Pathway to the Future: How Workforce Development and Quality Jobs Can Promote Quality Care Conference Package. Executive Summary


A top priority for the Department of Labor’s (DOL) Employment and Training Administration (ETA) is serving America’s workers through effectively meeting the workforce needs of business. The High Growth Job Training Initiative of ETA and its Business Relations Group recognizes that workforce development is not separate from economic development but an integral part of it.

The health care industry was selected as one focus within the High Growth Job Training Initiative. Health Services comprised 5.8 percent ($589.9 billion) of Gross Domestic Product in 2001.3 In 2002, the total employment in health services was 11,529,000.4 The Labor Department’s Bureau of Labor Statistics projects that the industry will add 3.5 million new jobs, or 16 percent of all wage and salary employment, between 2002 and 2012. Nine out of the twenty fastest growing occupations will be in health care.5

Significant workforce supply and demand gaps currently exist across the U.S. that affect acute care, long-term care and primary care health care provider sectors. These gaps are even more significant across all three sectors in rural America.

This report provides the results of information gathering from key health care informants regarding workforce issues as reported by the ‘demand’ side of the workforce. The provider or owner/operator associations employing the greatest numbers of health care workers are the primary employer informants. Parallel to meetings and interviews with employers, relevant workforce reports and information were sought from the DOL Bureau of Labor Statistics, the Department of Health and Human Services Health Resources and Services Administration, health care workforce researchers, reports of provider associations, educators, public and private workforce professionals -- including Workforce Investment Boards, and the contacts suggested in interviews with members of these sources.

The initial analysis of the information generated concluded with a clustering of the workforce issues or challenges by topic and by sector within the health care industry:

  • Pipeline Challenges/Issues: Recruitment and Retention
    • Increasing available labor pool
    • Increasing diversity and seeking workers from non-traditional labor pools
    • Reducing turnover
  • Skill Development Challenge/Issues
    • Entry-level worker preparation
    • Incumbent worker training
    • Need for targeted and specialized areas of skills
  • Capacity of Education and Training Providers Challenges/Issues
    • Lack of academic and clinical instructors
    • Lack of facilities and resources
    • Lack of alignment between employer requirements and curricula, and specialized skills areas
  • Sustainable Workforce: Leadership, Policy, and Infrastructure Challenges/Issues
    • Need for sustainable and adaptive workforce partnerships at national, state and local levels
    • Opportunities to leverage funding and other resources
    • Planning tools (data, projections, and information systems that are useful in projections of demand at the single facility and local levels)
    • Policy issues including those of regulation

The majority of the workforce issues reported are the same or similar across primary, long-term care and acute care sectors. For example, all types of provider groups report that the current number one problem in occupational vacancies is for registered nurses. There are, however, some identifiable differences among the provider sectors. For example, long-term care providers identify a serious concern regarding the current and projected supply/demand gap of senior managers, while neither acute nor primary care providers share the same degree of concern. The acute care providers’ vacancies include a significant number of direct care workers, medical diagnostic and treatment technologists and support workers. The rural health vacancies across a wide spectrum of occupations are of continuing concern and made more problematic with the current vacancy rates nationally.

A second step in information gathering and analysis was performed prior to and during the course of three Workforce Development Industry Forums held in October 2003. The 126 forum participants were selected from a pool developed through nominations from owner/operator associations, the National Association of State Workforce Agencies, the National Association of Workforce Boards, the American Association of Community Colleges, and other workforce leaders from whom project staff had previously sought information. Some of the participants represented health care workforce projects currently funded by the Employment and Training Administration. Participants were asked to complete a validation tool containing challenges gathered in Phase I and invited to suggest additional issues. In addition, at the forums they were presented with an overview of the challenges and issues and asked for additional input. No changes in the challenges were made.

Participants in the forums were assigned to one of four groups. They clarified challenges or issues, generated 1001 solutions, and ranked the solutions by a voting procedure. For the 83 highest-ranked solutions, small teams worked to develop a matrix that includes the challenge, the solution, critical attributes for a successful solution, key stakeholders, resources required, policy barriers at the local, state and national or federal level, and any other needed clarifications.

The highest-ranked solutions include recommendations in the following areas:

  • Issue: Pipeline: Recruitment and Retention
    • Solution: Creating and expanding youth-focused programs to better inform young people about health care careers and encourage them to consider health care occupations.
  • Issue: Pipeline: Recruitment and Retention
    • Solution: Ensuring that public workforce programs provide adequate preparation of entry-level workers in the basic knowledge required to enter many health care occupations, adequate social and financial supports during the training period, opportunities for work placement, and support during the transition to the workplace so these workers can succeed and be retained in the health care industry.
  • Issue: Pipeline: Recruitment and Retention
    • Solution: Marketing health care career opportunities to youth, potential worker pools that do not traditionally enter the health care industry, dislocated workers, immigrant communities, older workers, and traditional worker pools.
  • Issues: Pipeline: Recruitment and Retention and Skill Development
    • Solution 1: Attracting and retaining workers through significant improvement of the “culture” of the health care workplace by implementing shared governance, incumbent worker training, career ladders, access to education and training opportunities, and other attributes identified by employees, researchers, and from exemplary continuous improvement programs.
      • Solution 2: Providing management training and credentialing in long-term care, consistent with this type of workplace improvement.
  • Issue: Skill Development
    • Solution: Designing health care occupation curricula that provide the basic knowledge and skills needed for effective entry to practice in the high-growth areas of employment in primary care, long-term care and acute care sectors. Develop curricula so that there is a fit between programs for advancing the careers of health care workers (often provided through the workplace) and the requirements of the educational institutions.
  • Issue: Skill Development
    • Solution: Examining the state credentialing requirements with the goal of expanding less traditional paths to meeting occupational requirements, such as career ladders, apprenticeships and other workforce development strategies. Creating “cross walks” from practice to educational programs and credentialing requirements based on nationally developed measurement of worker skills.
  • Issue: Capacity of Education and Training Providers
    • Solution: Addressing the capacity problems (i.e., lack of faculty, resources, etc.) in many community colleges and other post-secondary education and training organizations where barriers to applicants exist and where there are inadequate numbers of qualified applicants for actual or projected demand for some health service occupations. Capacity is affected by lack of faculty and other resources.
  • Issue: Sustainability: Leadership, Policy, and Infrastructure
    • Solution: Partnering among a wide range of stakeholders in the health care workforce in order to project changes in workforce demand at the local/regional, state and national levels and to generate long term, efficient, and sustainable approaches to those changes.
  • Issue: Sustainability: Leadership, Policy, and Infrastructure
    • Solution: Developing methods for projection of medium-term occupational needs that can be used by a health care entity, such as a hospital or home care agency, as a basis for internal planning and for planning with partners in education, workforce development and other health care workforce stakeholders.

The Department of Labor Employment and Training Administration’s Business Relations Group reviewed the solutions generated during the Workforce Development Industry Forums. The purpose of the review was to:

  • Identify for referral those solutions that are both the responsibility of other entities and not in the domain of the Department of Labor;
  • Identify solutions that are jointly in the domain of the Department of Labor and another federal department;
  • Identify solutions where the Department of Labor or the public workforce system already have program commitments; and,
  • Identify solutions within the Department of Labor’s domain that if implemented effectively and widely will have a significant impact on managing the present and future workforce challenges of the health care industry. The latter group of solutions was examined by asking the question: “How can the Employment and Training Administration best use its resources and influence to have a positive impact on the challenges identified by the health care industry?” The solutions selected for initial action are ones that can be adapted to many settings, that are built on partnerships among stakeholders, that provide other opportunities to leverage resources (including funding), and that are relevant to the basic problem of adapting the workforce to changing industry needs.

The solutions anticipated to have the clearest impact include the following program areas:

  • Youth-related programs developed and implemented by partnerships that include schools, health care employers, post-secondary programs for health occupations, and public workforce system entities.
  • Programs focused on non-traditional and traditional pools for health care entry-level workers that both broaden approaches to preparation programs and enhance career mobility in health care and related industries. Competency models for these programs should be developed through a partnership of educators, employers, and workforce professionals.
  • Initiatives that meet the needs for academic and clinical faculty in high-demand health care education programs and that are designed to adapt to changing levels of workforce demand.
  • Programs that deal with the community college and other educational organizations’ insufficient capacity through innovative partnerships and other approaches. These capacity issues include the need for appropriate clinical practice opportunities, funding for students, diagnostic and treatment equipment, and laboratory support.
  • Improvement of health care workplaces by interventions such as management training, incumbent worker training, career mobility programs, accessible education and training opportunities, and reducing staff fluctuations through workforce projections.
  • Effective initiatives to build a sustainable national infrastructure with local, state, and national elements tasked with continuous balancing of workforce demand and supply within the health care industry.

The majority of the solutions identified by forum participants are not sector specific. However, many solutions can be adapted to the particular needs of a sector or a community.

National, State and Local Partnerships for Implementing Workforce Solutions

Dealing with workforce challenges in the health care industry requires collaboration at the national, state and local levels, and between these levels. Executive and Workforce Development Industry Forum participants recommend a national, systemic approach that aligns the workforce resources available with the challenges facing the health care industry today and well into the future. This direction is consistent with the thinking behind the High Growth Job Training Initiative.

A central role of the Employment and Training Administration is that of identifying and communicating effective workforce solutions that can be replicated to respond to national challenges such as management training or youth-related recruitment programs. A second aspect of that role is the funding of pilot programs, by ETA alone or in partnerships, that are most effective in dealing with some aspect of workforce challenges, and that are replicable by other entities. At the national level, providers and others also identify the need for a national warehouse of sound and effective workforce interventions with a search engine that makes it possible for a local Workforce Investment Board, a human resources manager, or others to identify solutions that have worked elsewhere.

The actions of state governments and state-level entities are pivotal to any national workforce effort. State government decisions direct how some federal funding is used to support some workforce programs. For example, the Workforce Investment Act provides funding to states, and through the states to local Workforce Investment Boards and workforce-related programs. These funds and others, such as Temporary Assistance to Needy Families and Medicaid, are used to provide training, support, and placement for many occupations including those in health care. It is at the state level that policy and funding decisions are made about higher education, licensing and regulation. Medicaid programs that directly affect employment conditions and delivery of care, worker training, collection of information for programs and policy development, and other initiatives that directly influence the implementation, are among many of the solutions recommended in the Executive Forums and Workforce Development Industry Forums. A sustainable, adaptive and effective workforce strategy in health care requires strong public and private partnerships in every state. Without these partnerships ETA cannot respond adequately to current problems or prevent future ones.

Local partnerships, including Workforce Investment Boards, employers, employees, educators and other community members, are needed to implement workforce solutions closest to health care delivery sites, and to potential labor pools. Through such partnerships, both the workforce demand and supply sides can identify the needs in their own communities. Partners can use their state and national networks to find solutions to better manage their particular challenges.

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