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Impact of Vision: Benefits from Investing in Frontline Workers Jennifer Craft Morgan, PhD Research Scientist, Institute on Aging, University of North.

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Presentation on theme: "Impact of Vision: Benefits from Investing in Frontline Workers Jennifer Craft Morgan, PhD Research Scientist, Institute on Aging, University of North."— Presentation transcript:

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2 Impact of Vision: Benefits from Investing in Frontline Workers Jennifer Craft Morgan, PhD Research Scientist, Institute on Aging, University of North Carolina Tom Strong Program Officer The Hitachi Foundation Barbara Trehearne, Ph.D., RN VP, Clinical Excellence, Quality & Nursing Practice, Group Health Cooperative Special thanks to our Diamond Sponsors: Coopersmith Health Law Group, Coordinated Care, and TeamHealth

3 The Impact of Vision: Benefits from Investing in Front Line Workers Tom Strong Program Officer, Hitachi Foundation Barbara Trehearne, PhD, RN VP Clinical Excellence, Quality and Nursing Practice, Group Health Cooperative Jennifer Craft Morgan, PhD Research Assistant Professor, Department of Allied Health Sciences, UNC School of Medicine; Scientist, UNC Institute on Aging

4 The Hitachi Foundation Our focus: the role of business in society. Our goal: business practices that improve the lives of low-wealth Americans.

5 Why focus on frontline workers (FLWs)? Health care delivery is changing - and must change further. Low-wage frontline workers represent the fastest growing and least-constrained asset in the sector. Vacancies have eased off recently, but will return. Instability, training, and productivity of frontline workforce has an impact on quality of care. FLWs often play an important role in meeting the needs that healthcare organizations serve.

6 Pioneer Hospitals A national effort to identify and promote hospital efforts that help entry-level workers develop careers in health care 15 to 20 case studies of hospitals from across the country “Pioneer employers” are employers whose policies and practices have resulted not only in a measurably better quality of life for entry-level workers, but have also created a measurable return toward the organization’s bottom line

7 Pioneer Hospital Case Study Group Health Barbara Trehearne RN, PhD Vice President, Clinical Excellence Quality & Nursing Practice

8 Group Health Nursing Staff PositionCountFTE RN LPN MA ARNP6452

9 Career progression programs Business office staff to Medical Assistant Medical Assistant to Licensed Practice Nurse RN to BS in nursing

10 Business office staff to Medical Assistant September 2009-June 2011 Partner with North Seattle Community College 12 participants selected Online MA training with in-class labs 6 completed $15K/participant

11 Medical Assistant to Licensed Practical Nurse Partner with Renton Technical College 13 participants - 13 completions Cohort based, on site RTC, clinicals at GHC $15K/participant Wage increase

12 RN to BS in nursing Ongoing but focus on cohort Partner Seattle Pacific University 13 participants Cohort based, video conference $24K/participant Job mobility

13 Employer practices/policy Tuition reimbursement Paid education days Schedule flexibility support Track support Preceptors/adjunct faculty Coordination support Troubleshooting Employment benefits for.45 or.5 FTE

14 “I’ve talked with many of them and they say, oh, I’m not stopping here. You get them going and you know they want to keep going.” Roger Walker, Analyst, Nursing Operations

15 “I am one that does push my staff to get trained. I feel that training is first and foremost in that you build the foundation of that individual. There’s nobody out there who doesn’t want to work. It’s just that they weren’t given the right tools to be successful and a lot of it is taking to time to make sure that they’ve been granted the time to grow and learn.” Ardis Goulart, RN, BSN (Clinical Operations Manager, Primary Care Travel Group)

16 Critical Success Factors Organizational Learning Culture Supervisor Involvement Strong Partnerships with Community Colleges Progressive Human Resource Policies Full-time Coordinator

17 What’s in it for us? Recruit to new roles from existing staff Wage progression Opportunity for better educated workforce Employee satisfaction Role models Retention

18 Return on Investment A highly educated workforce Increased productivity High worker satisfaction Improved skills Lower Vacancy Rates

19 Lower turnover LPN Turnover Rates Year Group Health Cooperative Washington State average MA Turnover Rates Year Group Health Cooperative Washington State average

20 Other Organizational Outcomes Community development Employer of choice Strengthened integration of education and practice Improvements to care delivery

21 Learning from the Pioneers: Investing in Frontline Workers Jennifer Craft Morgan, PhD Scientist, Institute on Aging Research Assistant Professor, Department of Allied Health, UNC School of Medicine

22 Hospital characteristics (e.g., size, type of ownership, affiliation) Organizational culture/climate (i.e., values and norms shared by people and groups within the organization) Management strategies (i.e., policies and practices put in place to manage and organize work) Organizational context (e.g., workforce needs, skill shortages, recruitment/retention problems) Local context (e.g., county unemployment rate, community demographics) Program implementation Perceived Return on Investment Improved quality of care Increase number of qualified applicants for positions Decreased turnover Increases in employee skills/competency levels Improved productivity Reduction in the number of position vacancies Reduction in absenteeism Increased revenue Improved work environment Improved teamwork Perceived Return on Investment Improved quality of care Increase number of qualified applicants for positions Decreased turnover Increases in employee skills/competency levels Improved productivity Reduction in the number of position vacancies Reduction in absenteeism Increased revenue Improved work environment Improved teamwork The Impact of Investing in Frontline Workers – the Employers’ View

23 A national initiative to promote skill and career development in incumbent frontline health care workers $15.8m investment over 4 years, supporting program implementation and research grants 17 sites nationwide; almost half are hospitals Funded by Robert Wood Johnson and Hitachi Foundations, and U.S. Department of Labor From Jobs to Careers: Transforming the Front Lines of Health Care

24 Develop HR policies that support employee advancement Provide wage increases with increased skill/responsibility Recognize employees for competencies attained Make career ladders transparent and navigable Create a “grow your own” culture Have senior leaders talk about the institutional values regarding employee advancement Encourage supportive supervision Show support for employee development Change work processes to support learning for work Build-in opportunities to demonstrate and document competence Use critical incidents and identify other “teachable moments” Role of the Employer

25 POLICYDESCRIPTION Case management/ Emergent support services for FLWs Providing FLWs with access to a case manager that can help them with access to resources, such as childcare, transportation, or healthcare. Competency-based pay raise Pay raises upon documentation of having learned a competency or set of competencies. Competency-based promotion/ job descriptions Promotion upon documentation of having learned a competency or set of competencies linked to job descriptions for positions Educational release timeProviding paid time-off for workers to attend classes, participate in WBL activities, or study. Formalized mentoring positions Designating mentoring as a job responsibility and formally including it in a job description; sometimes includes additional compensation for increased responsibility. 25 Strategic HR Policy Changes

26 POLICYDESCRIPTION In-house credentialingOn-site training that leads to additional credentials for participants. Promotion from withinHiring current employees for jobs that advance their careers; often includes specific policies regarding how long a job will be posted within the organization before it is posted outside the organization. Replacement staff for educational release time Providing either a 1) pool of workers or 2) additional funds to hire temporary or agency workers to cover scheduling gaps that result from educational release time. Skills assessment for new FLWsAdministering tests of basic skills to all FLWs to determine their training and remediation needs. Strategic HR Policy Changes

27 POLICYDESCRIPTION Tuition advancementProviding FLWs with funds for tuition at the beginning of a course (rather than the end) so that FLWs do not have to pay tuition costs up-front. Tuition reimbursement on a sliding scale Providing additional funds for FLWs for higher education as compared to other job categories with higher wages. Expanded Tuition coverageProviding FLWs with expanded tuition support to include non-degree, continuing education and/or remediation needs. Strategic HR Policy Changes

28 Organizational Learning or “Grow Your Own” Culture High-level champions for career/educational advancement Supportive supervision (e.g., flexible scheduling, mentorship, coaching, conveying values of organization) Support with training (not just for frontline workers!) Celebrate successes (even the “small” ones)

29 Changes to the Work Processes Rotating Job Assignments (e.g., cross training) Participatory Decision-making (e.g. formalizing avenues for frontline worker input) Integrating education into practice (e.g. identifying teachable moments, assignments for “school” based in work, involving supervisors in “school”)

30 Developing an evidence base…

31 High Performance Work Practices (HPWP) Incentive pay, job rotation, flexible scheduling, team-based work systems, and participative decision-making. Purpose: To examine the effect of high performance work practices (HPWP) on frontline healthcare workers’ job satisfaction and perceived quality of care.

32 High Performance Work Organizations: Findings Team-based work systems and opportunities for participative decision-making have the most impact on frontline worker job satisfaction and perceived quality of care. Use of incentive pay, job rotation, and flexible scheduling did not impact frontline worker job satisfaction or perceived quality of care unless implemented in tandem with at least one of those two practices.

33 So what? Job re-organization around participative decision-making and team-based models is likely to have an impact This finding has implication for how and in what order and pairings, such practices might be most effectively implemented

34 Questions for Your Consideration How can improving the skills of frontline workers help: Reduce readmissions? Improve triage in the ER? Address physician unhappiness with team performance? Reduce coding errors? Improve patient satisfaction?

35 Discussion/ Q & A Barbara Trehearne, PhD, RN Jennifer Craft Morgan, PhD Ed Phippen Tom Strong


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