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The scope and scale of the healthcare workforce shortage exceeds the resources and reach of any single hospital or system. When healthcare organizations collaborate, forming partnerships with education, workforce training and economic development agencies, the result is more workers who enter health care and more workers who stay in health care. The alternative — i.e., competing against one another for a diminishing labor pool — is a poor use of resources and ultimately counterproductive.
"The problem of workforce shortages has escalated into a crisis," according to a recent VHA Health Foundation and U.S. Chamber of Commerce Study, Community-Wide Career Ladders. It requires "the same sort of willing collaboration healthcare organizations typically display in the face of more obvious emergencies, such as natural disasters," the authors state.
The potential payout for collaborative initiatives far outweighs that of stand-alone tactics. The organized advocacy efforts of the Hospital Association of New York State (HANYS) resulted in legislation allocating $3.5 billion to New York health workforce initiatives over three years. The Center for Health Workforce Development in Tennessee (CWHDT) made collaboration a requirement for its 2002-2003 grant awards. The partnerships created by CHWDT grantees harness the collective creativity, brainpower and influence of multiple stakeholders. Link goes to CHWDT grant award document previously provided
Locally, collaboration makes even more sense. Community-wide workforce development initiatives have more credibility and leverage when all major healthcare interests are involved. Active commitment and funding levels increase when collaborators know they are playing by the same rules.
The prudence of collaboration also applies within our organizations. Effective workforce development strategies combine the best skills and practices of both human resources and marketing professionals. These experts are working together in new combinations in many hospitals, with significantly improved results.
Creating a steady flow of workers requires systematic development of a consistently productive pipeline. This is a multi-level process. It begins with outreach to guidance counselors and teachers at multiple levels (elementary, middle, high school, post-secondary) and in multiple disciplines (especially English, math and science).
Educational opportunities, including health sciences curricula and clinical sites, must increase proportionately with student interest in health careers. So should extracurricular career exploration opportunities such as HOSA, Medical Exploring, hospital-based job shadowing, internships and summer camps.
Healthcare providers must assess and address the adequacy of their local, state and regional educational infrastructures. Infrastructure includes range and access to post-secondary training and sufficient availability of faculty, student slots, tuition assistance and articulation agreements. Student achievement, graduation ratios and pass rates on licensure exams are additional local concerns affecting healthcare providers.
Hospitals' human resource departments already are strained for resources. Devoting sufficient attention to these issues is implausible without the leverage of local collaboration. THA and the Center for Health Workforce Development in Tennessee (CHWDT) will continue to supplement local efforts with statewide advocacy, analysis and technical support to address members' priorities. The communities that achieve the most success in developing local health workforce pipelines will be those where statewide efforts complement local partnerships.
Community hospitals frequently struggle to differentiate themselves in the market. They may offer the same basic range and quality of services, even overlapping medical staff rosters. When all else is equal, or is perceived so by consumers, product positioning grows in importance. Positioning is how you are viewed by your market — or want to be.
Hospitals that actively foster healthy communities through outreach, staff volunteerism and corporate sponsorship can become positioned as civic leaders and exemplary corporate citizens. Competitive advantages in recruitment, philanthropic giving, image, awareness and preference share can result.
Health professionals who represent their professions and hospitals in community service make the health careers story real. Practicing the values that attract people to health care, including concern for others, collegiality and teamwork, is a powerful tool for retention as well as recruitment. Employee participation in community outreach programs can enhance satisfaction, loyalty and pride.
Arizona hospitals recently selected 120 nurses and allied health professionals to serve as ambassadors in the Campaign for Caring, a long-term, multidimensional health workforce development initiative sponsored by the Arizona Hospital and Healthcare Association (AzHHA). They will act as role models and career information specialists, making presentations to students throughout the state.
Workforce development, like retention, is ongoing. There are no quick fixes. Sustained success will depend heavily on cultivating long term relationships of respect and regard between:
- Healthcare facilities and educational institutions.
- Healthcare employers and potential employees.
- Practicing professionals and interested students.
Hospitals and local schools have a natural symbiosis. Hospitals can be rich sources of much-needed clinical laboratory equipment and supplies, health education and services, career guidance speakers, volunteer support and youth mentoring. Hospital CEOs, especially in smaller communities, should make it a point to develop personal relationships with local school principals. For more information on cultivating partnerships with local schools, read Growing a Local Garden of Healthcare Heroes elsewhere in this guide.
Career exploration and pursuit can be a rocky path. Early health careerists need ongoing information and guidance as they prepare themselves to enter a profession. Families move. Students change schools. Financial aid packages appear and disappear. Students discover new interests and make new choices. They switch majors and switch back again. They grow up and get married. They begin to balance school schedules with work schedules, homework with childcare. As employers and prospective employers, we must tend and nurture our gardens.
Not every child will be interested in a health career. But every child will be a lifelong healthcare consumer. Our overarching mission as an industry should be to create healthy communities, one life at a time. Building bonds with schools and students serves hospitals' individual missions and margins, and benefits the industry as a whole.
The consumer response pyramid, a strategist's tool described elsewhere in this guide, depicts the hierarchical process that occurs between launching a promotional message and making a sale. A consumer's awareness of a product or service offering is merely the first step. He or she must progress from awareness, to interest, to evaluation and then to product trial before finally deciding whether to make a purchase. At each level, the number of potential buyers decreases.
Perception is critical in the marketing of intangibles. A consumer's interest is engaged only if he perceives the advertiser/manufacturer as trustworthy and the product of competitive quality. At any point in the sequence of awareness, interest, evaluation, the most captivating promotional message can be neutralized by negative feedback from previous users.
Word of mouth is by far the most powerful form of local market communication in the service sector. This is especially true in health care, where there is a high degree of "perceived risk" (a marketing term assessing the potential for bad outcomes from choosing the wrong product). Word of mouth derives from actual experience with the product. It tends to be exaggerated or distorted with each degree of separation from the original user, much like the parlor game of Gossip. When a product or service does not live up to its promotional promises (whether in reality or by perception), negative word of mouth trumps formal marketing. Using "hype" to make a faulty product appear desirable will produce, at best, only short-term results. Overstated promises are an unproductive marketing strategy that destroys credibility.
Are health careers a great product offering? Numerous employee retention and satisfaction studies suggest otherwise. Unhappy employees and former employees often rant about their disappointing work experiences. What they say becomes the word on the street about hospital employment in your local market.
Cutthroat competition among local hospitals also is self-defeating. Many consumers find "hospital wars" baffling, even offensive, and are turned off by the perceived waste of resources. When we espouse values of respect, collegiality and teamwork in health professions, then fail to live by them in our own organizations or in competition with others, we disserve our cause and our incumbent workers.
Competition among local hospitals for trained personnel and entry-level workers is a fact of life, but how we compete is as important as winning. Nationwide, a number of hospitals have engaged in bidding wars for nurses and other high shortage professionals, competing with lavish sign-on bonuses and new-employee perquisites. These practices are counterproductive. They are demoralizing to existing staff and make other professionals feel devalued. They create internal competition for resources and recognition, pitting department against department. Not exactly a good strategy for attracting the best and brightest, nor for building a model workplace.
Competing against other local hospitals should be our least concern in workforce development. The outstanding youth and career-changing adults we seek have numerous workplace options. We compete for their skills against other industries. Once directed on a health career path, we compete to keep them in colleges and universities close to home. We compete for graduates to return home after living in locations where they have established new ties. Hospitals compete against other healthcare workplaces promising less stress, better pay and more convenient hours (witness the egress of hospital pharmacists).
It is essential that we know what these alternative paths offer, their competitive advantages and disadvantages. We must know how health careers compare to other choices being presented, especially within our local markets. We must be savvy in our marketing and packaging to ensure that our product "cuts through the clutter" of promotional messages that bombard our target audiences each day.
Health careers have many inherent advantages over other offerings. Our challenge is to deliver consistently on the promises we make, in all markets and workplaces.
The pool of potential healthcare professionals has many subdivisions, or market segments. Each exhibits different characteristics, desires and behaviors. Market targeting begins with comparing the relative size, accessibility, durability, defensibility and responsiveness of potential segments. Consider where your recruitment investment will have the most leverage before devoting significant resources to any particular segment. Targeted segments might include:
- Elementary and secondary students.
- Post-secondary students (those undecided on a career, unhappy in a declared major or unsuited to their initial choice).
- Underemployed adults and workers laid off from other industries.
- Former healthcare workers, either retired or employed in non-hospital or non-healthcare settings.
- Your own employees (who may be unaware of alternative career paths inside the organization).
Two sub-rules apply:
- Maintain high selectivity standards. We are not just seeking additional employees. We are searching for more heroes.
- Avoid targeting workers at competing local hospitals. Steal-away is a game where both sides lose.
Once you have selected the segments most likely to be responsive to recruitment initiatives, seek to understand them thoroughly. Know their communication preferences, motivations and work/life priorities. These characteristics are revealed in consumer research and workforce studies. Your own hospital's consumer research, employee opinion surveys and exit interviews also can be a fertile source of marketing insight into some of the groups named above.
Nurse executives Julie Schaffner and Patti Ludwig-Beymer write about teens' career expectations in their book, Rx for the Nursing Shortage, available through AHA and the ACHE. The authors report the following general expectations teens have about careers, then show how speakers and recruiters can specifically tie these expectations to nursing careers. Similar arguments can be made for many allied health and medical professions. Their research indicates:
- Teens are interested in careers that offer a degree of independence, autonomy, critical thinking and continuous learning.
- They seek variety, challenge and choice throughout their work lives.
- Teens are idealistic and team-oriented. They want to "make a difference in the world" through careers that involve collaboration.
- Teens desire professions that will support them financially and be worth the requisite investment in education and training.
Teens who explore careers through research, extracurricular activities, adult role models, career guidance and trial experiences will be more successful in choosing paths that satisfy their goals.
The term "local market" may well be an oxymoron in the Internet age. People are linked in communication paths that have no boundaries. As a result, isolation from other people, worlds and ideas is virtually nonexistent, even in the most rural communities.
Long-term recruitment is synonymous with uncertainty and unexpected outcomes. We can introduce local youth to health careers and help start them down the right academic paths. We can effectively market health careers in Tennessee, but we cannot keep all our recruits (especially our youth) in Tennessee.
An increasing number of healthcare employers offer scholarships and financial aid with contractual work agreements. Meaningful mentoring relationships between hospitals and aspiring health professionals can create bonds that are even stronger, and last longer.
The ultimate solution to the health workforce shortage is multiple local pipelines, built and maintained by coalitions of employers, educators and local stakeholders. These community-based initiatives must be complemented by effective advocacy at state, regional and national levels.
For more information on THA's advocacy agenda for health workforce development, contact Bill Jolley at bjolley@tha.com
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