As president of Good Samaritan, a 317-bed adult care community teaching hospital based in Baltimore, MD, Larry Beck faced a dual challenge familiar to many hospital administrators: high turnover and vacancy rates among crucial frontline workers, and an inadequate pipeline of skilled applicants for these essential positions. The national health care workforce shortage is an issue that keeps many a hospital administrator up at night, threatening to reach cataclysmic proportions in the coming decades.
Yet skilled frontline workers, who interact most directly with patients, are often the most difficult type of employees to find and retain. Baltimore is no exception. (Even with the down economy, turnover rates among certain frontline positions like nurse extenders and CNAs approached 20% in 2009 in Maryland. It is widely agreed among health care practitioners that when turnover rates for providers reach double-digits, quality of care is at risk.) Moreover, while the recession has temporarily neutralized turnover and vacancy issues in some areas in the country, in the longer term these are the greatest challenges hospital leaders face. In Maryland, growth for these same frontline jobs approaches 30% for the period 2006 to 2016.
Health care reform will dramatically boost the demand for acute care services within a couple of years, and hospitals are going to have to figure out how to do more with an increasingly scarce supply of direct care workers. In that context, the high costs of an unstable workforce—personnel overtime, expensive pay practices, dependency on temp agencies, low morale and reduced quality of care—will not be sustainable for any hospital.
In short, a new approach is needed.
In Good Samaritan's case, Larry and others recognized an opportunity to take a more proactive role in developing one. In order to leverage available resources and collaborate with local employers tackling similar challenges, Good Samaritan teamed together with Baltimore Alliance for Careers in Healthcare (BACH)*, a workforce intermediary supporting health care providers in establishing worker training and support programs with a "dual customer" approach: helping employees advance their skills and earning potential, and employers to better manage their workforce. Together with BACH and its other partners, a program was developed to recruit and train incumbent hospital employees to become credentialed as nurse extenders. Ron Hearn, Executive Director of BACH, describes the alliance's approach:
Good Samaritan recruited students from environmental, dietary, transportation and other support areas of the hospital, e.g., notoriously "dead end" jobs. Recognizing that traditional classroom-based certification approaches usually do not fit well for this population due to personal circumstances and family care obligations, they adopted a work-based learning approach.
The work-based learning approach emphasizes the workplace and the work process itself as the optimum place for learning, involving methods that capture, document, formalize and reward learning that occurs on the job. Structured expectations and competencies lead to academic credit or industry-recognized credentials for achievement.
Another integral component of the program was the use of coaches assigned to individual students, often selected among nursing staff. Coaches work with students to develop an individual development plan including a career map and timeline — a clear track leading directly to credential, certification, and/or competencies resulting in higher paying jobs. Coaches are both motivators and troubleshooters, often stepping in to help an employee deal with a problem situation before it becomes a management issue. They help the employee address challenges such as childcare and transportation, two issues that routinely keep frontline workers from sticking with their job. In short, they are to the frontline worker what an executive coach is to a corporate leader. JoJo Romero is a nurse educator and coach at Good Samaritan. She describes her coaching role, along with two of the employees she coaches, in this video clip:
In the following video clip, Larry Beck describes how this "grow our own" approach has helped the hospital fill "hot jobs" and achieve significant savings by reducing turnover and decreasing reliance on temp agencies: "We are helping ourselves by helping to develop this talent pool that's going to be needed for the future."
What's more, creating a career ladder has helped employees to acquire new skills, while creating a more motivated workforce, directly correlating to better patient care. Creating a pipeline of well-trained nurse extenders helps to mitigate future shortages while vastly enhancing capacity.
Given its success, similar work-based learning programs are under development for various other positions within Good Samaritan, including nursing Baccalaureate and Master's programs, surgical technician, medical coding and respiratory technician programs.
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Learn more about the work-based learning model employed at Good Samaritan Hospital.
For more information about a national initiative to address the needs of today's frontline healthcare workers while ensuring a skilled and prepared health care workforce for the future, visit Jobs to Careers.
* The Hitachi Foundation supports BACH, as a founding funder of both the National Fund for Workforce Solutions and Jobs to Careers.
