Trustee talking points
- As health care transforms, the health care workforce will have to change, too.
- Hospital boards should make workforce planning and development part of their strategic process.
- Self-assessment is critical for hospitals to begin workforce planning.
- A diverse workforce and new types of education will be needed in the coming years and decades.
Health care leaders face a critical need to elevate the discussion around workforce planning and development. Senior leaders must ensure that this discussion becomes a standing component of comprehensive strategic planning for hospitals and health systems and not just a response to a crisis situation.
Given the dramatic changes occurring in the field, hospitals and health systems should begin this comprehensive planning now — aligning workforce planning and development with general operations — and begin to identify and employ innovative solutions to traditional workforce challenges.
The American Hospital Association’s 2016 Committee on Performance Improvement engaged hospital leaders and experts in the field to identify key workforce challenges. These are challenges that already exist today and are expected to grow larger as transformation continues and pressures mount with the various dynamics of a changing payment and delivery system. The committee’s report, The Imperative for Strategic Workforce Planning and Development: Challenges and Opportunities, examines:
- Rural communities that face challenges around recruiting health care professionals as well as providing needed education and training opportunities for existing staff.
- The current inadequate supply of behavioral health professionals.
- An educational pipeline that needs to be enhanced and partnerships between academic and medical institutions that need to be strengthened.
- Recognizing and appropriately harnessing the potential of technology to meet the workforce needs of the future.
- Community partnerships that can be expanded to improve community health and wellness.
- Regulatory and policy constraints that impede the ability of hospitals and health systems to recognize the full potential of the existing workforce.
- How strong leadership will be vital to implementing innovative change.
- How ensuring a safe work environment must be incorporated into any discussion of the workforce.
- A recognition that the current workforce is already diverse but that, as hospitals and systems plan for the future, they must strive for more diversity in all aspects — race, ethnicity, gender and age.
- A role for human resources that will be even more vital as workforce planning and development becomes a component of comprehensive strategic planning.
In addition to addressing these challenges, it will be imperative for the planning and development process to assess the current and future needs of patients and the community, redesign the organization to meet those needs and, in doing so, ensure that the organization has the correct mix of health care professionals with the appropriate skills and capabilities.
Leadership and succession planning
Following are excerpts from the full report about some key workforce challenges:
Strong, innovative leaders can pave the way for change. Health care leaders must be willing to invest in the workforce for training on new care models while ensuring there are appropriately trained care teams, and to identify up-and-coming leaders for mentoring and career advancement opportunities. Attracting new employees and helping existing staff learn and understand how they contribute to excellent patient care in a transformed care environment are key tactics for leaders. Senior leaders can be instrumental in creating a strong and committed culture in a health care organization. Doing so entails transformative thinking from the top down.
Health care leaders should evaluate their process or model for workforce planning each year and adjust as necessary, based on the changing health care landscape and community needs. Leaders, along with their executive team, should begin by conducting an assessment of their organization. It can be effective and important for all staff to understand what they are looking for from their career, the intersection of their career and personal life, and the value they find working at the organization.
Beyond the internal leadership team, trustees must be actively involved in developing leadership continuity, engaging in cascade planning for all levels of the organization and participating in ongoing education. The board should help drive culture through all staff and ensure that workforce planning is part of the strategic planning process. In addition, diversity — in all its aspects — should be represented at the board level. Boards should reflect the community and should infuse diversity in planning for the future workforce.
Another important step for senior leaders is conducting an organizational assessment to best understand their specific workforce needs, combined with the strategic direction and needs of the hospital and patients. The future strategic direction of an organization will directly affect its workforce needs. What path of transformation is the hospital traveling? What additional pressures, whether payment related or policy constraints, will affect the organization? How will unmet community needs overlay or direct planning?
Assessments also can be helpful in looking at the skill sets of current staff, determining the future needs of patients, identifying actions needed to create care teams, building partnerships and developing a pipeline for new staff.
Using data will help an organization identify the demographics of the current workforce, including employment trends; understand existing competencies; and develop continuing education and growth opportunities to allow staff to work at the top of their skill set. Hospital leaders should consider analyzing and taking an inventory of all job descriptions within the organization to determine if the workforce is properly allocated and therefore focused on achieving the organization’s goals. Doing so also will help identify gaps where staff might be reassigned or where new staff roles might be needed.
Supporting and encouraging innovation is also a key theme identified by successful leaders. Leaders may want to explore establishing apprenticeship programs or internal leadership academies to facilitate upward mobility and identify and encourage internal talent. Engaging younger employees and helping to build career pathways that emphasize needed skills and talents are critical.
Innovative approaches to workforce planning also may help extend an aging workforce: Consider implementing reduced schedules while retaining benefits, allowing sabbatical policies for experienced staff, and permitting flexible schedules and shifts.
As with the current workforce, the workforce of the future must reflect the diversity of the community. The commitment to achieve a diverse and culturally competent workforce must come from leadership, executive teams and governance teams, which must incorporate cultivation of a diverse workforce into strategic planning. The dynamics of a growing intergenerational workforce must also be considered.
As the United States becomes more diverse, health care must reflect and respond to an increasingly heterogeneous patient population. Hospital leaders must recognize that their communities and organizations are diverse, regardless of the community’s primary ethnicity. Equity strategies should encompass wide inclusiveness for veterans, multiple generations, and people of diverse religions, disabilities and sexual orientation. A recent AHA Institute for Diversity in Health Management webinar presented these facts:
- By 2042, whites are expected to be a minority in the U.S. (47 percent of the population).
- The black population will grow by 56 percent.
- The Latino population will triple to 29 percent of the U.S. population.
Given these and the multitude of other statistics that demonstrate national demographic changes and inequitable access to care for certain populations, the approach to workforce planning needs to shift, change and develop just as health care is shifting and changing.
This commitment to increasing and supporting diversity in health care is critical because, as our communities become more diverse, our workforce must also diversify so that it begins to mirror the communities it serves. Learning how to care for people with different values and perspectives about health and wellness is a moral, business and strategic imperative that requires the input and participation of senior leaders and every member of the health care team. Awareness of diversity issues and a commitment to collaborate and focus on such issues across the workforce are key components of any workforce strategy.
Multiple generations are now in the workforce: baby boomers, Generation X and millennials, collectively representing the largest percentage, plus smaller numbers of traditionalists (born 1945 or earlier) and Generation Z or iGen (those born after the millennial generation). Millennials — the definition of them varies, but they can be considered to range in age from 18 to 37 — comprise the largest population cohort in U.S. history.
The variety of American workers is unprecedented and provides another element of diversity in the workforce. It also presents opportunities and challenges to strengthen the workforce and better care for communities that mirror this diversity.
Diversity is an integral piece of workforce planning and development, and the incumbent workforce must be engaged in creating a work environment that supports an inclusive and culturally competent workforce. Barriers to establishing a diverse workforce, including educational costs or complex and hard-to-fill-out applications and forms, should be addressed.
The educational pipeline
The education of the future workforce is an integral piece of workforce planning and development. Effective education includes not only new students entering health profession programs but also members of the incumbent workforce, many of whom are not prepared to deliver care outside of the acute care setting, in which they were trained.
To date, training for health care professionals has not kept pace with changing delivery settings. As an example, much education and training continues to emphasize inpatient care even as patient care now has shifted dramatically to the outpatient setting. Workforce training needs to reflect such changes, and hospitals will need to work more closely with educational institutions to properly develop, educate and train the workforce of the future. Hospitals also must not overlook elementary and high school education partners in developing a different pipeline for entry into middle-skill jobs.
For new students entering medical or nursing school or other health profession programs, the emphasis on systems, quality, safety, team-based care and informatics is increasing. Curriculum changes are being made and will continue to be needed in order to ensure that training for health care professionals occurs for all needed skills and competencies.
Medical students are spending more time with patients earlier in their studies, and nursing students are learning about population health issues, epidemiology and care coordination strategies. At the University of Washington School of Medicine, new faculty have been hired to teach communication skills throughout the four years of a student’s medical education, with a focus on communicating with patients.
All health profession faculty need to incorporate interprofessional, team-based education for students who will most likely be practicing and caring for patients as part of care teams. The Interprofessional Education Collaborative, founded by a cadre of education associations for the health care professions, has developed competencies for interprofessional education that many schools have adopted. Additionally, hospitals will not achieve a diverse workforce without purposefully supporting diverse students with educational opportunities and career paths.
The next challenge is helping and training faculty to teach these new concepts even when they have fewer resources available to them for their own training and when many of them are nearing retirement age. Many professional associations have developed resources for faculty that include webinars, publications, case studies and scenario-based examples to assist educators in teaching new topics.
Preparing faculty to teach new concepts and prepare the future workforce is only one piece of the education pipeline. New graduates are entering the workplace with new skills and important knowledge about the current health care landscape, but it does not mean they are fully prepared to practice in evolving new care models. This is where the important concept of academic-practice partnerships must be considered to ensure new staff have the essential skills needed to be ready for the job.
All of the education experts the committee heard from underscored the importance of hospitals partnering with health profession programs and schools so that schools understand hospitals’ needs and hospitals understand the curriculum and how education translates into practice. Some ways to enhance academic-practice partnerships include creating joint appointments at a hospital and a school; understanding the costs (both financial and quality) incurred by schools and hospitals when the education and training of students is insufficient to care for patient needs; and co-creating curricula that provide a creative and mutually beneficial transition to practice for all students.
For the workforce already in practice — the incumbent workforce — the need for education and retraining is great and involves the same topics as those new students face: new care delivery models, population health, care coordination, team-based care, quality and, most important, national changes in health care. It is critical that members of the incumbent workforce understand their role in the organization and the changing system, open and accelerate new paths for advancement, and understand that their roles are vital to sustaining the organization’s mission and vision. The ability to address their concerns, address their education needs and train them to deliver care differently — however it may be needed for your organization — is paramount in retaining them as part of your workforce.
Hospitals have a long history of serving as a cornerstone of care, an economic engine and, in many cases, an engaged partner. The partnerships and collaborations of the past need to become more robust, more strategic and more comprehensive. Per Internal Revenue Service requirements, hospitals conduct community health needs assessments. If not already a key driver in strategic planning discussions, partnerships should certainly become one as workforce planning and general strategic planning become better aligned.
The role of hospitals is changing, and to meet the needs of patients and achieve community health, each hospital must actively reconsider its role. Hospitals may not need to lead all efforts, but they can convene and collaborate with other organizations that are best suited to tackle community challenges. Doing so may build a stronger health care infrastructure with better outcomes.
Begin by conducting the hospital’s CHNA to identify patient and community needs, barriers to care and resources that already exist to meet needs. Next, hospitals should work to establish the best, most efficient way to meet any particular need. The solution may not always be in the hospital setting. A strong collaborative effort with community partners may enhance capabilities and expertise in meeting any specific challenge or providing needed services. Additionally, collaboration allows efforts to be honed and strengthened, not duplicated.
The hospital of the future will play an active role in community health, but it cannot address all community needs alone. The workforce planning process should identify which organizations and individuals within the community possess certain competencies. Then, community partners can work to establish a collaborative approach, identifying key responsibilities for improving population and community health. Community partners can augment many outreach activities, enhancing sustainability and increasing recruitment and legitimacy.
Partners that should be considered are community colleges and, more widely, leaders in local school systems. In addition to partnering with educational institutions, hospitals should consider partnering with other hospitals, public health departments, social service organizations, law enforcement, workforce investment boards, and even city and county urban planning and development departments. Developing relationships with these institutions should become key to any outreach or partnership strategy.
The bottom line for hospitals is to expand upon what has already been done in terms of community partnerships to enhance the value of community outreach work. T
Excerpted, with permission, from The Imperative for Strategic Workforce Planning and Development: Challenges and Opportunities, a report from the American Hospital Association 2016 Committee on Performance Improvement, Kimberly McNally, chair.
The future workforce's mandate
- Be innovative.
- Be willing to take calculated risks.
- View change as an opportunity.
- Build strategic and unique relationships and partnerships.
- Understand the business and policy implications of health care.
- Encourage continuous learning at all levels.
- Understand data and statistics as they relate to quality improvement.
- Learn about disease prevention as well as treatment.
- Know the basics of information technology.
- Possess general communication and management skills.
- Possess moral courage.
How boards can evaluate their workforce
Members of the American Hospital Association's 2016 Committee on Performance Improvement developed a set of strategic assessment questions for hospital boards thinking about their workforce:
- How do you currently engage in workforce planning and development?
- Whose responsibility is workforce planning?
- How is workforce planning and development woven into your organization’s overall strategic planning process?
- What role does your board play in workforce planning?
- How are you investing in workforce planning? What percentage of your total budget is spent on building workforce capacity?
- How have you assessed, collected data on and modeled future workforce needs and gaps?
- Do you actively engage in recruitment and retention efforts?
- What succession planning processes do you have in place?
- How does your workforce affect your community’s health? Have you used your community health needs assessment to guide workforce planning and development?
- Have you partnered with other organizations — health care or community partners — to:
- Bolster educational opportunities?
- Enhance recruitment efforts?
- Engage in interprofessional education?
- How confident are you that you will meet your workforce needs in the coming year? In the next three to five years?
- Have you measured your organization's safety culture as well as your employee engagement (and assessed reasons for disengagement)?
Trustee Takeaways: 12 Recommendations
The final section of The Imperative for Strategic Workforce Planning and Development: Challenges and Opportunities, by the American Hospital Association's 2016 Committee on Performance Improvement, offers senior leaders a list of recommendations on workforce planning gleaned from the committee and subject matter experts:
- Know your system transformation strategy.
- Know your system model of care (and/or help create it).
- Develop a workforce plan based on community needs and a continuum model of care.
- Know the timeline for implementing and transitioning to various components of your system strategy.
- Develop an education plan for the different and new roles and functions of your workforce.
- Create an overall transition plan and timeline for all areas of the care continuum.
- Budget for staff education and training.
- Budget for transitions to and from areas along the continuum.
- Educate all leaders on your timeline, their roles and responsibilities in developing a systemwide talent-mapping process, development plans for staff, and effective transition plans.
- Use and include provider skills and expertise in your talent-mapping process.
- Collaborate with other entities in your community.
- Collect and use data; create dashboards to assess progress.
– American Hospital Association 2016 Committee on Performance Improvement