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Impact of Vision: Benefits from Investing in Frontline WorkersJennifer Craft Morgan, PhDResearch Scientist, Institute on Aging, University of North Carolina Tom StrongProgram OfficerThe Hitachi FoundationBarbara Trehearne, Ph.D., RN VP, Clinical Excellence, Quality & Nursing Practice, Group Health Cooperative

Special thanks to our Diamond Sponsors:Coopersmith Health Law Group, Coordinated Care, and TeamHealth

the impact of vision benefits from investing in front line workers

The Impact of Vision: Benefits from Investing in Front Line Workers

Tom Strong

Program Officer, Hitachi Foundation

Barbara Trehearne, PhD, RN

VP Clinical Excellence, Quality and Nursing Practice,

Group Health Cooperative

Jennifer Craft Morgan, PhD

Research Assistant Professor, Department of Allied Health Sciences, UNC School of Medicine; Scientist, UNC Institute on Aging

the hitachi foundation
The Hitachi Foundation
  • Our focus: the role of business in society.
  • Our goal: business practices that improve the lives of low-wealth Americans.
why focus on frontline workers flws
Why focus on frontline workers (FLWs)?
  • Health care delivery is changing - and must change further.
  • Low-wage frontline workers represent the fastest growing and least-constrained asset in the sector.
  • Vacancies have eased off recently, but will return.
  • Instability, training, and productivity of frontline workforce has an impact on quality of care.
  • FLWs often play an important role in meeting the needs that healthcare organizations serve.
pioneer hospitals
Pioneer Hospitals
  • A national effort to identify and promote hospital efforts that help entry-level workers develop careers in health care
  • 15 to 20 case studies of hospitals from across the country
  • “Pioneer employers” are employers whose policies and practices have resulted not only in a measurably better quality of life for entry-level workers, but have also created a measurable return toward the organization’s bottom line
pioneer hospital case study group health

Pioneer Hospital Case StudyGroup Health

Barbara Trehearne RN, PhD

Vice President, Clinical Excellence

Quality & Nursing Practice

group health nursing staff
Group Health Nursing Staff

Position Count FTE

  • RN 875 674
  • LPN 307 261
  • MA 395 343
  • ARNP 64 52
career progression programs
Career progression programs
  • Business office staff to Medical Assistant
  • Medical Assistant to Licensed Practice Nurse
  • RN to BS in nursing
business office staff to medical assistant
Business office staff to Medical Assistant
  • September 2009-June 2011
  • Partner with North Seattle Community College
  • 12 participants selected
  • Online MA training with in-class labs
  • 6 completed
  • $15K/participant
medical assistant to licensed practical nurse
Medical Assistant to Licensed Practical Nurse
  • 2003-04
  • Partner with Renton Technical College
  • 13 participants - 13 completions
  • Cohort based, on site RTC, clinicals at GHC
  • $15K/participant
  • Wage increase
rn to bs in nursing
RN to BS in nursing
  • Ongoing but focus on 2010-11 cohort
  • Partner Seattle Pacific University
  • 13 participants
  • Cohort based, video conference
  • $24K/participant
  • Job mobility
employer practices policy
Employer practices/policy
  • Tuition reimbursement
  • Paid education days
  • Schedule flexibility support
  • Track support
  • Preceptors/adjunct faculty
  • Coordination support
  • Troubleshooting
  • Employment benefits for .45 or .5 FTE

“I’ve talked with many of them and they say, oh, I’m not stopping here. You get them going and you know they want to keep going.”

Roger Walker, Analyst, Nursing Operations


“I am one that does push my staff to get trained. I feel that training is first and foremost in that you build the foundation of that individual. There’s nobody out there who doesn’t want to work. It’s just that they weren’t given the right tools to be successful and a lot of it is taking to time to make sure that they’ve been granted the time to grow and learn.”

ArdisGoulart, RN, BSN (Clinical Operations Manager, Primary Care Travel Group)

critical success factors
Critical Success Factors
  • Organizational Learning Culture
  • Supervisor Involvement
  • Strong Partnerships with Community Colleges
  • Progressive Human Resource Policies
  • Full-time Coordinator
what s in it for us
What’s in it for us?
  • Recruit to new roles from existing staff
  • Wage progression
  • Opportunity for better educated workforce
  • Employee satisfaction
  • Role models
  • Retention
return on investment
Return on Investment
  • A highly educated workforce
  • Increased productivity
  • High worker satisfaction
  • Improved skills
  • Lower Vacancy Rates
other organizational outcomes
Other Organizational Outcomes
  • Community development
  • Employer of choice
  • Strengthened integration of education and practice
  • Improvements to care delivery
learning from the pioneers investing in frontline workers

Learning from the Pioneers: Investing in Frontline Workers

Jennifer Craft Morgan, PhD

Scientist, Institute on Aging

Research Assistant Professor, Department of Allied Health, UNC School of Medicine


The Impact of Investing in Frontline Workers – the Employers’ View

  • Perceived Return on Investment
  • Improved quality of care
  • Increase number of qualified applicants for positions
  • Decreased turnover
  • Increases in employee skills/competency levels
  • Improved productivity
  • Reduction in the number of position vacancies
  • Reduction in absenteeism
  • Increased revenue
  • Improved work environment
  • Improved teamwork

Hospital characteristics (e.g., size, type of ownership, affiliation)

Organizational culture/climate (i.e., values and norms shared by people and groups within the organization)

Management strategies (i.e., policies and practices put in place to manage and organize work)

Program implementation

Local context (e.g., county unemployment rate, community demographics)

Organizational context (e.g., workforce needs, skill shortages, recruitment/retention problems)


From Jobs to Careers: Transforming the Front Lines of Health Care

  • A national initiative to promote skill and career development in incumbent frontline health care workers
  • $15.8m investment over 4 years, supporting program implementation and research grants
  • 17 sites nationwide; almost half are hospitals
  • Funded by Robert Wood Johnson and Hitachi Foundations, and U.S. Department of Labor
organizational learning or grow your own culture
Organizational Learning or “Grow Your Own” Culture
  • High-level champions for career/educational advancement
  • Supportive supervision (e.g., flexible scheduling, mentorship, coaching, conveying values of organization)
  • Support with training (not just for frontline workers!)
  • Celebrate successes (even the “small” ones)
changes to the work processes
Changes to the Work Processes
  • Rotating Job Assignments (e.g., cross training)
  • Participatory Decision-making (e.g. formalizing avenues for frontline worker input)
  • Integrating education into practice (e.g. identifying teachable moments, assignments for “school” based in work, involving supervisors in “school”)
high performance work practices hpwp
High Performance Work Practices (HPWP)
  • Incentive pay, job rotation, flexible scheduling, team-based work systems, and participative decision-making.
  • Purpose: To examine the effect of high performance work practices (HPWP) on frontline healthcare workers’ job satisfaction and perceived quality of care.
high performance work organizations findings
High Performance Work Organizations: Findings
  • Team-based work systems and opportunities for participative decision-making have the most impact on frontline worker job satisfaction and perceived quality of care.
  • Use of incentive pay, job rotation, and flexible scheduling did not impact frontline worker job satisfaction or perceived quality of care unless implemented in tandem with at least one of those two practices.  
so what
So what?
  • Job re-organization around participative decision-making and team-based models is likely to have an impact
  • This finding has implication for how and in what order and pairings, such practices might be most effectively implemented
questions for your consideration
Questions for Your Consideration

How can improving the skills of frontline workers help:

  • Reduce readmissions?
  • Improve triage in the ER?
  • Address physician unhappiness with team performance?
  • Reduce coding errors?
  • Improve patient satisfaction?
discussion q a
Discussion/ Q & A

Barbara Trehearne, PhD, RN

Jennifer Craft Morgan, PhD

Ed Phippen

Tom Strong