Program design strategies

Best practices for facilitating internal advancement

Key Elements

  • Utilize a cohort training model focused on specific positions
  • Partner with local educational institutions and community organizations
  • Provide additional supports to build employee and community wealth

Cohort training model targeted at specific positions

The cohort model has utility for incumbent worker trainings as well. Training employees as a group reduces costs and is a more effective way to fill critical skills gaps. An example of this approach is the Pathway to Patient Care Assistant (PCA) program at University Hospitals (UH) in Cleveland, Ohio. In the Pathway to PCA program, interested employees apply to the program, and, if selected, are hired as PCA’s and then paid to complete the necessary trainings. All selected candidates complete training together, which reduces training costs and allows UH to fill many vacancies at once. There are also cost savings associated with hiring internally as opposed to recruiting outside candidates.1Debbi Perkul and Danielle Price, interview by David Zuckerman and Katie Parker, Cleveland, OH, January 11, 2016, transcript. West Philadelphia Skills Initiative, in Philadelphia, Pennsylvania, has worked with hospitals to develop similar custom trainings for incumbent workers, including one for animal laboratory positions and one for information technology positions.2Sheila Ireland, interview by David Zuckerman and Katie Parker, March 30, 2016, transcript.

 Partnerships with local educational institutions

Universities, community colleges, and technical schools are critical partners in developing worker-training programs. Often, these partners have the relevant expertise and have developed the necessary curriculum to run training programs. Or they are in good positions to develop specific programs if there is enough demand. An example of a successful education partnership is the creation of a Licensed Practice Nurse (LPN) program at Central Valley Medical Center in Nephi, Utah. In the early 2000s, the rural hospital faced a nursing shortage, and had difficulty hiring LPNs. To address the shortage, leadership from the hospital and a local community college, Snow College, came together and created the LPN program. The community college is located forty miles from the hospital, but the classes are offered on-site and instructors from the community college tele-teach, using virtual classroom technology. Central Valley provides the classroom space and coordinates the clinical rotation component of the course. Through this partnership, Central Valley trains and recruits LPNs and Snow College offers students trainings connected to local employment opportunities. Partnerships such as these benefit both the health system and the educational partner. In these partnerships, the health system can provide access to clinical space and on-site training, in-kind resources that are a necessary component of high-quality medical training. 

Providing additional supports to build employee and community wealth

One of the benefits of this pipeline to pathways approach is that it can create measurable impact on employment and wages in particular neighborhoods.

The goal of frontline worker training programs is to move employees into career-level jobs with higher wages, added benefits, and greater stability. One of the benefits of this pipeline to pathways approach is that it can create measurable impact on employment and wages in particular neighborhoods. Given that financial status is a primary determinant of health, these efforts can help to improve the overall health of the community by increasing economic security and resilience over time. In order to further sustain the investment in their employees and communities, health system leadership should consider implementing other programs that represent long-term investments in the physical and economic health of those they serve. Examples of these long-term investments are included below.

Employer-assisted housing program

Employer-assisted housing programs offer several employee and community benefits. For lower-wage employees, homeownership is a critical tool for building wealth and achieving economic well-being and security.  With built in support measures, such as connections to financial institutions with stable loan products and homeowner financial literacy trainings, these programs often provide sustainable paths to homeownership. This strategy can help to address the displacement pressure lower-wage employees can face in high-cost neighborhoods or neighborhoods undergoing redevelopment.

This strategy can help to address the displacement pressure lower-wage employees can face in high-cost neighborhoods or neighborhoods undergoing redevelopment.

Intentionally linking local hiring initiatives to an employer-assisted housing program can ensure that a broader range of employees can take advantage of this type of benefit. There are many strategies for structuring such a program, including forgivable loans, down payment assistance, or a mortgage buy-down.3A full list of strategies can be found in Anna Afshar and Federal Reserve Bank of Boston, “New Arguments for EA Housing,” New England Community Developments 1 (2006): 3, www.bostonfed.org/commdev/necd/2006/q1/EmployerAssistedHousing.pdf Although many institutions already have employer-assisted housing programs, special measures can be employed to consider how such a program can complement an inclusive local hiring strategy so that entry-level workers also have realistic access to such employee benefits.

Matched Retirement Savings Program

Another way to help magnify the impact of higher wages is to help facilitate employee savings. Employer contributions to a retirement plan—a common employer strategy—help do this. However, Mercy Health, a Cincinnati-based health system operating in Ohio and Kentucky, puts particular emphasis on ensuring that frontline workers receive benefits to help build their wealth and avoid retiring with little savings. In addition to a “just wage” provision and added health benefits for low-income workers, Mercy offers its 34,000 employees a matched retirement savings program. There is a floor for employer contributions of $1,400 per year, or 2 percent of an employee’s salary, which gives extra financial support to low-income workers. Employees are automatically enrolled, and 97 percent of employees participate. The employer contribution is 6 percent, and can reach as high as 11 percent for low-income employees.4Joseph Gage, interview by David Zuckerman and Katie Parker, Cincinnati, OH, January 14, 2016, notes.

Critical Strategies

Core elements of building career pathways

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

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. Debbi Perkul and Danielle Price, interview by David Zuckerman and Katie Parker, Cleveland, OH, January 11, 2016, transcript.
2. Sheila Ireland, interview by David Zuckerman and Katie Parker, March 30, 2016, transcript.
3. A full list of strategies can be found in Anna Afshar and Federal Reserve Bank of Boston, “New Arguments for EA Housing,” New England Community Developments 1 (2006): 3, www.bostonfed.org/commdev/necd/2006/q1/EmployerAssistedHousing.pdf
4. Joseph Gage, interview by David Zuckerman and Katie Parker, Cincinnati, OH, January 14, 2016, notes.