When Dartmouth Health set out to expand employment opportunities in its region and bolster its workforce, it faced a complex set of issues. The health system — which includes Dartmouth Health Children's, the only children’s hospital in New Hampshire — serves a largely rural area with a relatively small pool of available workers and limited access to affordable housing, public transportation, and child care services.
That meant to hire the people needed to deliver care, it had to simultaneously deal with a multitude of interrelated challenges. And as the state’s largest private employer, the health system knew the community’s well-being hinged on its success.
“We recognize that workforce limitations are not just a constraint on our business model but on the health of our populations in the entire region,” said Sally Kraft, MD, MPH, vice president of population health at Dartmouth Health. “We must invest in economic opportunity through workforce to achieve health equity across the region.”
The health system deployed initiatives around skill development, community engagement, and external barriers to address these issues and enhance its region’s workforce.
“These interconnected issues won’t be solved by any one intervention. You have to start by doing something to begin chipping away at it,” said Carolyn Isabelle, system vice president of talent acquisition and career development. “It’s going to be the cumulative effect of a whole bunch of different interventions and strategies and investments that will help us change the current dynamic.”
8 diverse interventions
These are some of the health system’s interventions:
- Workforce Readiness Institute (WRI). A scarcity of workers with the skills and credentials necessary for jobs in health care led the health system to establish a licensed career school. Since the program’s inception in 2014, more than 1,600 graduates have transitioned into full-time roles at Dartmouth Health. The training programs include those for licensed nurse and medical assistants, pharmacy technicians, phlebotomists, ophthalmic assistants, and surgical technologists. Importantly, WRI participants receive a training wage while they learn, and some programs lead to an associate's degree in health science from Colby Sawyer College. “For someone who's currently affected by poverty, the idea of spending 10-to-20 weeks in an unpaid training program is a non-starter,” said Greg Norman, director of community health. “These programs provide a living wage during training and create a foundation for advancement through credentials and education.”
- Academic partnerships. Dartmouth Health leverages its relationships with post-secondary schools in the region to develop a pipeline of student talent. The system hosts more than 1,100 health care program students annually for clinical training and rotations to support regional education programs and connect with potential future employees.
- Advanced career training. Current high-performing employees are eligible for sponsored education programs for critical roles in nursing, respiratory therapy, diagnostics, and the medical laboratory. Selected employees are hired into a trainee role in a hosting department while they complete their educational requirements and their clinical training with that department. Employee support may include paid learning time and/or tuition resources such as tuition reimbursement, scholarship, or sponsorship to attain a degree or credential with an academic partner.
- Job readiness and skill development. This strategy focuses on supporting people to qualify for training or employment in health care by connecting them with entry level employment, resources for completing high school (e.g. GED), career counseling, ESOL classes, and college content like medical terminology.
- Youth engagement. “Half of the people in New Hampshire who graduate from high school seeking a four-year college or further degree leave the state. Once they're gone, they often don't come back,” Kraft said. In 2017, the health system launched a partnership program with area high schools to acquaint students with health care careers, its readiness institute and other training programs. This outreach includes career days at the Medical Center, speakers and events, and a paid summer internship program that provides professional development, mentoring, and experiential learning.
- Housing assistance. Estimates indicate the Dartmouth Health region needs 10,000 more housing units to meet demand. That pressure drives up home prices and makes it difficult for team members to live near work or relocate to the area to accept a position. The health system subleases 150 apartments in the area to new patient care hires who are relocating. The program has helped more than 600 workers relocate.
- Extending childcare. A significant child care shortage exists in the region. Dartmouth Health funds initiatives to recruit and train child care providers, support existing third-party child care centers, and explore ways to expand capacity at its own centers.
- Enhanced transportation. The housing market has pushed many team members an hour or more from their workplace, making affordable transportation a major barrier. Dartmouth Health subsidizes regional bus services, collaborates with bus providers to expand their routes and schedules, and financially supports commuter bus services for its employees.
Three keys to Dartmouth Health’s success
Dartmouth Health’s workforce investments tie in with its membership in the Healthcare Anchor Network (HAN). Launched in 2017, HAN includes more than 70 health care organizations around the country seeking to address economic and racial inequities that contribute to poor health conditions in their communities. Participating institutions strive to affect change through more inclusive standards in purchasing, investing, and hiring practices. Additionally, Dartmouth Health is one of 17 health systems that has signed HAN’s Impact Workforce Commitment, pledging to meet specific goals aimed at equitable hiring and employment standards. The health system’s leaders see strong peer support as a key to successfully addressing workforce equity concerns.
“Healthcare Anchor Network’s framework has helped us organize as we come around the table to solve these issues. Otherwise, it’s very easy to get lost,” Kraft said.
Strong partnerships with organizations across the community are vital as well — especially outside the hospital walls, such as Dartmouth Health’s work in supporting local childcare providers. “They know their industry, the people, and have their trust. Their place in the solution is one we as a standalone health care system can't and shouldn't have,” Isabelle said. “It’s all about understanding your partners’ strengths and who can have the greatest impact.”
When addressing a large, complex challenge like this, it’s important to not get bogged down in the details of where to begin. “What helped us succeed was starting where there was a really strong business need,” said Jenny Macaulay, director of career development and workforce strategy. “The business case to make the investments was need-based. Then, we were able to create a strategy that also helps serve some of our broader outcomes and goals.”
