30

Contributors . . . . . . . . . . . . . . . .32

CONTENTS

The Implementation Guide is designed to provide you with abroad snapshot of the types of outcomes, challenges, and suc-cesses that were found in the Pioneer Employer Hospital project,and then direct you to more detailed information about the spe-cific case studies you may find interesting. It begins with anoverview of the outcomes and program elements that werecommon amongst all the Pioneer Employer Hospitals. It is thenorganized by the four types of Pioneer programs:

■ CREDENTIALING PROGRAMS – training resulting in new credentials

■ JOB-SPECIFIC TRAINING – cross training or adding new skills■ BASIC SKILLS – preparing employees for work and college ■ LEADERSHIP DEVELOPMENT – developing leadership skills

For each program, the toolkit summarizes the following:■ A brief definition of the program,■ Common outcomes from this program,■ Types of workforce challenges this program could address,

and■ Common elements for success.

IMPLEMENTATION GUIDE


Regardless of the type of Pioneer Employer Hospital program you considerimplementing, there are commonalities that the researchers found across all ofthem. These include:

Common Outcomes■ Increased engagement and reduced turnover

■ Increased strategic use of professional development funds resulting in morespecific and traceable outcomes

■ Improved recruitment and increased competitiveness in hiring talent

■ Improved quality and efficiency

■ Increased patient satisfaction

Common Elements that Help Promote a Successful Program■ Career coaching

■ Place students into cohorts and use other strategies that encourage peersupport

■ Organizational history of promoting from within

■ Strong partnerships with necessary external partners

■ Key human resource policies such as: tuition assistance for everyone, benefits available to 0.4 to 0.5 FTE employees, and advance paymenttuition assistance

■ Flexible scheduling to allow participation

■ Supervisor involvement at multiple stages including helping design the pro-gram, selecting participants, job shadowing, flexible scheduling, as well assharing the success of students

■ On-site education and training programs

COMMON OUTCOMES AND PROGRAM ELEMENTS

4 Developing Your Own Pioneer Program IMPLEMENTATION TOOLKIT

Commonly Achieved Outcomes■ Faster on-boarding

■ Strengthened integration of education and practice

■ Improved recruitment

■ Better fit between the employee and job

■ Workforce stability

Workforce Challenges this Addresses■ Your talent needs fluctuate (these programs can be sized regularly to

meet evolving talent needs)

■ You need to reduce orientation and other on-boarding costs

Key Elements of Success■ You have or can create realistic career ladders for employees

■ Build non-job-related skills into the curriculum, such as work readinessskills

■ If possible, customize the training to meet your specific needs

■ Identify a dedicated coordinator

■ Make the training program longer so part-time workers do not get over-whelmed

■ Make sure candidates are a good fit for the job/department before theyare selected for training

■ Provide in-house mentors

■ Support supervisors and managers by allowing them greater use of floatpool or overtime while their employees are in training

Hospitals Using This■ Bassett Medical Center

■ Beth Israel DeaconessMedical Center

■ Good SamaritanHospital

■ Group HealthCooperative

■ Providence St. PeterHospital

CREDENTIALING PROGRAMSAny accredited training resulting in a new academic credential. The training can be providedin-house by qualified employees or in collaboration with an external partner, such as a com-munity college.


Commonly Achieved Outcomes■ The ability to use staff more flexibly through cross-training

■ Increased skills development results in improved efficiency and quality

■ Work and learning are integrated

■ New graduates have increased productivity

■ The ability to integrate mission and values into the training

■ Improved care delivery and/or innovative care delivery staffing models

Workforce Challenges this Addresses■ You need to improve quality and/or skills in a specific department

■ You want to create additional steps on a wage ladder

■ You need staff who are prepared to work in multiple jobs

■ Your talent needs fluctuate (these programs can be sized depending onneeds)

Key Elements of Success■ Use standardized competencies

■ Ensure structured training is tied to rewards

■ The ability to translate needed skills into competencies and training pro-grams

■ Support excellent communication between human resources and man-agers

■ Use portfolios to document achievements for career progression

■ Use or create wage progression to incent employees

■ Incorporate participatory decision making

■ Support supervisors and managers by allowing them greater use of floatpool or overtime while their employees are in training

Hospitals Using This■ Beth Israel Deaconess

Medical Center

■ Faxton-St. Luke’sHealthcare


■ Providence St. PeterHospital

■ Thompson Health

■ Virginia Mason MedicalCenter

■ The University of NorthCarolina Hospital

JOB-SPECIFIC TRAININGTraining workers to move up in their current jobs or cross-training workers to fulfill multipleroles/tasks/responsibilities


Commonly Achieved Outcomes■ Increasing workforce diversity

■ Building a pool of incumbent workers who can address shortage areas inthe future

■ Increasing communication skills

■ Increasing patient satisfaction

■ Acquiring external funding to help support the programs

Workforce Challenges this Addresses■ Your organization’s diversity is confined to entry-level positions

■ High turn-over in entry-level positions is a problem

■ You have a significant number of workers who lack the math and/orreading skills to fill mid-level positions

Key Elements of Success■ Partner with community-based organizations that have funding and

expertise with these programs

■ Provide culturally appropriate curriculum

■ Offer career navigation

■ Proactively assist and support exploring and enrolling in college

■ Identify and share the accomplishments of frontline workers who partici-pate in training

■ Break large goals into more achievable smaller goals

■ Blend soft-skills training into the basic skills, such as how to call-in sick

Hospitals Using This■ Advocate Lutheran

General Hospital

■ Beth Israel DeaconessMedical Center

■ Faxton St. Luke’sHealthcare

■ NorthwesternMemorial Hospital

BASIC SKILLS DEVELOPMENTHelping workers acquire the basic academic skills needed to succeed at work, and/or enterformal college degree or certification programs.


Commonly Achieved Outcomes■ Improving management skills

■ Integrating work and learning

■ Creating a formal pipeline of future leaders

■ Strengthening the skills of informal leaders

Workforce Challenges this Addresses■ Your organization needs to enhance its leadership pipeline

■ Your organization needs help communicating the “bigger picture” toemployees

Key Elements of Success■ Careful selection process

■ Project-based learning that impacts the organization

■ Group projects

■ Formal mentorship program

Hospitals Using This■ Faxton St. Luke’s

Healthcare


■ Virginia Mason MedicalCenter

LEADERSHIP DEVELOPMENTIdentifying potential leaders and providing them with the skills they need to assume leader-ship roles in the future. These programs are generally not limited to individuals in clinical positions.

MENU OF KEY PROGRAM ELEMENTS

Building a successful training program for frontline workers canseem overwhelming at first. The purpose of this chapter is tohelp you identify some meaningful, yet manageable first stepsto take in getting started. This menu of practices representssome common steps taken by health care organizations thathave successfully targeted the skill development and careeradvancement of frontline workers in meeting critical skills orworkforce gaps, improving care quality, and/or enhancing workprocesses. No one hospital implemented all of these practicesand each tailored the strategies to comport with their ownhuman resource functions and workplace cultures. As you moveforward with your workforce strategy, this chapter will help iden-tify and surmount common barriers, build support, and developa work climate conducive to successful implementation.


DEVELOP A CULTURE OF LEARNING

It is difficult for clinically focused professionalsto add one more thing on their already fullplates. Having a program coordinator or teamdedicated to running the credentialing, job-specific training, basic skills, and/or leadershipdevelopment programs for frontline workerswas critically important for most of the hospi-tals we profiled. Even if you cannot afford afull-time person, dedicating a portion of oneperson’s time - as little as .25 FTE - can helpimmensely. Some first steps a person in thisposition can take include:

■ Be the single point of contact for pro-gram inquiries from potential partici-pants and managers/supervisors.

■ Identify and work with educationalproviders to develop curriculum andcourse content keyed to organizationalskills gaps or workforce needs.

■ Work with human resources to helpdevelop or enhance competency-basedjob classifications and career ladders/lat-tices so that all employees can advancetheir career through education.

DEDICATE STAFF TIME TO PROGRAM COORDINATION

Each hospital in our study spent a significantamount of time and energy developing a cul-ture of learning that extended throughout alllevels from the environmental services techni-cian to the CEO. The most successful are builtupon existing core values and aligned with theorganization’s strategic priorities. For example,one hospital used the story of their CEO whorose through the ranks, and connected that tothe importance of workplace advancementthrough education.

Other first steps you might try:

■ Value and publicly acknowledge any andall learning. Learning makes the teamsbetter, the care better, and the organiza-tion better.

■ Celebrate successes. Plan the celebrationsin advance, so busy managers can attend.

■ Take advantage of teachable moments.Allow everyone to have a chance atlearning new skills and acquiring newknowledge.

■ Create time and space at work for learn-ing (e.g., coaching circles, brown bags,seminars, and on-site classes). All learn-ing is not necessarily convenient but ifyou work together you can find periodsduring work time to accommodate thelearning process.


■ Help workers seeking education andadvancement navigate the barriers tosuccess, from applications through gradu-ation and transition to new jobs.

■ Help supervisors develop successionplans within their own departments.

■ Track program data to evaluate, improveand understand the returns on theinvestment to the organization.

■ Communicate all aspects of educationand training within the organization tostakeholders – and celebrate every success.

Most hospitals provide tuition assistance andother financial support for employee educa-tion, but relatively few have a deliberate strat-egy for doing so. Taking the time to developsuch a strategy is a big part of what separatessuccessful workforce programs from the restof the pack. The following policies and prac-tices have each been used by several of theprofiled cases to support workforce develop-ment for frontline workers.

■ Provide tuition assistance that is:

● Available to all employees (not justprofessional staff );

● Offered for all stages of the learningprocess depending on where theworker is on his/her career path (e.g.,basic skills development, certification,or degree programs); and

● Provided as an advance or by directbilling from the college partner suchthat workers have minimal to no out ofpocket cost to serve as a barrier. Tuitionassistance can also take the form ofloans, which may be repaid through

payroll deduction upon the employee’sadvancement to a higher wage level.Or they may be forgivable throughcompletion of a specified period ofservice in the higher-skilled position.

■ Reduce FTE required to qualify for bene-fits, particularly health insurance. Somehospitals in our study providedemployee learners the opportunity toreduce work hours but maintain healthbenefits while completing educationalprograms (e.g., at .4FTE or .5FTE), up tothe level of nursing. These programsachieved very high graduation/comple-tion rates, and saw significantly lowerturnover as well.

■ Institute scheduling flexibility or self-scheduling. This can be achieved eitherformally through self-scheduling practices,or informally through working with super-visors/managers to accommodate classtime, clinical placements (where applica-ble), and test/study time as needed.

INSTITUTE STRATEGIC HUMAN RESOURCES POLICIES


■ Other paid support. Strategies related topaid support varied across hospital sites.Some allowed workers to take classes onwork time. Others split the time withworkers at the end of shift to supportclass attendance but also to make sureworkers had a personal investment in the

programs. Depending on the nature ofthe frontline worker’s job, some hospitalsalso provided a budget (separate fromthe departmental budget) to providebackfill so that departments were notunderstaffed while employee learnerswere in class.

Frontline workers often face persistent barriersto education and advancement based on lim-ited household earnings and the complicationof managing work, personal, and education-related responsibilities simultaneously.Recognizing their particular needs can helpdismantle these barriers. Some of the waysthis can be accomplished are as follows:

■ Design curriculum to be culturally sensi-tive based on the language, culture, anddemographics of the communitiesserved by the hospital.

■ Provide tailored pathways for English asa second language workers to reachappropriate education based on prioreducation experience rather than justbased on language barriers.

■ Develop experiences for potential appli-cants that reduce education anxiety, acommon barrier for frontline workers.These experiences could include tours ofthe local college, informal meet andgreets with instructors/managers, andpanels or celebratory events whereworkers share their own success stories.

■ Provide career coaching to help employ-ees bridge gaps in knowledge aboutwhat is possible and what pathwaysmake sense for them. For example, atone site, the program coordinatorhelped workers identify their interests,discover career options within the hospi-tal related to those interests, and pro-vided detailed guidance and supportrelated to achieving short- and long-term career goals (e.g., registering forclasses, preparing a resume, negotiatingschedule changes with supervisors, andarranging for childcare).

■ Cultivate mentoring, precepting, and/orresidency programs that can help createhighly supportive cultures of learningthroughout a department. The managersor experienced workers that are pairedindividually or through a structured pro-gram can provide students with a realis-tic preview of the jobs they are trainingfor and give them real-world advice ashow to navigate obstacles.

RESPOND TO THE NEEDS OF FRONTLINE WORKERS


■ Provide basic skills programs to helpmotivated workers achieve the skills nec-essary to succeed in college-level course-work (e.g., School at Work® programs orstipends associated with improved scoreson standardized achievement tests suchas COMPASS or WorkKeys).

■ Provide opportunities for peer supportto emerge. A sense of camaraderie andsupport can go a long way to helpingemployee learners succeed. Paying spe-cial attention to cohort creation, pairingemployees who often work together, and

scheduling to reinforce potential peersupport within cohorts of learners, oftenhelps workers overcome obstacles tosuccess.

■ Provide space, where possible, for class tohappen on-site (or at a convenientlylocated site close by) at a time that is bestfor the workers. This goes a long way toreduce logistical barriers (e.g., transporta-tion, childcare, or shift work) that makesregular college more difficult for manyemployee learners.

Make sure there is strong support and participation from the executive level

OTHER KEY INGREDIENTS TO KEEP IN MIND

Unsurprisingly, the visible support of seniormanagement has been critical to the develop-ment and sustainability of many workforcedevelopment programs. In addition to approv-ing and funding new and on-going programs,many executives in our study take time out oftheir busy schedules to make presentationsabout their departmental operations, mentionprogram successes in high-level meetings,participate in celebration events, and share

their own career growth stories. This sets thetone for other management to be supportiveand involved in creating opportunities foremployees. In getting that support, it is essen-tial to make sure that the workforce develop-ment approach you select helps realize yourorganization’s strategic priorities - which inturn can help you determine the metrics thatyou need to track.


Make sure there is support from managers/supervisors

Similarly, the support of managers and super-visors is critical to success – without their fullengagement, any workforce initiative is likelyto fail under the weight of everyday pressures.This is one of the reasons that dedicatedcoordinators are so critical. They are able tooffload program-related work (e.g., coun-selling employees, providing information oncareer pathways, and tracking outcomes) thatwould fall to managers in their absence.Dedicated coordinators balance program participation with the day-to-day needs of

individual departments, and implement robustcommunication plans to keep everyoneengaged and informed. The essential element,however, is to keep managers involved: inplanning/logistics, in scheduling, in the selec-tion process, even in conducting training. Itcan also help to allow supervisors to use floatpool workers or overtime to fill in staffingneeds when workers are in class. Finally, con-sider formal training for managers in commu-nication, teaching, and/or coaching.

Develop strong partnerships

The majority of the workforce developmentprograms profiled in our study engaged edu-cational partners to assist organizations indeveloping or implementing training andeducation for frontline workers. Partneringwith local educational institutions pools

resources to increase returns on investment,and in the end, reduces the burden on anyone partner (See Roadmap for Collaboratingwith Educational Partners for a primer on theculture, organization, and financing of post-secondary organizations).

ROADMAP FOR COLLABORATING WITHEDUCATION PARTNERS

In almost all cases, mounting a successful workforce develop-ment effort for frontline workers requires close collaborationbetween the educational partner (e.g., community college, four-year college, and training provider) and the employer. This chap-ter shares lessons learned from studying such partnerships, andhelps you understand how to build such a partnership yourself.This includes discussions about the potential benefits of thesepartnerships, what your partners are likely looking to get out ofthe collaboration, and some key information on the funding andaccountability structure of educational institutions.

In order to create an effective partnership, it is important toknow your partner in terms of motivation, structure, and incen-tives. There are many cultural and organizational similaritiesbetween higher education providers and hospitals. Both tend tobe hierarchical institutions that rely on highly educated workers.Multiple public and/or private bodies usually regulate both.Similar to managed care payments for health services, somepublic educational institutions are paid a flat amount for educat-ing students, regardless if the student participates in a low-costprogram such as English, or a high-cost program such as nurs-ing. Finally, whether unionized or not, both types of organiza-tions tend to have multiple stakeholder groups with which tonegotiate.


THE BENEFITS OF COLLABORATION

In discussing potential collaborations withboth internal and external partners, it isimportant to understand what each partycould get out of a successful partnership.Tremendous benefits await both educationalpartners and health care employers consider-ing a collaboration. These partnerships can:

■ Align educational offerings and localworkforce needs. Programs developedwith health care employers for incum-bent workers allow educational partners,such as community colleges, to developcourse content and pathways that canbe expanded and integrated into regularcourse offerings.

■ Integrate education, research, and prac-tice. This integration means that the rapidinnovation (e.g.,

evidence-based practice, technologicaladvances, and electronic medical records)experienced by health care employers isreflected in educational content or inpractice rotations.

■ Reduce startup time and lay groundworkfor subsequent collaborations as collegepartners become familiar with the needs,preferences, and workplace culture ofyour organization.

■ Attract new resources and leverage exist-ing resources to promote economicdevelopment for communitymembers/incumbent workers.

When you approach an educational provider, ithelps to know what they might value from thepartnership. These partnerships can result in:

“The biggest benefit to this institution would be the relationship it buildswith the employer. Because medical assistant is one program that this institution offers – that’s what we’re doing with Virginia Mason. VM alsoemploys nurses. We train nurses. VM employs surgical technicians. Wetrain surgical technicians. If the employer has a good experience with us,and, more importantly in this venture, gets an employee who’s what theyneed, who’s skills are good, and has a good work ethic, they’re moreinclined to come back to us for our other programs because they view usas a quality provider of training good workers. So that’s the benefit for us.”

MARTY HEILSTEDTVICE PRESIDENT OF INSTRUCTION, RENTON TECHNICAL COLLEGE


■ New pools of students. Collegeenrollment tends to increase during peri-ods of high unemployment and decreaseduring periods of low unemployment. Bypartnering with employers to learn howto better serve incumbent workers, col-lege administrators will learn strategiesthat could help them deal with the vex-ing problem of balancing the enrollmentfigures regardless of the economy.

■ Increased course offerings for allstudents as a result of curriculum devel-opment projects.

■ Improved course completion rates,which tend to be significantly better forincumbent worker programs. Thesenumbers are key metrics for many edu-cational partners and this improvementhelps them meet their target numbers asan organization.

■ Better alignment between depart-ments/divisions within the institu-tion. For example, credit-based andcontinuing education or adult basic edu-cation departments often develop moreintegrated approaches to meet the needsof low wage incumbent workers and theiremployers.

■ New faculty. Your senior employees willdevelop relationships and learn aboutoptions to become part-time instructorsat local colleges.


KEY PRACTICES TO WORKING WITH EDUCATIONAL PARTNERS

Cultivate buy-in from top-level administratorsSuccessful workforce development collaborations often require systemschange within both partners. Making this happen requires an educationalprovider who prioritizes relationships with industry and understands the needsof frontline employee learners. Just as it is important to have high-level buy-infrom hospital leaders, it is essential to work directly with someone in the col-lege with positional authority. High-level administrators such as vice presi-dents/deans/directors are able to get approval from key gatekeepers (e.g.,curriculum review committees, accreditation bodies, and professional stan-dards bodies) whose buy-in is critical to developing new programs. Employersshould also look for a partner who emphasizes active experiential learning(rather than traditional lecture orientations) and is flexible enough to accom-modate needs related to timing (e.g., off semester schedule), scheduling (e.g.,at convenient times for employee learners and their departments) and loca-tion (e.g., on the work site).

COLLEGE PRESIDENT: The college president is essentially theCEO of the college. He/she is the liaison between the board oftrustees and/or the state level community college system andthe administration of the college. Depending on the size andbreadth of the academic programs offered, the president canplay a large role his/herself or delegate the administration of ac-ademic duties to the deans. Regardless of the day-to-day role inacademics, the president will have a role in appointing commit-tees and final decision-making related to academic programs.The president has additional public relations and developmentresponsibilities as the leader of the organization as well. It is alsopossible that the president has a role to play in lobbying efforts.The president, or his delegate, leads strategic planning for thecollege.

PROVOST OR VICE PRESIDENT OF INSTRUCTION: The provostor vice president of instruction is the top executive for academicaffairs. This person has broad authority over the quality andcontent of academics and the vitality of academic programs.While this person has high positional authority, colleges oftendraw on the recommendations of deans/directors of academic disciplines and committees that are constituted by faculty.

VICE PRESIDENTS/DEANS/DIRECTORS: These titles often corre-spond to high-level executives. Their positional authority de-pends on the unit to which they are attached. Vice presidentsare usually named to units that are not academic units (e.g., Vice President for Instructional Technology or Vice President ofFinance). Deans sit over academic units, usually schools (e.g.,Dean of Health Sciences) whereas directors (also sometimescalled chairs or coordinators) preside over departments or institutes within such units (e.g., Director of Workforce Development).

PROGRAM MANAGER/PROJECT DIRECTOR: These titles areoften used for those who are leading externally funded grants orcontracts within colleges. They rarely have high positional au-thority unless they have another high-level title (see above).These individuals are often responsible for meeting the require-ments of grants or contracts as proposed by the college. If theyare well integrated into the college, they can have strong tieswith departments, particularly those associated with continuingeducation or workforce development units. Sometimes thesepositions are temporary and are released once grant or contractfunding ends.

COMMON ACADEMIC ADMINISTRATOR TITLES AND ROLES


Understand the level of academic flexibility requiredWhatever type of workforce development approach you choose, getting col-lege credit for your students is an important consideration. Credits can helpyour employees develop meaningful career opportunities, and also havefinancial and other implications for the educational provider. From their stand-point, the process of developing credit-bearing courses and pathways is oftengoverned by state rules as well as by external accrediting agencies, similar tothe Joint Commission. Whether public or private, these regulations typicallydescribe the instructors’ educational credentials and the rigor of the coursework. While credit-bearing units are less flexible than employer-oriented con-tinuing education units, these credentials can also have implications for you.For example, credentials sometimes determine how and if services deliveredby workers are “billable” to insurance by the health care provider. To managethis sensitive topic, it helps to have upfront conversations about collegerequirements for documenting academic rigor (e.g., articulating course goalsand competencies achieved) and to make sure that employee learners do notget caught without necessary preparations to continue on the career path-ways. For example, workers who take college courses at the worksite yet donot have the test scores required for admissions may not qualify for the cred-its. Knowing these requirements will help you avoid having students who aredelayed or stymied. Further, it is important that students and employersunderstand what prerequisite coursework may be needed prior to entering acreditworthy career ladder program. You will need to understand when edu-cational partners can waive these prerequisites versus requiring students tocomplete them. You will also need to come up with appropriate selectionrequirements, and find ways to help students who need to increase basic skills(contextualized to their particular pathway if possible).


Understanding the revenue structure of youreducational partnerFunding models for educational institutions vary greatly across institutions andstates. Community colleges have various funding streams and thus differentaccountability metrics. Understanding these streams and the metrics involvedare important when developing mutually beneficial partnerships (and out-come measures). For instance, direct state support for community collegesranges widely from lows in the teens to over 50 percent of the budget.Community colleges with low levels of state support must raise tuition (whichdecreases access) or find grant or contract support to make up for lack ofstate support. Grant or contract support requires community colleges to fulfillthe specific purposes of that funding in addition to their main mission. Finally,some states have appropriations tied to performance, similar to Value BasedPurchasing. This means that these colleges are keyed to particular metrics bywhich they receive their performance-based portion of funding. Colleges withhigh levels of state funding are often focused on headcounts of studentsserved, which illustrate to state policymakers the impact of the college on thecommunities. Performance-based funding, in contrast, encourages a focus onstudent success metrics. Understanding the revenue structure and outcomemetrics important to your educational partner may give insight into how tocollaboratively design workforce development programs.

Leveraging resources between institutions that aligninterests and promote communicationFormalizing relationships between employers and educational providers oftenhelps partnerships succeed. Some strategies for building such a formalarrangement include:

■ Paying to increase the number of faculty for high-demand programs.This is often a strategy used for nursing pipeline programs where nursingprograms are already filled to capacity with students and offering addi-tional classes for incumbent workers means they need additionalresources for faculty salaries.

■ Developing contractual relationships whereby employers are directlybilled for the tuition of their employees. As mentioned previously, thisstrategy reduces out of pocket burden for frontline employee learners.

Formalizing relationshipsbetweenemployers andeducationalproviders oftenhelps partner-ships succeed.


■ Making your own qualified professional employees, such as nurses, avail-able to teach, either through creative employment agreements or byfacilitating an employees’ second job as faculty. Sharing employees/fac-ulty in this way increases the alignment of the content to the practices(e.g., technology, job descriptions, and scope of practice of position) ofthe specific health care employer. It also provides a vehicle for employersto have a voice in the revision of the content or processes of the educa-tional partner. You and/or your college partner may need to navigatecollective bargaining agreements, if applicable, to implement this tactic.

■ Increasing the visibility of both organizations by co-hosting recruiting,informational sessions, or health fair events across organizations (e.g.,sharing pools of potential employees and students).

■ Finally, draw on the strength of your local community. Community basedorganizations and local non-profits have programs aimed at economicdevelopment in local communities. These organizations often haveknowledge of local vulnerable populations and strategies in place toassist community members to get ahead (e.g., scholarships, basic skillsaccrual programs, and English as a second language offerings) that couldbe leveraged as your programs are developed.


Advocate for practices that support your employeelearnersBelow is a list of potential practices that educational partners can put in placeto meet the needs of frontline employee learners in the context of your work-force development program.

■ Create collaborative and active learning environments. Adultlearners do better in collaborative learning environments than with tradi-tional authority-oriented teaching techniques. Incorporating input fromstudents and their supervisors into course design, timing, scheduling,and implementing active learning strategies (e.g., role playing, work-related assignments, facilitated discussion, and group work) will helpthem succeed.

■ Allow workers to test out of courses by demonstrating compe-tencies. Acknowledging skills gained through work experience andreviewing workplace training curriculum for overlap with completed edu-cational coursework are potential strategies for awarding credit for priorlearning.

■ Create flexible pathways to certificate/degree completion. Just asflexible work scheduling can help workers thrive while pursuing educa-tion, flexible coursework can help them manage the competing demandson their time, while also easing the pressures on their supervisors.Examples of coursework flexibility include: providing multiple options forbundling courses to fulfill certificate/degree requirements; allowing stu-dents to complete degrees on a part-time basis; articulating non-creditcourses with for-credit coursework; and extending time limits for comple-tion and expiration of credit.


■ Offer evening, weekend, end of shift, and/or online courses. Onthe same note, finding the time to attend class is a barrier for low-wageworkers, many of whom work two jobs or have family responsibilities.Providing classes on-site, online, and at times when transportation andchildcare are easily extended (e.g., end of shift) helps removes this bar-rier, and gives workers the opportunity to achieve something that other-wise might not be possible.

■ Expand student services to include coaching. Mentoring can be asimportant for frontline workers as it is for advanced professionals.Extending academic advising to include coaching on navigating work,education, and personal lives helps workers manage these competingdemands more effectively. Interaction with college professionalsdecreases education anxiety for employer learners and helps them gainfamiliarity with the resources available to them. Providing services orreferral information related to childcare, transportation, and finances areexamples of coaching areas especially relevant for low-wage employeelearners. College faculty also appreciate coaching as it improves studentperformance and allows faculty to more fully concentrate on teaching.Finally, coaching is also a way to keep graduates of your workforce pro-gram engaged as you move on to develop future cohorts.

Workforce programs for frontline health care workers represent a greatopportunity for both educational institutions and health care employers, and itmakes sense to approach that opportunity with collaboration in mind.Educational partners have important resources (e.g., basic skills developmentprograms, career counselors, and curriculum development specialists) that canhelp employers develop long range plans for their staffing and successionmodels. And health care employers can help educators tap a large new mar-ket with the promise of improving their completion rates and balance outdrastic enrollment fluctuations driven by the economy. The strategies outlinedhere can help program planners get a jump-start on developing successfulcollaborative workforce development programs for frontline workers andavoid common pitfalls.

FREQUENTLY ASKED QUESTIONS


WE DON’T HAVEWORKFORCESHORTAGES. WHYARE WE DOING THIS?

The economic collapse that beganin the fall of 2009 created wide dis-ruption in labor markets across theUnited States. In health care, work-ers asked for more shifts, previouslyretired workers returned to work,and people held on to their jobseven if they were dissatisfied. As aresult, vacancy and turnover ratesare at historic lows across the indus-try. But the demographic issues thathad been driving concerns aboutworkforce shortages prior to 2009have not diminished, and in manyplaces the recession has exacer-bated them.

Workforce shortages are less expen-sive to prevent than repair.Organizations that plan for themhave the luxury of implementingmore sustainable solutions andspreading costs over a longerperiod of time. Those that wait forthe shortages to impact businessstrategy have fewer tools availableand will absorb high costs in ashorter period of time.

WHY SHOULD THIS BE A PRIORITY FOR OURORGANIZATION?

This should be a priority becausefrontline workers have a consider-able amount of patient contact.Beginning October 2012, Medicareimplemented value-based purchas-ing, withholding one percent of hos-pital payments to be distributed asbonuses to hospitals scoring aboveaverage on several measures.Patient satisfaction scores will deter-mine 30 percent of the bonus, whilequality factors will determine thebalance.

To earn above average scores, hos-pitals will need above average

strategies. Providing career devel-opment opportunities to frontlineworkers is a proven strategy thatimmediately reaps improvedengagement for affected workersand impacts those around them1. Inthe medium- to long-term, hospitalsengaging in these strategies will beable to recruit individuals interestedin developing careers rather thanthose just interested in a job,thereby bringing additional talent tothe workforce, such as critical think-ing skills, without necessarilyincreasing wages.

1Gallup Strategic Consulting has studied engagement extensively. More is available athttp://www.gallup.com/strategicconsulting/employeeengagement.aspx


WHAT WOULD WEGET OUT OF THISINVESTMENT?

There are many reasons why organi-zations begin this work; but theygenerally boil down to two buckets.First, most health care leadersacknowledge that they have cadresof smart, talented people trapped inentry-level jobs. Many of these folkshave been with their organizationsfor multiple years. These workershave a deep knowledge of theorganization, have bought into themission and culture, and are com-mitted.

Second, organizations of all stripeshave workforce issues. Today’shealth care organization is rapidlyevolving and the need for talent willevolve with it. Regardless of aggre-gate vacancy or turnover rates,these challenges often crop up atthe unit or department level.

The Pioneer Employers have docu-mented that by addressing both ofthese challenges simultaneouslythey create significant positive out-comes for their organizations. Byinvesting in the career developmentof their frontline workers they reapsolutions to vexing workforce chal-lenges. They fill their talent needswith individuals who will not leavethe organization because of a poorfit with its mission or culture. Theyreduce orientation time becausethese “new” hires bring multipleyears of experience and history withthe organization. And they increaseengagement, loyalty, and quality notjust with these workers, but also withtheir co-workers who suddenly rec-ognize new opportunities to turntheir jobs into careers.

WHY DO SOME OFOUR EMPLOYEESNEED MORE HELP?LOTS OF PEOPLEIMPROVE THEIRCAREERS ON THEIROWN.

Tuition reimbursement programs aretypically not helpful to workers livingpaycheck to paycheck. They havedifficulty fronting the money to payfor tuition, books, and supplies. Ourcase studies demonstrate thatorganizations that pay tuitionupfront often see significantly highergraduation/advancement rates forfrontline workers.

Second, employees that have littleor no experience with the post-secondary education system can beintimidated and confused abouthow to access their services. Helpnavigating post-secondary educa-tion can pay dividends by removinga barrier that was preventing anemployee from making greater con-tributions to their organization.


WHAT IS TO PREVENTEMPLOYEES FROMLEAVING THECOMPANY AFTERTHEY RECEIVE THETRAINING?

A more common reaction amongstemployees who have benefitedfrom enhanced career developmenthelp is increased loyalty. Hospitals inthe Pioneer Employer Hospital studyexperienced lower turnover, at leastpartly attributable to their careerdevelopment work. In particular, vol-untary turnover was decreased.

Even so, most employers thatembark on this work set up strategies

to protect their investments. Somechoose to ask participating employ-ees to commit to work for theirorganization for a certain number ofyears or else pay off the organiza-tion’s investment. Others offer forgiv-able loans to participatingemployees. Either approach estab-lishes clear expectations in the frontend and helps the organizationsinvest in employees who are trulycommitted to staying.

I’M A MANAGER ANDI CAN’T AFFORD TOLOSE MY BESTPEOPLE TO WORK INOTHER AREAS OFOUR ORGANIZATION.WHY SHOULD ISUPPORT THIS?

There are many reasons why man-agers support these types of pro-grams. One of the most broadly feltis that managers want to rewardtheir best employees and believethere is no better way than by help-ing them along in their careers.Managers also report that as theword gets out about their supportfor these programs, they begin toget applications from candidateswho bring more engagement andcritical thinking to their positions.

Many of the programs studied offermore staffing flexibility as employeesbring new skills to the workplace.Morale can increase as existingemployees begin to understand thecareer options available to them.Finally, while voluntary turnover in aspecific unit may slightly increase it’sworth noting that these programsrun several months to several yearsin length, which leaves plenty oftime for managers to plan for even-tual departures.


IS THERE REALLYDEMAND FOR THIS TYPE OFBENEFIT IN OURORGANIZATION?

Many health care organizations offertuition reimbursement and somefind that these benefits are not fullyused by employees. Howeveremployers are frequently surprisedat the demand for a program thatoffers real opportunity for career

advancement. For example, one ofthe employers in this study offered aprogram to train incumbent workersto become nurses and had over tentimes the number of applicants, asthere were available slots.

WE CAN’T AFFORDTHIS. WHO CANHELP?

These programs can be expensiveand, while many employers find thereduced turnover, improved recruit-ing, and increased engagementworth the investment, there areexternal stakeholders who can help.Even in the current downturn, publicfunding can be found to help entry-level workers with career progres-sion. Community colleges oftenhave access to state or federal dol-lars that can be used to subsidizetraining. Workforce investmentboards, using federal, state and pri-vate funds, can provide resourcesthat help offset the costs of training,as can United Ways and many com-munity-based organizations. Finally

the state and local divisions of eco-nomic development occasionallyhave access to funding that canhelp.

Some health care employers havefound success acquiring funding byforming collaborations with otheremployers that wish to operate simi-lar training programs. Because theseprograms often have a fixed cost –the instructor – it tends to cost thesame if one person participates or15 people. For this reason, a largercareer development program span-ning multiple employers can helpreduce the cost per employee aswell as attract external resources.


WE DON’T HAVE THERIGHT PEOPLE ONSTAFF TO DO THISTYPE OF WORK. WHOCAN HELP US?

Many of the same organizationsthat have access to funding tolaunch these programs also havestaff with deep experience designingand implementing successful pro-grams targeted at entry-level work-ers, especially workforce investmentboards, community-based organiza-tions, and some community col-leges. Despite significant talents andsmarts, this population can some-times bring challenges that cannotbe addressed by traditional post-secondary education programsincluding: personal finances, aca-demic preparation and/or previousacademic success, and family commitments.

Working with stakeholders thatunderstand this population and can

demonstrate previous success inplanning and implementing careerdevelopment programs can havemultiple rewards. For example awell-designed program shouldresult in higher student completionrates than those found in traditionalcommunity college programs.

If no external stakeholders arehandy, some organizations haveexperienced success in designingthese programs after senior execu-tives interview the target populationto gauge both their interest andpotential challenges. The RobertWood Johnson Foundation’s Jobs toCareers initiative required applicantsto do this prior to applying andmost found it a rewarding and use-ful investment of time.

WE ALREADYPROVIDE SOMEASSISTANCE, FOREXAMPLE OURTUITIONREIMBURSEMENTPROGRAM, WHYSHOULD WE DOMORE?

During the current economic reces-sion most health care organizationshave found it more cost-effective topurchase the necessary talent in thebloated labor market rather thandeveloping it themselves. However,they also understand that this willnot always be the case. Given thedemographics of the health carelabor market, with its aging work-force and anticipated increase indemand for care, labor scarcitiesand wage inflation will eventuallyreturn. Because these programs take

time to plan, test, and grow, Pioneeremployers have found that it makessense to launch them before theyneed them. The results includedeveloping needed skills while pro-viding a recruiting advantage overlocal competitors.

Some assistance, such as tuitionreimbursement programs, are toocommonplace to provide employerswith the competitive edge for peo-ple or skills that will help them thrivein the coming war for talent.


OUR ORGANIZATIONPROVIDES SIMILARPROGRAMS TOTHOSE STUDIED.WHY WERE WE NOTCHOSEN TOPARTICIPATE?

The purpose of this project was tohighlight some of the best examplesof what is occurring in this field. Weselected organizations that couldprovide a diverse array of premier

examples. Evaluating each of the5,700 hospitals in the United Stateswas not possible nor within theobjectives of this project.

developing your own pioneer program

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