The stories run as deep as a hospital's roots in its local community. Stories about employees who came, stayed, learned and grew beyond their dreams. Many healthcare professionals start out on lower rungs of the career ladder — from central supply technician to medical technologist, nurse aide to CRNA, secretary to physical therapist. Top healthcare CEOs have risen from the ranks of nursing, pharmacy, marketing and other in-house operations. Success stories like these are among health care's best-kept secrets. Now, with the help of grants, local partnerships, focused benefit plans and strategic HR planning, hospital employees have more opportunities for advancement than ever before.

Knowledge age organizations are evaluated by their human capital as well as hard assets like equipment and cash in the bank. You can build your hospital's financial value and market position through human capital management. First, identify individuals with high current value and/or high potential. Then, assess the entire organization's training and education needs for both technical and "soft" (relationship and life) skills. Finally, develop customized plans for recruitment, retention and employee development to meet today's and tomorrow's needs.

Proactive HR planning (using the Square Wheels© analogy) allows you to step back from the wagon, view the big picture and determine what resources are already at hand. Once you know the people assets you have and the people assets you need, follow this formula for staffing success:

• Attract and hire people with the potential to grow who also share the organization's values
• Train and nurture them
• Promote them
• Keep their skills up to date
• Honor, recognize and reward them regularly and consistently
• Maintain a culture of community, teamwork, mutual respect and lifelong learning.

Organizations that stick to this plan will thrive while others struggle with increasing staff shortages.

Hiring for Keepers

The health workforce pipeline starts with local youth in every market. The healthcare industry's task is to form relationships with each new generation, welcoming pre-selected recruits into long-term career paths in health care.

Healthcare employment opportunities are vast, and include both care giving positions and support staff. Nursing has the largest number of slots to fill, but current vacancy rates are highest (averaging 15%) in allied health professions, estimated at 60% of the healthcare workforce. Entry-level workers in all areas are also in short supply. Health care is competing against retail, hospitality, manufacturing and other industries for a dwindling population of entry-level job applicants. (See Competing Against Other Industries for more on this subject.)

A broad gap exists between the skills entry-level workers have and those they need to succeed. Allied health program graduates are often inadequately prepared to fill the positions they seek, according to a report by The Center for the Health Professions at the University of California-San Francisco. Allied health employers and new graduates alike are frustrated by unmet expectations and skill deficits. The study reported troubling deficiencies in:

• Employment skills
• Critical thinking
• Communications
• Technical and computer skills
• Work ethic.

Some hospitals have resorted to training non-clinical, entry-level workers in such basic life/employment skills as punctuality, proper dress and time management.

One answer to these problems is forging a bond with prospective employees at the earliest stage of career development. Exposure to real-life employment settings provides a strong advantage to high school students engaged in health sciences clinical rotations, medical exploring or junior volunteer programs. If they are unsuited for health care, they will know it early. Those who remain, studies show, are more likely to sustain their commitment to a health career beyond high school.

Teen work opportunities also allow employers to identify and recruit high-potential candidates for future positions. Many hospitals are growing hard-to-find specialists by creating school-to-work tracks for high school graduates. They provide scholarships, mentoring and flexible work hours during students' post-secondary training. When hospitals make these investments in individuals, they get back more than work agreements. They build dependable workforce pipelines.

To recruit for future healthcare heroes, look for individuals with what the early astronauts called the right stuff. Not every new hire needs to be intellectually gifted or fully trained. They do need to be keepers — people who will work well on your team, responsibly and with dedication. Screen applicants for values alignment with organizational mission. Screen for strong work ethic, emotional intelligence, relationship skills and integrity. If you can attract applicants with the right core characteristics, then appropriate supervision, coaching, training and education can create an extraordinary employee over time.

There is no guarantee that every employee cultivated for growth with stay planted in the organization. Employment changes are inevitable in our mobile society. But nurturing employees' growth is an effective recruitment, retention and hospital of choice tactic. In addition, if all hospitals maintained high standards for recruitment and training, the quality of the workforce pool would be raised for every facility.

Houston's Memorial Hermann Healthcare System embraces a "grow them ourselves" philosophy. It recently opened an 18,000 square foot Technical Education Center on one of its Houston campuses. The center is training about 160 future workers, including licensed practical nurses, surgical techs, phlebotomists, radiographers and mammography technicians. "We realized . . .one of the best things we could do was select the students, educate them, and place them," said director Judith Farmer in a July 2003 interview with HealthLeaders magazine. Students are trained by Memorial Hermann staff and physicians. They are also taught Memorial Hermann's Partners in Caring philosophy, which promotes the values of teamwork, respect, courtesy, communication and professionalism throughout the organization. Memorial Hermann expects to hire about 85% of the Technical Education Center graduates. Those who sign two-year work agreements will have 50-66% of their tuition costs forgiven.

Ideas in Action: Growing Entry-Level Employees

Middletown Regional Health System in southwest Ohio piloted a program in 2002 to develop specific skill sets and career paths among entry-level employees. The program was funded by a $67,000 grant from a regional workforce policy board. Over 100 employees completed six-hour group sessions that tested math and reading skills and identified their personal values, career interests, skill aptitudes and abilities. Participants then received one on one counseling to review results and develop individual career plans. Employees in entry-level positions with wage levels between $12,376 - $29,952 were targeted. The hospital offered financial aid for further education to those who completed the career-planning process.

Bridge Programs

A number of hospitals and communities have benefited from welfare to work programs and basic skills training for underemployed populations. Welfare to Work, a 2001 VHA Health Foundation study of nine leading hospitals' experiences, showed high success rates. The programs ranged from three to twelve weeks. Participants received life skills and occupational training, case management and (in some programs) individual mentoring. Participating hospitals later applied many lessons learned from these welfare to work programs to entry level workers in general. In all cases, training programs in basic skills were considered more effective expenditures than traditional recruitment activities because they expanded the pool of qualified applicants.

Soft skills training is considered essential with welfare to work and many other entry level employees. Such training includes problem solving, conflict resolution, communication and interpersonal relations. Entry level workers may also need social services support such as transportation and child care to succeed. ("Buses don't run at 11:30 p.m.," one director was quoted.)

A grant-funded follow-up study in 2003 built on the 2001 Welfare to Work findings. Projects at three sites — Washington, D.C., Sacramento, CA and St. Paul, MN — examined the feasibility of implementing health career ladders specific to the unique issues of each market. Community-Wide Career Ladders for the Health Sector calls for collaboration and partnership among community health organizations and local agencies to solve unemployment and health workforce shortage issues simultaneously. By training underemployed groups in basic skills (for example, English as a second language (ESL) classes) and providing in-house career ladders, hospitals can raise the socioeconomic status of their communities while building a stable workforce.

The Washington, D.C. team recommended that hospitals group positions into job families that require common sets of hard (technical) and soft skills, then define career ladders for progression through a job family. They also called for local healthcare organizations to standardize skills requirements to leverage the impact of all institutions' training budgets.

Staff development in many hospitals is evolving into human capital development. Human capital development focuses more resources on planning, tracking and goal-setting than traditional training efforts, but expects greater bottom-line returns. Current initiatives include:

• Targeting high potential and high value employees for individualized training and retention efforts.
  
  
• Aligning employee benefits policies governing tuition aid with institutional business priorities.
  
  
• Offering onsite college classes in partnership with local colleges and universities.
  
  
• Developing hospital-sponsored, hospital-based certificate programs in high-shortage allied health professions.
  
  
• Creating more accessible educational opportunities for shift workers and single parents.
  
  
• Launching in-house career fairs and communications programs that broaden employees' awareness of health careers and training/career ladder opportunities.
  
  
• Supporting working students' practical needs, including flexible scheduling, full-time pay for part-time employment, employee assistance services, childcare, transportation and mentoring.
  
  
• HR succession planning for specific positions.
  
  
• Creating both scholastic and accreditation pathways for employees to pursue advanced nursing and allied health positions.
  
  
• Establishing HR policies that favor and support internal promotion to higher level positions over external recruitment.
  
  
• Fostering an organizational culture that celebrates and rewards promotions and accomplishments of all employees, regardless of rank or position, as essential members of the healthcare team.
  
  
• Encouraging employees' involvement in local rather than national professional organizations, whose efforts to promote higher educational standards for new entrants have been at odds with healthcare management leaders.

More Ideas in Action