Meeting the workforce challenge with apprenticeships

Dartmouth-Hitchcock’s creative approach to identifying, attracting and training new sources of talent


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“Workforce” is perhaps the most used word in business, education and govern­ment circles these days – and it should be. We are in a perfect storm of a rapidly changing business environment. The busi­ness demand for talent is voracious, and the education and supply of talent is insuf­ficient to meet demand. Health care pro­viders feel this talent gap acutely.

Most economic indicators for New Hampshire’s post-recession economy are favorable, especially a remarkably low un­employment rate. While low unemploy­ment is good for the workforce, it presents challenges for employers – particularly those seeking specialized skills such as in health care.

Like many New Hampshire employers, Dartmouth-Hitchcock faces significant challenges. We routinely need to fill about 10 percent of our 10,000-member regional workforce each year and receive almost 60,000 applications for all levels of em­ployment, from housekeeping services to neurosurgeons.

New Hampshire’s median age makes it one of the oldest of states, with many employers retiring people faster than they can replace them. Also, there is a perception among our youth that opportunity is “elsewhere,” and many leave the state looking for ways to grow rather than seek a career locally. Despite good schools and a great qual­ity of life, we are seeing fewer new families moving here, perhaps also due to a per­ception that New Hampshire isn’t a place for job growth.

At the same time, the health care sector is changing more rapidly than the rest of the economy, as we move from fee-for-service – where medical providers charge patients for every exam, test or procedure – to population health, where we will be paid for keeping people healthy and not treating them only when they are sick.

To accomplish this goal, we are changing the way we provide medical care. We need new workers who are knowledgeable, flex­ible and responsive to our patients. Care that is not solely provided by medical doctors or even nurses, but also includes medical assistants, who greet patients as they enter the clinic, take vital signs and record basic medical history. We also need medical coders, pharmacy technicians and other employees who are so important to overall patient care.

Sustainable workforce strategy

Finding those highly qualified workers is a challenge. Most medical assistant pro­grams are based on a two-year associate degree program and can cost students up to $20,000. Dartmouth-Hitchcock’s goal is to hire as many as 500 of these new work­ers in the next five years. Currently, we hire as many as we can, but we need more – and we need them now.

Two years ago we realized it was becom­ing harder to find qualified applicants. We needed a sustainable workforce strategy. We also knew that there existed an under-employed workforce, mostly in the service sector, who yearned for new opportunities but lacked the ability to stop working, go back to school, incur debt and find a new career. We had a need, they had a desire and we found a way to match those cir­cumstances.

We expanded our thinking about how we define applicants. Instead of just look­ing for qualified candidates, we started to think about how to identify and find “tal­ent.” We asked ourselves tough questions: Could we identify people who had an apti­tude to learn and a passion to care for oth­ers, then teach them what they needed to learn to do our work? What would it look like to build a sustainable workforce? How could we attract people who already live in our communities and help them gain the knowledge, skills and credentials they need? Instead of hiring for skill, and hop­ing the person was a cultural fit – could we hire new workers for their vision and values, and teach the skills they needed?

As an organization, we have needed to think creatively about how to identify, at­tract and even train new sources of talent. Rather than look for a completely trained workforce, we have been building pro­grams that enable us to invest in individu­als with the right attitude and aptitude, and provide them with opportunities to earn and learn at the same time.

Rediscovering apprenticeships

 In 2014, working closely with the U.S. Department of Labor, state partners in New Hampshire and Vermont, and other partners, we developed an innovative training program that aligned with this new workforce strategy. We launched the Dart­mouth-Hitchcock Workforce Readiness In­stitute to build a portfolio of ready-to-work apprenticeship programs that includes the creation of a robust portfolio of Registered Apprenticeships – an opportunity for New Hampshire and Vermont residents to earn while they learn.

These apprentice programs include col­laborations with our local college systems to offer individuals the opportunity to gain college credit for their work and grow and develop while on the job. In essence, we re-created an apprenticeship program that provides two or three months of intensive, accelerated education and a year of on-the-job training and mentoring to create these key front-line caregivers.

The apprentice model of training for meaningful employment has almost been lost in the U.S. work­force. It seems now is the time to re­discover apprenticeship as a viable workforce option to build the next generation of qualified employees.

We also knew we needed to make this affordable for the students. As an academic medical center, we al­ready provide clinical training. We know how to do research, how to analyze data, how to scrutinize pro­cesses and study outcomes. Build­ing an education program from the ground up provided an exceptional learning experience for our stu­dents – and ourselves.

By looking closely at our processes, we identified ways to do our work more efficiently. We also engaged existing employees to mentor and support our train­ees. And many of our patients comment that they see the difference in our clinics.

We are engaging our employees in the process and literally investing in their futures. We are providing the training at no cost to them and hiring them immediately as ap­prentices and employees. They succeed by having a good job, good benefits and an op­portunity to grow. We succeed by growing an enthusiastic and loyal workforce.

To date, Dartmouth-Hitchcock has trained more than 150 apprentices in five entry-level roles. Our apprentices bring a diversity of experience and backgrounds. Almost 30 percent of our program par­ticipants are over the age of 40, many are veterans and more than 80 percent qualify as under- or unemployed prior to our pro­gram participation.

We believe that our apprenticeship model makes great business sense and provides unprecedented opportunities for our new workers – and for us as employers. These programs have positively influenced employee engagement, quality of care and patient satisfaction. We have created an environment where we are constantly looking for ways to grow and develop. It is our belief that programs like this are an investment in our business, our talent and our community. This workforce develop­ment program will help enhance and sus­tain healthier and more vibrant communi­ties in our region for generations to come. We also believe that we are better pre­pared to ride out the perfect workforce storm.  


Harvard Pilgrim offering telemedicine services

 Harvard Pilgrim Health Care, New Hampshire’s second largest commercial insurer, has begun offering video medical visits to commercial and self-insured plans.

The telemedicine services will be offered through California-based Doctor On Demand and from doctors in the Harvard Pilgrim net­work that already offer telehealth.

“We believe this service will provide flexibility and value to augment the existing relationships our members have with their primary care phy­sicians,” said Beth Roberts, Harvard Pilgrim’s senior vice president of enterprise sales and marketing.

Under the service, no referrals are needed and members may use a smartphone, tablet or com­puter to connect to a board-certified doctor via Doctor On Demand’s highly-rated video plat­form. Member cost-sharing will be equal to the primary care cost sharing on a member’s plan, and payable with a credit or debit card via the Doctor On Demand application. All Doctor On Demand physicians are licensed in the state the member is calling from at the time of the visit.

Harvard Pilgrim said some of the common medical conditions that may be treated include cold and flu, asthma and allergies, bronchitis and sinus issues, rashes and skin issues, eye issues, upset stomach, pediatric issues, urinary tract in­fections, yeast infections and sports injuries.

Patients with minor issues after hours can also avoid costly trips to the emergency room, im­proving patient experience and reducing health care spending.

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