ADVANCING THE FRONTLINE WORKFORCE IN HEALTH CARE – WHAT WE’VE LEARNED, WHERE WE’RE GOING Randall Wilson, PhD Northern New Jersey Health Professions Consortium December 4, 2012 Bergen Community College

Setting the Stage

Overview Setting the Stage Key Challenges Some Promising Practices The Way Forward Discussion

A Glimpse of Frontline Health Care Workers

Who is the Frontline Workforce? Diverse occupations, including nurse aides, medical assistants, surgical technicians, and community health educators Generally non-licensed and require less than a Bachelor’s degree Annual incomes largely below $40,000 Often lack clear career ladders or means of job enhancement

Why Invest in Frontline Workers? Frontline workers are essential to care – Half of health care workforce, most of the direct patient contact High and costly turnover – Low wages, difficult working conditions, limited career paths Low employer investment in skill and educational development of this workforce Opportunity for better care care through better jobs and career advancement

The Changing Health Care Landscape More patients seeking health care Aging population, sicker patients Cost pressures on health care Shift to clinical and home-based care New models of care delivery New models of paying for care

Why Invest in Frontline Workers: An Aging and Frailer Population Age 65 & over will double to 72m – One in six need long-term care (6 million) – 90% with at least one chronic condition Age 85 & over will more than triple by million people will have Alzheimer’s disease in 2030, up from 4.9 million in 2007 More living longer, but more living with functional impairments and chronic diseases

Why Invest in Frontline Workers: More diverse population mix Uninsured are: – More likely to be non-white or Hispanic – All (2011): 15.7% – African Americans: 20% – Asians: 17% – Hispanics: 30% – English as second language: 31% Providers want “people who look like our patients”

Frontline Occupations in Demand Patient-Centered Positions # Jobs 2010Job Outlook Change Home Health and Personal Care Aides 1,878,70070%1,313,200 Nursing Aides1,505,30020%302,000 Licensed Practical Nurses 752,30022%168,500 Medical Assistants 527,60031% EMTs and Paramedics226,50033%75,400 Technology-Centered Positions # Jobs 2010Job Outlook Change Pharmacy Technicians334,40032%198,300 Radiologic Technicians219,90028%61,000 Medical Records & Health Information Technicians 179,50021%37,700

The Supply Side: An Aging Workforce Over 23% of active physicians are 60 or over – Projected shortages: 132,000 by 2025 By 2020, close to half of RNs will be 50 or over – Projected shortages of one million by 2025 About one-third of active social workers will soon reach retirement age 30% of direct care workers over 55 by 2018

The Affordable Care Act Covers over 30 million new patients – 14 million as of 1/1/14 Promotes new models of care – Improve coordination – Lower costs – Increase quality (higher satisfaction, lower readmissions) – Shift from hospital to clinical and home-based

Workforce Implications With fewer MDs, more responsibility for Advanced Practice Nurses (APNs). PA’s, etc. Higher quality demands all clinical staff “work at the top of their license;” better teamwork New roles and functions emerging: – Care coordination – Patient navigation, case management – Health educators, coaches – Health information technology

Challenges Workers Basic skill needs, including job readiness Family and life issues Lack of career information Employers Lack transparent career pathways Resource constraints – underinvestment in workforce Educational Institutions Program offerings not fully aligned with needs of workers, adult learners, and employers Regulatory Organizations Reluctant to recognize “out of the box” approaches 14

Some Promising Practices Jobs to Careers: quality care through work- based learning Allied Health Initiative: employer-led development of pipelines Accelerating Opportunity: integrated pathways from basic skills to credentials National Fund for Workforce Solutions: employer-led partnerships

Jobs to Careers $15.8 million-dollar national initiative funded by the Robert Wood Johnson Foundation, The Hitachi Foundation, and the U.S. Department of Labor (2005 – 2011) Emphasized work-based learning 17 sites nationwide Focused on hospitals, community health centers, long-term care facilities, behavioral health Employer-driven, evidence-based, and learning- focused JFF was National Program Office and TA provider

J2C’s 17 Sites

Participation across 17 grantee sites Over 900 Participants 34 Employers 24 Educational Institutions 8 Workforce Intermediaries

The Goal of Jobs to Careers The goal of Jobs to Careers was to promote skill and career development in incumbent frontline health care workers by: – Testing models of work-based learning – Designing systems to support learning and career growth of frontline workers – Developing partnerships of employers, colleges, and others (including workforce boards and unions)

Work-based Learning Uses job responsibilities to achieve learning objectives Measures achievement of specific competencies Engages supervisors and peers in the learning process Rewards mastery with academic or industry- recognized credential Complements other modes of learning Promotes reflection, critical thinking 20

Why Work-Based Learning? A more effective learning strategy A more efficient training approach A more productive workforce More accessible learning

J2C Success Over 900 frontline workers at the 17 sites participated in the Jobs to Careers program. Participants typically: – increased skills – increased wages – improved self confidence – achieved greater job satisfaction – Improved patient care

Benefits to Frontline Workers Access to seamless educational pathway Access to college credits and credential Increased confidence and job performance Understanding the “why” not just the “how” Higher pass rates via cohort support and coaching Access to career advancement and higher wages

Benefits to Employers Cost effective training delivery Flexible, modularized curriculum Engagement of employee in learning and skill enhancement Increased employee effectiveness and performance – increased quality of care Created a cohesive patient care team Maximize investment in training Support career development

Systems Change at the Employer Changes in human resource policies – Adjustments to tuition reimbursement policies. Changes in organizational culture – Evolving role for supervisors. Changes in the organization and process of work – Creation of new positions.

Lessons Learned – Employer perspective Provide incremental career opportunities Develop relationships between employers and educational partners Address financial limitations to obtaining additional education Address time barriers to obtaining additional education Address the basic skills needs of workers Encourage supportive supervision – organizational learning culture 26

System Changes at the Educational Institution Changes in academic policies Shifts in organizational and faculty culture Processes of curriculum development, delivery, and assessment

Lessons Learned – Educator perspective Develop credit for prior learning policies Create flexible pathways to certificate and degree completion Incorporate non-traditional teaching techniques Offer courses at convenient times and places Cultivate buy-in from top-level administrators Expand student services to include career coaching

Allied Health Initiative 3-year program, responding to shortage of allied health workers in Boston hospitals Address skills mismatch between frontline workers and skills necessary to enter professional pathways Create pre-allied health pipeline, focusing on academic readiness, in three major hospitals $1.5m (Boston Foundation), leveraging $13m employer match

Allied Health Initiative Employer-led model, to support flexible approaches, buy-in and sustainability – Distinct strategies in each hospital (occupational focus, instructional providers, technology) – Expand internal capacity for workforce programs – Adaptable as occupational demand shifts – Catalyst for supporting a learning culture and further innovation

Allied Health Initiative: Innovations Pre-college, college courses, college placement tests offered onsite Expanded access to career and academic counseling and coaching (BIDMC) “Online Learning Readiness” course (PHC) Blending clinical and basic skills instruction for Central Processing Techs (BMC) Work-based & online modules in Rad Tech

Allied Health Initiative: Lessons Flexible resources and employer leadership a plus – greater buy-in, increased capacity, ability to experiment Longer pre-college preparation due to greater basic skill needs Ability to negotiate and change vendors Support for operating costs to start up or deepen workforce development

Accelerating Opportunity Changes the delivery of Adult Basic Education by states and community colleges Builds integrated pathways from basic skills to credentials and careers Five states (KS, IL, NC, KY, LA) with 3-year grants to support 8 colleges per state Pathways in diverse sectors, but all states include health care

Accelerating Opportunity: the Model Two or more pathways/state, with demonstrated local demand Accelerated learning, including contextualized and hybrid approaches Comprehensive academic and student supports Stackable and credit-bearing credentials (min. 12 credits), college readiness, bypass dev education Partnership with WIBs and employers State and institution-level policy changes

The Road Ahead: Opportunities Under ACA? Expanding frontline workers’ roles in care team – enabling professionals to work at the top of their license Improving performance to increase patient satisfaction, reduce infection and errors, prevent readmission Preparing for new roles in coordination of care, patient education, health IT

The Road Ahead: An Emerging Role? AtlantiCare Special Care Center: making “health coaches” integral to improving care and lowering costs Career ladder step for Medical Assts/LPNs Coaching patients in prevention and managing chronic disease Knitting together acute care, rehab, MD office, pharm; support coordination at discharge

The Road Ahead: Making the Case Build evidence that workforce development “works” to achieve health care goals Make the business case with performance improvements and new staffing models Enlist employers as advocates Organize for policy and systems change in support of frontline worker development

OTHER RESOURCES

J2C Resources Work-Based Learning Toolkit – Subsector reports (LTC, Hospitals, CHCs) Practice Briefs – “A Primer for Work-Based Learning” – “Supervisors Stepping Up” – “Creating Career Pathways for Frontline Health Care Workers” – “Jobs to Careers in Community- Based Care” Evaluation reports and articles Research reports

CareerSTAT: A Guide to Making the Case for Investing in the Frontline Hospital Workforce

The Virtual Career Network (VCN) is a publicly accessible, Web-based health care career platform that includes assessment, learning, and career management tools. Its primary purpose is to help its users explore health care careers, and enter into educational programs leading to the credentials they need to begin or advance in health care careers. The American Association of Community Colleges (AACC) and its many education, healthcare and workforce development partners developed VCN through a grant from the U.S. Department of Labor. Introduction to the VCN

What Makes the VCN Unique? The inclusion of two vital functions that do not currently exist within a single website: A Learning Exchange (LE) through which a user can find, compare, enroll in, and take remedial and technical skills development courses online that provide a pathway into health care careers; and A Career Management Account (CMA) where the user can store testing, assessment, counseling, course completion, and other credentialing data to document and present to third parties such as counselors and employers. These tools will enable users to manage their own learning and career pathways.

QUESTIONS?

Randall Wilson TEL FAX Broad Street, 8 th Floor, Boston, MA Pennsylvania Avenue, NW, Suite 5300, Washington, DC