Critical Strategies

Core elements of building career pathways

Key Elements

  • Offer job coaching for new hires and map out potential career pathways
  • Provide tuition assistance for trainings accessible to frontline employees
  • Locate training programs on-site

Job coaching for new hires and mapping out potential career pathways

Providing entry-level workers with job coaching is an important first step in setting them up on a pathway to advancement. Just as the initial application process can be a barrier for candidates, navigating the many departments within a hospital can also be a challenge for employees, especially if they are interested in applying to a new job category. Coaches can help bring to light possible pathways. They can also identify critical skills gaps and help employees find opportunities for getting necessary training. Ultimately, career coaches support employee retention, since they provide soft skills support and help employees navigate the work environment.

Coaching Models

Coaches can be contracted through the workforce intermediary that provided the initial training or hired internally. Coaches employed through intermediaries are often connected to other wrap-around support organizations and have expertise in soft skills support. In Northpoint Health’s On Point Program, a workforce placement effort housed within the health system in Minneapolis, Minnesota, coaching for trainees post-hire is a critical success factor of the program. Client and family services director with NorthPoint Human Services, Sara Lueben has an anecdote that illustrates the importance of this support: “Sometimes the job is the most fragile place to be…We had a case where one of our participants got a great job and a couple weeks into her job, her car got repossessed. Her job wasn’t on the bus line, so she contacted her coach and said, ‘Well I’m just going to quit, I don’t have a way of getting there.’ The coach said, ‘Hold on, don’t quit your job. Talk to your employer. You can tell them you need a couple of days off to get your transportation figured out.’”1Sara Lueben, interview by Katie Parker, April 18, 2016, transcript.

This example illustrates the benefit of having a job coach situated outside of the health system, since employees may feel more comfortable talking to external coaches about issues and obstacles that arise. At Atlanta CareerRise, a workforce intermediary in Atlanta, Georgia, coaches continue to meet with employees six months into their hire. “It reduces risk and takes the burden off of employers if small issues arise,” explained director Dr. Cinda Herndon-King.2Cinda Herndon-King and Helen Slaven, interview by Katie Parker, February 24, 2016, transcript. Advocate Healthcare in Illinois is launching a program that will provide case management support for employees up to a year after hire. University Hospitals (UH) in Cleveland, Ohio also employs this strategy, hiring workforce partner Towards Employment to provide coaching services for six months.

Job coaches can also be hired internally and embedded within the institution. Internal job coaches often better understand future employment needs within the hospital, and can help connect employees to new positions more effectively. This approach helps to ensure that positions do not remain vacant and facilitates employee success. Johns Hopkins University and Health System has job coaches on staff, bolstering the longevity of the coaching program and signaling that staff development is an institutional priority.3Yariela Kerr-Donovan, interview by David Zuckerman and Katie Parker, Baltimore, MD, January 7, 2016, transcript. Hiring job coaches on staff can also be a strategy to institutionalize grant-funded positions.

Mapping out potential career pathways for frontline workers can help to enhance coaching.

Mapping out potential career pathways for frontline workers can help to enhance coaching. Institutions that outline the necessary training steps for employees to advance can help employees and coaches understand the timeframe needed to pursue advancement opportunities and whether they are realistic. Mapping pathways within the institution can also illuminate where lateral pathways might facilitate career advancement. For instance, University Hospitals has outlined specific pathways from frontline positions to career ladders within the institution. A training participant hired into an environmental services role in Step Up to UH (UH’s workforce development program) can participate in training that will allow them to move laterally into the patient care assistant position. From here, they can advance into more higher-level patient care work, and eventually to nursing, taking advantage of tuition support and coaching resources along the way.4Debbi Perkul and Danielle Price, interview by David Zuckerman and Katie Parker, Cleveland, OH, January 11, 2016, transcript

Tuition assistance for frontline worker training

Some tuition support policies only apply to degree-granting programs, which in essence makes frontline workers pursuing other types of training ineligible, even though these employees may benefit most from financial support.

An essential strategy for guaranteeing that local hire pipelines include career paths is to ensure that tuition assistance programs are accessible to frontline workers. Some tuition support policies only apply to degree-granting programs, which in essence makes frontline workers pursuing other types of training ineligible, even though these employees may benefit most from financial support.5Cinda Herndon-King and Helen Slaven interview. Tuition assistance should be made available for certification programs as well as skills-building programs. These include classes in English, literacy, college preparation, and paths to citizenship, as well as hospital-specific certification programs, such as medical coding, patient care, surgery technician training, and phlebotomy specialization, amongst others.

It is crucial that institutions communicate clearly to frontline workers about the availability of these opportunities. One strategy employed by Johns Hopkins University and Health System is to attend all new employee department orientations to present information about incumbent worker training opportunities.6Yariela Kerr-Donovan interview. In addition, it is important that employees become eligible for internal training programs within a reasonable timeframe. Career coaches can also help connect employees to tuition support opportunities. Even if employees will not be eligible for tuition assistance until after six months of employment or later, they can begin working with the career coach early on so that the coach can help them assess their skills and identify trainings they might be interested in. 

Tuition advancement or grants

Since the upfront cost of training programs can be a barrier to participation for frontline workers, as many are hundreds or even thousands of dollars, tuition advancement and direct payment for trainings help make these programs more accessible. Hospitals that provide tuition advancement often ask employees to sign agreements stating that they will work at the institution for a designated period of time after completing the training, and that they will complete the degree program. These accountability measures allow institutions to more clearly trace the impact of what are often costly tuition programs. Other measures include requiring back payments if the employee does not finish or pass the program. With agreements such as these, it is critical that job coaching and academic support be provided to troubleshoot problems as they arise and improve completion rates.

Since the upfront cost of training programs can be a barrier to participation for frontline workers, as many are hundreds or even thousands of dollars, tuition advancement and direct payment for trainings help make these programs more accessible.

An example of adapting tuition payment to help facilitate participation can be found at Partners HealthCare (Partners), in Boston, Massachusetts. Partners’ Workforce Development Program stipulates that after six months of work at Partners or a Partners member institution, employees are eligible for tuition assistance that can be used for degree-granting or certificate programs.  In addition to tuition reimbursement, there are various grants, scholarships, loan forgiveness programs and other financial assistance resources available to employees within Partners and its member institutions. Partners also participates in a business-to-business agreement with College for America to offer employees competency based online degree and certificate programs at a low cost after tuition reimbursement. This program also includes an option for “tuition deferment,” allowing employees to take courses and pay their limited portion of the cost over a longer period of time.

Release time and paid training opportunities

Another way to facilitate participation in training programs is to provide release time for employees, so that they can complete trainings during paid time and maintain their full-time wage and benefits. In this case, the employee’s department often covers the wages, especially when the employee is being trained to move into a high-need position within that department. The organizational learning department can also cover wages, which is common if the employee is being trained into a high-need position outside of their department. Wages can also be paid for through grant funding for frontline worker training.

 Manager Engagement and Staffing Support

Educating managers about the importance of career advancement opportunities can help them see the benefit of investing in their employees.

An important element of this strategy is creating buy-in amongst department managers. If department heads provide employees with release time, they must cover that time by switching around shifts, offering overtime, or utilizing temporary workers. All of these options require time and/or resources on the part of the manager. Educating managers about the importance of career advancement opportunities can help them see the benefit of investing in their employees. Creating communication channels between department managers and the organizational learning department helps to ensure this education piece happens and that managers are able to troubleshoot and find solutions when scheduling is a challenge. In addition to this logistical support, organizational learning can also provide actual resources to alleviate the burden on managers.

An example of this sort of collaboration and financial support can be found at Johns Hopkins University and Health System’s Project REACH program, a formerly grant-funded incumbent worker training effort.  Participants in Project REACH are in training for sixteen hours a week. Training time, which was originally funded through Department of Labor grant funds, is paid for by the education arm of Human Resources. Rather than pulling funding from the department where the employee currently works, this pot of funding covers employee time during training. This ensures that the time does not need to come from the department’s budget, while enabling the employee to retain a full-time salary and benefits. Shift managers can then request a replacement through the intradepartmental staffing agency or through the local resident internship program. More information about this program and sample forms for managers can be found on the Project REACH website.7Yariela Kerr-Donovan interview; Johns Hopkins Medicine, “Project REACH Retrospective,” Human Resources JHH/JHHSC. Accessed May 2016. www.hopkinsmedicine.org/human_resources/education_programs/employees/job_training_project_reach/retrospective/index.html

On-site training programs

While tuition assistance might make training programs financially accessible, there can still be major barriers for participation, especially for low-income workers. Individuals might have multiple jobs or may not have access to reliable transportation. Providing on-site training opportunities can help facilitate participation by reducing commute time and making it easier for employees to attend. Moreover, if the training has a clinical component, employees become familiar with institution-specific equipment and facilities.

While tuition assistance might make training programs financially accessible, there can still be major barriers for participation, especially for low-income workers.

An example of this is the School at Work© (SAW) model utilized by all of the hospitals and health systems in the Greater Cincinnati region.8SAW is a proprietary curriculum that employers purchase from Louisville, Kentucky-based Catalyst Learning, Inc. SAW is a blended adult education and career development program designed to equip frontline, entry-level healthcare employees with the skills they need to advance in the industry. Over the course of six months, SAW participants, led by a coach, learn and apply life management and employment skills (e.g. reading, math, writing, communication) that are critical to their success in the healthcare industry. Participants simultaneously define their career goals and develop a career and learning plan that outlines the training and education necessary to meet their goals.  Students attend two hours a week of training during work hours. The program is free for employees and each hospital has its own eligibility criteria. Participation requires permission from managers, but SAW program coordinators will work with managers on scheduling to help facilitate participation.9Sharron DiMario, interview by David Zuckerman and Katie Parker, December 3, 2015, notes; Heather Brasfield-Gorrigan, interview by David Zuckerman and Katie Parker, Cincinnati, OH, January 15, 2016, notes.  SAW programs are onsite, which decreases the time investment by the employee and allows them to complete training while still working full time.

Program design strategies

Best practices for facilitating internal advancement

  • Utilize a cohort training model focused on specific positions
  • Partner with local educational institutions and community organizations
  • Provide additional...

Institutional strategies

Tools to sustain and embed programming

  • Connect forecasting, training, and hiring departments
  • Connect programming to health system diversity and outreach goals

Other Resources

CareerSTAT is a network of healthcare leaders formed to champion the business case for investing in frontline workers.

References   [ + ]

1. Sara Lueben, interview by Katie Parker, April 18, 2016, transcript.
2. Cinda Herndon-King and Helen Slaven, interview by Katie Parker, February 24, 2016, transcript.
3. Yariela Kerr-Donovan, interview by David Zuckerman and Katie Parker, Baltimore, MD, January 7, 2016, transcript.
4. Debbi Perkul and Danielle Price, interview by David Zuckerman and Katie Parker, Cleveland, OH, January 11, 2016, transcript
5. Cinda Herndon-King and Helen Slaven interview.
6. Yariela Kerr-Donovan interview.
7. Yariela Kerr-Donovan interview; Johns Hopkins Medicine, “Project REACH Retrospective,” Human Resources JHH/JHHSC. Accessed May 2016. www.hopkinsmedicine.org/human_resources/education_programs/employees/job_training_project_reach/retrospective/index.html
8. SAW is a proprietary curriculum that employers purchase from Louisville, Kentucky-based Catalyst Learning, Inc.
9. Sharron DiMario, interview by David Zuckerman and Katie Parker, December 3, 2015, notes; Heather Brasfield-Gorrigan, interview by David Zuckerman and Katie Parker, Cincinnati, OH, January 15, 2016, notes.