9 Ways Hospitals can Support Frontline Healthcare Workers, and Create a Winning Culture!

Most healthcare leaders agree that a productive culture is a pillar of hospital success. But there are many organizations with lofty-sounding “corporate missions” that have less-than-stellar work environments for frontline employees. Frontline employees can sometimes be an afterthought in culture development, but they are often the voice and the heart of the hospital to patients and families.

To improve culture, ask yourself – are we supporting our frontline employees’ career and life goals? Is there a sense of belonging and shared commitment among employees about how they serve patient’s needs? Do we have employee programs that are accessible and build support for our organization’s culture?

Here are some nationally recognized hospitals that are super-serious about maintaining a winning Frontline Healthcare Employee culture and some of the steps they have taken:


With focus on patient experience and reduced costs, employers are making a business case for building talent by aligning workforce training and education programs with strategic areas of business impact. Developing talent needs to go further than just a “feel good” public relations objective, so it’s important to measure the success in numbers. Quantitative metrics examples are recruitment costs, reduced turnover, or preventable re-admissions. Qualitative metric examples are new employee competencies in taking care of patients, and improved team climate relationships in a unit.

Yale New Haven Hospital is a 1,541-bed facility that serves the entire state of Connecticut, ranked by U.S. News & World Report as one of the top 50 hospitals in the country in 11 different specialties. YNHH offers a wide range of career development services to its frontline workers; its basic skill development programs include entry-level employee communication effectiveness workshops, conflict management, and effective presentation skills.

With 4,000 trainees annually, these trainings help prepare entry-level hospital employees to meet high quality and safety standards and perform in their roles more effectively.

Read more about Yale New Haven Hospital and their efforts.


When hiring, make an effort to recruit underrepresented members of the local community and demographics that mirror patient populations. This could include a focus on improving lives of local community members facing barriers to employment, or disabilities. Be a part of local workforce boards and other organizations with local outreach.

University Health System, in San Antonio Texas, is an organization committed to equitable talent development. It hires many community members who do not speak fluent English. Their career development programs have expanded to keep pace with the evolving language and literacy needs of their employees, including offering onsite English for non-native speakers.

With their community hires, University Health Systems executes on-the-job learning and career development system through the ECHO (Expanding your Career and Health Opportunity) program, to give mid-level healthcare workers the chance to move into more advanced roles in the organization.

Read more about University Health System and their hiring.


Advancing frontline hospital workers, or “growing your own” will help with obvious staffing and orientation costs. But it will also help maintain organizational knowledge and culture. And now with the economy closer to full employment, a commitment to advancing your own workers instead of looking outside is even more important. Apprenticeships and training opportunities may be a way to turn frontline workers into prime candidates to fill mid-level positions that are open.

At Mercy, the country’s fifth-largest Catholic healthcare system, frontline healthcare employee development is at the core of business strategy. To reach its goals, Mercy operates a Lowest Paid Worker Committee to bring together senior leaders to develop and implement strategies to improve wages and opportunity for frontline workers. Lynn Britton, Mercy’s President and CEO, leads the Lowest Paid Worker Committee. “We invest in the development of frontline workers to help them realize their talents and to support their professional and financial advancement.” Mercy tracks and reports participation in their employee advancement programs yearly, monitoring scholarship programs, tuition advance programs, School at Work® (SAW) graduations, and transportation programs. Mercy measures business impact, citing that 32.5% of School at Work® graduates have advanced into new roles and 9% have enrolled in higher education.

Read more about Mercy and their commitment to advancing frontline workers.


Supportive workforce practices require both qualitative and quantitative data, necessitating the capacity for data collection and analysis. HR should use workforce data to track programs, assess impacts, and analyze future needs. Forecasting tools focus on specific occupational groups, and includes head count, turnover info, recruitment metrics, vacancy rates, employee engagement, and required skills. Using workforce planning and analytics to anticipate future need is especially important when a community is reaching full employment levels.

Norton Healthcare, Louisville KY’s leading healthcare provider, is a healthcare pioneer in integrating workforce investments with business impact. Investing over $11 million a year in staff education and development, Norton’s transformational approach to workforce development integrates with its strategic staffing priorities. Norton monitors future staffing needs, patient data analysis, internal and external partnership impact, and the impact of its investments on bottom line ROI measures. In 2017, Norton Healthcare did an exhaustive study on ways leading  healthcare organizations in the U.S. use frontline investments to improve six key business metrics: Workforce Availability, Employee Competency and Advancement, Employee Engagement, Patient Experience, Community Impact and Quality, and Safety.

Read more about Norton and their analytics.


When a healthcare organization is committed to supporting entry-level hospital staff, they may offer benefits and initiatives designed to ease employee burden, through EAP or HR-direct initiatives.

These could include personal counseling, medical premium assistance, financial coaching, affordable child care, tuition programs, onsite clinics, low-interest loans, transportation subsidies, or employee crisis funds.

UnityPoint Health in Iowa is a leader in providing services to advance frontline employees and help with life events. In fact, UnityPoint’s mission is “Come for a job, stay for a career.” UnityPoint offers a menu of supportive HR options such as tuition assist programs, career coaching,  free transportation, and flexible scheduling.

Read more about UnityPoint and their efforts.


Career exploration, coaching, and mentoring are steps that should be integrated with building talent and advancing frontline workers. Once frontline health workers have developed skills and see opportunity that is available in the organization, have HR or a professional mentor show where they can go to learn more about new positions. Have a commitment to employee coaching, and promoting talent from within.

UC-Davis Health offers career coaching and an array of educational opportunities designed to help employees develop skills and advance careers. UC-Davis Health uses School at Work® as a combination of career exploration and skill coaching, working with employees to define goals and connect them to internal and external services. UC-Davis Health has found this has reduced recruitment and on-boarding costs. UC-Davis Health was also interested in developing Administrative Assistants and has invested in this employee group.

Read more about UC-Davis and their coaching programs.


A great way to support a top-notch frontline employee culture is to invest in programs that promote diversity, foster collaboration, and participation and respect in the organization. Frontline employees are the largest group of workers in most hospitals, so be intentional about achieving more diversity at the apex of the health system.

Main Line Health in metro Philadelphia has been recognized by U.S. News & World Report as one of the top health systems in the country. Main Line organized a Diversity, Respect, & Inclusion Strategy Team to make sure it was developing leaders in the organization who mirror the demographics of metro Philadelphia. This team works to break HR obstacles, tracks entry-level employment patterns, and measures impact of employee advancement strategies like SAW, ECHO, and its internal Career Advisor program.

Read more about Main Line Health and their mission to increase diversity at the top of the apex.


Many C-Suite hospital leaders still view learning and development as cost centers instead of strategic investments. When the strategic apex of any organization looks at low-wage associate investment this way, expectations and leader involvement stay low, leading to little or mixed clarity of how enabling talent fits in with company goals. This is a mistake, because when learning happens throughout the entire organizational chart, all associates start to see themselves as “owners;” and when HCAHPS surveys are taken, you want employees who see themselves as imperative

East Alabama Medical Center (EAMC) has a longstanding tradition of growing their own associates to carry out the organization’s mission of “high quality, compassionate healthcare.” In fact, a V.P. started as an orderly 35 years ago, proof that senior leadership has walked the walk. EAMC is in a small metro market, so hanging onto their best employees is especially important. EAMC invests in skill and education assessments and frontline worker learning programs, building these tactics into the mission. EAMC has built a nationally recognized culture of internal talent growth. Learn more about EAMC.


TriHealth has done the best job of measuring RoI that we’ve seen in 14 years of working in the healthcare workforce development space. The importance of measuring results sounds obvious, but this types of analysis is usually not done. If HR leaders do not show ROI and value, programs can be terminated in later years when budgets get tighter. If you’ve worked to advance turnover/retention rates, days required to fill vacant positions, overtime costs, and Temp agency costs, show it!

TriHealth Inc is Cincinnati’s fifth largest employer, with two acute care hospitals and more than 120 locations. TriHealth was recently recognized by Working Mother magazine as one of the “100 Best Companies for Working Moms,” a designation it has received 9 times. TriHealth uses CareerCare, a web-based career exploration tool for entry-level worker participants, and School at Work® to provide on-site learning opportunities to increase basic literacy, mathematics, and interviewing skills. In 2013, TriHealth did a large 4 year ROI study to show how these investments in entry-level workers had paid off. TriHealth saw huge increases in promotions and employee wage gains, plus savings from turnover costs during the four years of the study. TriHealth also had better job satisfaction scores during that time. Read more about TriHealth.

Building a great culture and support for Frontline Health Employees will not happen overnight, but paying attention to what industry leaders are doing can be a great source of ideas and inspiration! Investing in entry and mid-level nonclinical employees who interact with your patients will pay off, so be sure to measure and communicate results.

With these types of tactics, your hospital could see gains in workforce availability metrics, employee, engagement, improved patient experience, and community impact. Set your organization up for success with a winning and supportive Frontline employee culture!

To see case studies on any of these health systems, please email and we will gladly send you further details. Thank you to the National Fund For Workforce Solutions and its CareerSTAT Frontline Employer Champion program for recognizing these institutions who invest in their entry-level healthcare employees.

TriHealth: Partnering to be the Employer of Choice

This article was written by the National Fund for Workforce Solutions, designating TriHealth Inc. (southern Ohio) as a CareerSTAT Frontline Healthcare Worker Champion employer. 

TriHealth is Cincinnati’s fifth largest employer, bringing together two acute care hospitals and more than 120 locations. TriHealth provides a wide range of clinical, educational, preventive, and social programs. TriHealth’s on-hospital services include physician practice management, occupational health centers, home health, and hospice care. Working Mother magazine recognized TriHealth as one of the 100 Best Companies for Working Moms,” a designation it has received nine times. Truven Health Analytics has named TriHealth as one of the nation’s top 15 health systems.

In 2009, TriHealth seized an opportunity to partner with the Health Careers Collaborative of Greater Cincinnati (HCC) to provide greater access to learning and foster advancement for entry-level employees. The HCC is a partnership of local healthcare employers, community-based organizations, and educators.

HCC programs include:
– Associate’s Degree Cohorts: TriHealth selects participants with little or no prior college education to form a supportive cohort that will stay together from start to graduation. Students can obtain degrees in nursing, surgical technology, respiratory therapy, and medical lab technician. Supports for these cohorts include:
» Tuition billed to the employer
» Assistance for remediation courses, when necessary
» A career coach who supports job search upon graduation
» A community college advisor
» Specially scheduled evening sections for HCC courses and no wait list for clinical courses

– School at Work®: SAW provides on-site learning opportunities, enabling employees to stay on the clock while attending weekly two-hour lessons on professional and academic skills. TriHealth builds in additional instruction in basic literacy, mathematics, and interviewing.

– CareerCare: This web-based career exploration tool allows participants to learn more about healthcare career options. 100 employees went through the pilot program and TriHealth is planning to offer it again. Several entry-level participants have applied for promotions or enrolled in college.

– Patient Care Assistant (PCA) Training: TriHealth pays the tuition cost and hourly wages for incumbents and new hires moving into the PCA role. This can include up to three weeks of full-time training for those who are not already State Tested Nurse Assistants (STNA).

In fiscal year 2013:
>> 137 State Tested Nurse Assistant and Patient Care Assistant trainees completed their training.
>> 10 employees graduated from SAW.
>> 2 HCC participants attained an Associate’s Degree in Nursing, passed the NCLEX exam, and were promoted to Staff Nurse positions.
>> 20 trainees achieved their STNA certificates; 64 trainees achieved their PCA certificates.


Reduced Turnover:
– Turnover was 5.7 percent for SAW participants vs. 19 percent for non-SAW participants annually.
– Turnover was 1.2 percent for HCC cohort participants vs. 14.5 percent for non-HCC cohort participants.
– TriHealth estimates that it saved close to $210,000 in turnover costs by effectively retaining these employees.

Job Satisfaction:
– 65.7 percent of HCC participants indicated complete satisfaction with their job vs. 46.2 percent of non-HCC participants.

“At TriHealth, much of our success depends on our ability to attract, retain, and develop the talent we need to provide quality care. As an organization we realize the importance of developing the skills of our employees. In fact, it is a major strategic initiative of ours.” —John Prout, President and CEO, TriHealth, Inc.

A few years after starting a secretarial position at TriHealth, Stephanie enrolled in TriHealth’s School at Work® program. Later, when TriHealth offered its employees the opportunity to participate in HCC’s nursing cohort, Stephanie jumped at the chance. The prepaid tuition, additional SAW grant funds, and evening course schedule helped make her dream of becoming a scrub nurse possible. In 2012, Stephanie graduated with her ADN, obtained her license soon after, and became a staff RN for TriHealth. Her pay has increased more than 50 percent since this journey began.

Google’s Best Managers Excel at Coaching?!

In 2002, Google took a bold step and got rid of its engineering managers. According to a Harvard Business Review (HBR) article, the idea was to allow its engineers, who didn’t see the value of managers, to focus on the tech and “not communicating with bosses or supervising other workers’ progress.”

The short-lived experiment wasn’t successful. Founder Larry Page was inundated with problems and questions from the company’s engineers that had nothing to do with technology; issues a manager typically addresses.

Page and co-founder Sergey Brin quickly saw the value of managers, but realized they needed their employees to see it as well. As a company founded on data and analytics, it decided to bring in a team of experts to prove it “with the same empirical discipline Google applied to its business operations.”

The team’s initial research found the proof they needed. Statistical evaluations showed that “high-scoring managers” had lower turnover. They also found “a tight connection between managers quality and workers happiness.”

The next step was finding out what made a “good” manager. Based on their data, they uncovered “eight key behaviors demonstrated by the company’s most effective managers.” Number one? Being a good coach.

The full list of behaviors:

He or she…
1. Is a good coach
2. Empowers the team and does not micromanage
3. Expresses interest in and concern for team members’ success and personal well-being
4. Is productive and results-oriented
5. Is a good communicator—listens and shares information
6. Helps with career development
7. Has a clear vision and strategy for the team
8. Has key technical skills that help him or her advise the team

The problem, according to a related HBR article, is that managers often lack the time and skills to be more effective coaches. “Yet 70% of employee learning and development happens on the job, not through formal training programs,” the author notes. “So if line managers aren’t supportive and actively involved, employee growth is stunted. So is engagement and retention.”

How to drive the change

Not all companies have the resources available to Google to study effective management, but they can apply the results. Healthcare organizations in which managers are trained on (and expected to use) these behaviors and skills can gain a competitive edge when it comes to hiring and retaining workers. It’s particularly important when it comes to frontline employees, where turnover is high and engagement can be low.

In an article on “The Balance Careers,” executive coach Dan McCarthy notes that “Coaching is the skill and art of helping someone improve their performance and reach their full potential.” He emphasizes that it takes practice, but “it’s an investment in people that has a higher return than just about any other management skill.”

When managers become more competent coaches, McCarthy explains that everyone reaps the benefits. “People learn, they develop, performance improves, people are more satisfied and engaged, and organizations are more successful.”

At Google, the information drawn from its multi-year research was used to help identify ways in which managers could improve. A manager who didn’t score well on coaching “might get a recommendation to take a class on how to deliver personalized, balanced feedback.”

Offering courses that help managers build the coaching skills they need is a sound investment in your employees and organization. Even short sessions can help managers significantly improve their skills. The experts on the invitation-only Forbes Coaches Council (FCC) also recommend formal training, but they encourage managers to develop their own coaching skills.

Forbes Coaching Council (FCC)

Based on their experience helping companies such as Nike, Johnson & Johnson and Mattel integrate coaching into their management framework, the FCC experts share their collective coaching wisdom with Forbes’ readers. Their suggestions include:

1. Know your employees and help them succeed
Several of the experts emphasized the importance of this. “Show interest in an employee’s life and how it affects their performance,” suggests one. Another says ensuring the success of every employee should be a top priority for every effective manager.

2. Practice active listening
“As a manager, you can practice this skill by simply being quiet and letting your associate talk without agenda or interruption,” advises one expert. “Resist filling an awkward silence — that’s where the gold is.”
The key is to stay focused on the person, and not the ever-present distractions of calls, texts, or emails. One coach recommends heading outside for one-on-one discussions.

3. Don’t tell, ask
Allowing employees to have input and make suggestions helps them develop critical thinking skills and builds confidence. A question such as “Why is that the best solution” is a better approach than telling employees what to do. It “allows the employees to take ownership of their ideas and think through the outcomes.”

Another expert recommends asking some questions regularly. “What’s going on with you right now? What’s going well? What’s not going well?” He solicits their input on what happens next and asks one last question.”Finally, what can I do to set you up for success?”

Research shows, and the experts agree, that successfully managing frontline employees isn’t based on telling them what to do. It’s about providing guidance and support, and removing the barriers that prevent them from doing their jobs well. Managers that excel in coaching employees instead of micromanaging them tend to have better performers, and that makes the organization stronger overall.


“How Google Sold Its Engineers on Management.” Harvard Business Review. David A. Garvin

“You Can’t Be a Great Manager If You’re Not a Good Coach” Harvard Business Review. Monique Valcour

“10 Ways To Lead Like A Coach.” Forbes. April 6, 2018. Forbes Coaches Council.

“How Managers Can Become Effective Coaches of Employees.” The Balance Careers. December 14, 2018. Dan McCarthy.

Frontline Employees: Coaching For Success

Hit the ball, make the shot, row in unison. Understanding the basics of any team sport is easy, but if knowing the requirements of the game was all it took to succeed, everyone could play in the major leagues. To be a top athlete, it takes time, talent and dedication, but even those elements may not be enough.

Regardless of the sport, the one thing all teams have in common is a coach. The coach’s job is to bring out the best in every player and provide the guidance they need to not only play well but to function as a team. It’s a critical role in the sports world, but it’s equally important in business, especially with frontline jobs where pay is low and turnover is high.

As healthcare organizations struggle to retain hourly workers, the key to success isn’t found in a thicker training manual or additional policies and procedures; it’s in helping frontline employees develop all of the skills needed to succeed. While employees may understand the tasks they need to perform in their daily job, they may struggle with more basic concepts such as time management or communication.

A good manager helps frontline employees learn these and other soft skills because it makes the workers more effective in their jobs and more satisfied with the work they do. The result is employees who are more engaged and far less likely to be looking for a new job.

The American Management Association emphasized the importance of coaching in a recent article, noting that it’s “the most effective way for managers to lead” and is now a “core skill required of every successful manager in the 21st century.” It goes on to say that if managers don’t acquire these skills “it is unlikely that they will be able to achieve sustainable long-term positive results for themselves or their organizations.”

One of the barriers, according to a Harvard Business Review (HBR) article, is that “managers tend to think they’re coaching when they’re actually just telling their employees what to do.” The authors analyzed managers’ coaching skills through self-assessments and expert evaluations before and after leadership skills training.

Before leadership training, managers tended to overestimate their coaching abilities. They saw coaching as listing and directing the steps employees needed to take to accomplish tasks; but effective coaching isn’t about directing, it’s about helping employees learn.

In fact, many aspects of successful coaching are based on principles of adult learning. A Rutgers University article on adult learners noted that, in general, “Adults cannot simply act as passive receptacles of others’ expertise as children often do.”

Instead, the Rutgers’ article points out that “adult students prefer a self-directed approach that allows for discovery on their own.” It also notes that adults typically respond better to learning a concept if they understand why they need to learn it in the first place. (For more information on Adult Learning Theory, read our related article, Health Industry Employee Training – 6 Key Principles)

To assess managers’ coaching skills, the authors of the HBR article identified nine core leadership coaching skills that follow these adult learning principles:

1. assisting with goal setting
2. letting the coachee arrive at their own solution
3. listening
4. questioning
5. giving feedback
6. showing empathy
7. recognizing and pointing out strengths
8. providing structure
9. encouraging a solution-focused approach

These skills allow managers to help employees understand “the why” and they allow for self-discovery. Even when it targets one area such as time management, effective coaching for frontline employees helps associates build foundational skills that will be beneficial in other areas.

What all this means to healthcare organizations is that employee training needs to focus on more than the hard skills required for the job at hand. Helping employees improve decision-making, problem solving, conflict resolution and other soft skills is just as important, if not more important than task oriented training. It doesn’t just help frontline workers become better in their current role; it helps them become better employees in any position.

Read more about adult learning principles.

“Most Managers Don’t Know How to Coach People. But They Can Learn.” Harvard Business Review. August 14, 2018. Julia Milner, Trenton Milner
“Five Ways to Transform Managers Into Coaches.” American Management Association. Mike Noble
“The Principles of Adult Learning Theory.” Rutgers University.

Becoming an Advocate for your Frontline Workers

Becoming an Advocate for Your Frontline Workers

Since the 1990s, healthcare jobs have been steadily ticking up, while former powerhouse employers such as the manufacturing industry were trending down. An article in The Atlantic, “Health Care Just Became the U.S.’s Largest Employer,” highlighted this growth, noting that healthcare outpaced both manufacturing and retail industries in 2017.

It’s a position that the healthcare sector is projected to hold for the next decade. This anticipated growth is driven in part by an aging population that will require more health-related services, a topic that healthcare has been discussing for decades. Now, with data supporting this growth in healthcare industry jobs coming from the Bureau of Labor Statistics (BLS), the Federal Reserve Economic Data (FRED) and other entities, the impact of an aging population driving the need for more healthcare workers is part of the general conversation, garnering coverage in main-stream media.

According to the BLS, healthcare jobs will grow more than any other industry from 2016 through 2026. The Atlantic article points to similar data from FRED, and further notes that the growth has been driven by non-clinical roles. And that’s not expected to change in the coming years. While you may have strategies in place to hire and retain nurses, doctors and other clinical professionals, do you have one in place for your frontline workers?

If not, you may find your organization isn’t able to be competitive in a jobs marketplace that’s wide open for hourly workers. In addition to competing with other healthcare organizations to fill positions, you’ll be competing with other industries such as retail or food service. Many businesses already have strategies in place to find and keep workers, offering higher wages, career paths, education assistance, and other benefits.


Finding and Keeping the “Right” Candidates

Across numerous service-related industries, the challenge is twofold: Getting employees to stay, and finding them in the first place. An article from the Society for Human Resource Management cites a PeopleMatter survey showing that finding enough high-quality job candidates is the #1 problem, but that the #2 industry workforce problem is turnover.

The article goes on to explain that when new people come onboard, the process “should do more than take care of paperwork; it should help new employees experience your unique culture, see how their work matters, know what’s expected of them, and help them picture a long-term career path with you.”

In fact, that approach is important well beyond the first few days or weeks of employment. Employees should consistently know that what they’re doing now is important and that if they aspire to grow within their organizations they are able to do so.

A long-term solution won’t be found in placing more recruitment ads or a new marketing campaign. It comes from a systemic approach that evaluates the entire frontline employee experience and creates a workforce development strategy that addresses the issues leading to high turnover and overall job dissatisfaction.


An Investment in Frontline Employees Is an Investment in Your Organization

Missouri-based Mercy, University Health System (Texas), U.C. Davis Health (California), and Yale New Haven Hospital (Connecticut) serve different types of communities and populations, but they have two things in common. They have all received national recognition for the healthcare services they provide and for making significant investments in the skills and careers of frontline workers, with each one recognized as 2017 CareerSTAT Frontline Health Care Worker Champions or Emerging Champions.

These organizations are clearly and strategically focused on their frontline employees and the reason is simple: Healthcare organizations that effectively become advocates for frontline workers are experiencing better outcomes for their employees. And this has a positive effect on organization and the patients they serve.

So what does an employee success story look like for a frontline employee? Elaine Thomas began her career in healthcare at East Alabama Medical Center (EAMC) in 1996 as a certified nurse assistant. After working in EAMC’s Skilled Nursing Facility for 10 years, and with encouragement from her manager, Elaine entered the SAW® program in 2006.

Soon after graduation, she accepted a promotion as an education department secretary. Elaine sustained her career ambition and desire to develop professionally. She became a basic life support instructor and took developmental leadership training classes offered by EAMC. In 2018, Elaine was again promoted, this time to education coordinator. Elaine regularly attends recruitment events and is a champion of EAMC’s development opportunities with the frontline staff.

Elaine’s success is based on three pillars: her desire to advance, the support of her manager, and the employee programs and training offered by her organization. Together, they made a solid foundation for her success, but take one away and her goal of career advancement might not have become a reality.

The not-so-hidden truth about effective frontline employee strategies is that they benefit both the employer and the employee, today and in the future. For organizations struggling to find “quality” hourly workers, the answer may not be in expanding recruitment efforts. Instead, hiring for organizational fit and providing basic skills training to help employees succeed in their current jobs can help a healthcare system fill those positions. Additional career training and support, along with other frontline worker strategies, allows employees the opportunity for career growth in the organization.

The end result is that frontline employees aren’t moving on, they’re moving up.



“Health Care Just Became the U.S.’s Largest Employer.” January 9, 2018. Derek Thompson. The Atlantic

“Employment by major industry sector.” Bureau of Labor Statistics

“Employers Struggle to Hire Hourly Workers as Turnover Rises.” July 31, 2015. Roy Maurer. Society for Human Resource Management

“6 Scary Numbers for Your Organization’s C-Suite.” October 30, 2018. Ryan Pendell. Gallup

National Fund For Workforce Solutions,

Want To Keep Frontline Employees? Think Like Trader Joe’s!

No matter what products they sell, many businesses in the retail industry know that success depends heavily on the frontline workers they hire to staff their stores. Typically the lowest paid employees in an organization, they play an inversely important role in driving sales and customer satisfaction.

The problem is the high turnover rate for entry level jobs, which can range from 30 to 60%. Not only does this impact the company’s bottom line, it can be demoralizing for other employees to view their company as a revolving door through which employees rapidly enter and leave.

This is an issue that extends well beyond the retail industry. In fact, if you gathered all of your frontline workers in one room, research outlined in a Harvard Business Review (HBR) article suggests that nearly half are planning to leave their jobs in a year, and less than one quarter are highly satisfied with their jobs.

To help understand what factors affect high turnover rates and how companies can address this costly issue, consulting firm FSG and Hart Research Associates surveyed 1,200 entry level workers in numerous industries, including retail and healthcare, and spoke with a dozen companies that have improved retention rates of frontline workers.

The HBR article outlined key areas that increased frontline worker dissatisfaction:

1. Unfair treatment by managers or supervisors

2. No clear career path within the company and no support for continuing education

3. No benefits, such as health insurance or paid time off

4. Not making enough money combined with a

5. Lack of schedule flexibility, and few or no opportunities to work more hours

In addition, FSG and Hart Research Associates found disparities for the frontline worker based on race and gender. Women and minorities were more likely to have negative experiences with their managers and saw fewer opportunities for career growth.

So how do organizations address the situation? By thinking like retailers like Trader Joe’s and the Gap, companies employing strategies designed to not only boost retention but also increase employee engagement and create a talent pipeline.

“It’s simple, really. We believe that doing the right thing, as it relates to all Trader Joe’s stakeholders—Crew, Customers, Vendors—is the right thing to do. And it starts with our Crew.”

Trader Joe’s combines several strategies to retain employees, including higher hourly wages and a hire from within policy in stores, but it perhaps is most effective in communicating that information directly to potential employees in the Career section of its website.

The main page outlines key benefits, including health insurance and the monthly cost. It also emphasizes the opportunity for growth by highlighting the fact that nearly 80% of supervisors are promoted from within and 100% of its store managers are promoted from supervisory roles. On the page to search for opportunities by state, the hourly pay range for each store employee opening is listed for each location.

From their first introduction to the company, job applicants can easily see what the company has to offer them and the potential for moving up in the company. The outcome? A turnover rate that’s below 15%.

At Mercy, the country’s fifth-largest Catholic healthcare system, frontline healthcare employee development is at the core of business strategy. To reach its goals, Mercy operates a Lowest Paid Worker Committee to bring together senior leaders to develop and implement strategies to improve wages and opportunity for frontline workers. Lynn Britton, Mercy’s President and CEO, leads the Lowest Paid Worker Committee.

“We invest in the development of frontline workers to help them realize their talents and to support their professional and financial advancement.” – Lynn Britton

Mercy tracks and reports participation in their employee advancement programs yearly, monitoring scholarship programs, tuition advance programs, Catalyst Learning Company’s School at Work® (SAW) program graduations, and transportation programs. Mercy measures business impact, citing that 32.5% of School at Work® graduates have advanced into new roles and 9% have enrolled in higher education.

The Gap is another leader in entry-level worker retention. Gap Inc. has focused its efforts on programs such as Personal Advancement & Career Enhancement (P.A.C.E.) to help women in the global apparel industry. P.A.C.E. helps women develop life skills through technical training and support. In addition, the company’s “This Way Ahead” initiative provides on-the-job training and life skills development for young people in low-income areas, which benefits the communities in general and helps the company maintain a talent pipeline.

In January of 2019, for the second year in a row, Gap Inc. was included in the Bloomberg Gender-Equality Index and recognized as a company with a commitment “to transparency in gender reporting and advancing women’s equality.”

Healthcare organizations with similar strategies can achieve the same success in employee engagement and retention. In an article highlighting the top-rated hospital workplaces, job site included employee quotes explaining why their hospital was included on the list. The article noted that “room for professional growth, supportive management and positive attitudes among coworkers” were some of the common themes found in employee feedback. Number one ranked Massachusetts General Hospital was mentioned for all three.

In addition to increasing the hourly rates your organization offers, you can translate successful retail strategies for frontline employees into your organization in four ways:

1. Train supervisors with the soft skills needed to manage frontline employees

2. Offer learning opportunities to help frontline employees develop the skills they need to succeed in their current position

3. Provide career pathways to those entry-level employees who aspire to excel

4. Recognize employees for their good work throughout the year and not just during an annual performance review.

The bottom line is that frontline employees not only want to be paid well for the work they do, they want to be treated fairly and know that there are possibilities for their personal and professional growth. And it doesn’t matter what industry they’re working in.

Following the lead of retail companies can help your healthcare organization hire and retain employees that are engaged with your company, and understand the importance of the work they do regardless of position or pay. In the healthcare setting, every employee plays an important part in patient satisfaction, whether it’s the doctor providing the direct care or the person serving meals in the cafeteria.

Tech Trends With Implications For Healthcare Talent Development In 2019

By Ted Smith, Deputy Director, Envirome Institute, School of Medicine, University of Louisville


Technology enhances and affects nearly every part of our lives, and adult corporate learning is no exception. Some learning and development (L&D) technology may already be implemented in your health system, as it can assist with clinical and non-clinical learning alike. While both care delivery and labor are moving away from a centralized hospital setting to a geographically separated health system, the need for digital tools to drive learning and development for adult workers is ever increasing. Organizations are seeking training that is inexpensive, industry relevant, and can be delivered with minimal interruption to productivity. What are differences between types of training/L&D? In other words, what are technology trends with implications for healthcare development in 2019?

Adaptive Learning
Adaptive Learning is a way to enable personalized learning to scale. No student learns at the same rate. Adaptive learning works by assessing learner performance and activity in real time, then using analytics to personalize content to reinforce concepts that target each learner’s strengths and weaknesses. Most often this will result in knowledge retention, increased confidence, decreased frustration, and improved results. Adaptive learning is most used in industries that rely on manual labor and experience high levels of employee turnover such as the healthcare, retail, transportation, and hospitality fields.

In hospitals, adaptive learning technology is used to train staff in essential functions such as the on-boarding process, customer service standards, and role specific training. Adaptive learning can meet employees at their own level, regardless of unique backgrounds or geographically separated locations. Adaptive learning helps employees get up to speed quickly and acquire the skill needed to make immediate impacts in alignment with health system goals. At this time adaptive learning is typically only offered within clinical roles at acute care hospitals. The New England Journal of Medicine, for instance, creates adaptive learning courses for physicians to maintain certification and receive continuing medical education. Adaptive learning in hospitals could someday help transform corporate recruitment and employee development on the front-lines. Instead of requiring Certified Nurse Assistants or Health Aides take a 120-hour training for instance, systems could offer micro-accreditation to make training for these hard-to-fill roles more appealing to adult learners.

Augmented Reality
Augmented Reality and Virtual Reality are moderately different, but we are lumping the two together here for simplicity. To clarify, ‘Virtual Reality’ refers to an entirely digital environment, while ‘Augmented Reality’ is a mix of virtual objects superimposed onto the real world.

The uses for augmented reality (AR) training would be to explain, enhance, or tell a story based around existing data or information. By overlaying information on top of pre-existing data, HR can create a training experience that elevates the way that people learn. AR is becoming an alternative technology for training programs, allowing users to learn and practice skills in realistic settings.

Healthcare workers have been quick to realize the benefits of AR technologies, mostly for clinical practitioners. Clinical employees must learn a sizable amount of information about anatomy and the way the human body functions. AR applications give learners the ability to visualize and interact with three-dimensional representations of bodies. Cleveland Clinic and Vanderbilt University Medical Center are two pioneer systems using 3D representations of human bodies for clinical learning. A top vendor in this field is VR PatientsTM, a company that builds training for EMS and nursing staff with advanced patient simulations.

Gamification learning technology refers to integration of gaming elements in digital learning to craft an engaging learning experience. Gamification is built to encourage learners to apply learning on the job by challenging them with real-life situations in a controlled environment. Gamification usually involves story lines, challenges, rewards, and analytics.

Gamification really is most effective when organization-wide community learning is needed. Gamification tends to spark increased engagement through positive peer pressure and social interaction. In hospital learning for entry-level staff, gamification learning technology includes challenges, instant feedback, points/objective ranking feature, badges, in addition to competition and collaboration.

One example of gamification at a major hospital is the University of California San Francisco Bennioff Children’s Hospital. UCSF Bennioff used gamification to boost job satisfaction and performance. The goals the organization had were an increase staff communication, enable peer recognition, encourage teamwork, and improve patient outcomes. Every hospital staff member received an account in order to be able to recognize the accomplishments of their colleagues. A system kept track of the recognition everyone received for various time periods (e.g. weekly, six months, and so on). Hospital leadership rewarded the staff members who obtained the most recognition for the week. There was also a chatting tool for reaching out to managers and other staff members to encourage communication. Over time, nursing teams developed a friendly competition contest, which rewarded the group with the highest patient satisfaction each week. Patient satisfaction increased from 86% to 97% over the course of only two contests.

Microlearning breaks down new skills and concepts into small individual chunks to be consumed one topic at a time. These learning modules can be completed while an employee continues in their professional role, allowing associates to incorporate new information into existing work routines almost immediately.

Health systems often do not find it feasible nor affordable to pull staff cohorts from their day-to-day operations and send them to participate in a training program. Microlearning modules can be assimilated during mere minutes of an associates’ day by using mobile platforms and interactive technology to deliver learning in small bursts. Microlearning is especially well-suited to the information-gathering style of millennials that are used to rapidly scanning and can have shorter attention spans.


Besides tech trends with implications for talent development, what are other tech trends which health system HR teams may see in 2019?

More Rapid Hiring – Organizations are using innovative digital screening tools to cut down hiring time. With Millennials expected to be 60% of the workforce by 2020 and Boomers retiring, organizations need faster hiring processes. Resumes and phone screenings are being pushed aside by end-to-end digital processes. Scores from gamified assessments and personality test fits are a next wave of hiring techniques.

Voice Assistants/Artificial Intelligence – Some may think that because healthcare is so labor intense, that AI won’t affect the labor force, however chatbots may replace some administrative roles. Cooks and information clerks could be replaced by automation. Secretaries can be replaced by artificial intelligence. Voice assistants may some day even perform HR tasks like finding employment candidates.

“What Augmented Reality Training Is And How To Leverage It In Your L&D Process,” eLearning Industry, John-Carlos Lozano, October 9, 2018
“How Hospitals Are Integrating Augmented Reality and Other Tech to Improve the Patient Experience,” MedCity News, Rick Halton, August 2, 2018
www., VRPatients
“Adaptive Learning: The Future of Corporate Learning,” Precision Frontiers, Ulrik Juul Christensen MD, February 20, 2017
“5 Killer Examples On How Gamification In the Workplace Is Reshaping Corporate Training,” eLearning Industry, Asha Pandey
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“Challenges with Adult Learning… Using Microlearning to Effectively Educate.” KTA University, Tiffany Kelly, February 16, 2018
“What Everyone Should Know About Cognitive Computing,” Forbes, Bernard Marr, March 23, 2016

5 Trends That Will Affect Your Entry-Level, Non-Clinical Healthcare Workforce in 2019

1) New Digital Interaction Jobs
With changes in technology, and younger consumers preferring digital interaction, hospitals will be challenged to prepare Frontline workers with jobs that don’t even exist yet – think Administrative or Medical Records roles that involve Social Media outreach and interaction. Digital interaction will also change Medical Assistants and Technician roles that deal with Teledoc customers or keeping health records organized, especially as care moves away from few large hospitals to quick-care and community- based health centers.

As hospitals become more invested in social media and engaging patients online, entry-level workers will need to be trained on how to provide positive customer experiences in a virtual setting. If your system hasn’t started a social media strategy yet, this will probably soon change, especially as patients begin to shop for healthcare the way they shop for cars or electrician services—by searching the Internet, looking for quality metrics and patient reviews, and comparing prices.

Another digital trend is Chatbots, and it might replace some administrative type roles. But that doesn’t mean Frontline workers in these positions will necessarily be replaced. Rather, their role will change to meet the new demands of other types of technology – analyzing data from wearables, teaching patients how to use wearables at home, and moderating Telehealth forums to interject and provide patient care when the chatbot is unable to resolve a question or issue.

2) Retail Mindset in Healthcare, and Workforce
A direct impact of patient centered care and “retail” inspiration may require additional interpersonal skill training. These are the soft skills of personal interactions, and ultimately drive health system brand loyalty. Quick care health locations in retail centers are popping up, including shopping malls and Walgreens, and existing hospitals are taking inspiration from the retail environment to improve the customer experience – for example, Frontline staff walking the floor and using iPads for check-in instead of the traditional desk.

A retail mindset will create shifting expectations of how Frontline staff interact with patients; to do this hospitals will use retail best practices to train employees. While broadening the skill set of eligible employees can be a good thing for hospitals, it’s also likely to increase turnover – an unfortunate result of this soft skill “retail” training is more employees could move back and forth between the health and retail industries as skills become more transferable.

We’ve also seen retailers invest in certification programs for their staff. This isn’t surprising as healthcare continues to mimic retail, we would expect to see more streamlined and third-party training and certification programs become prevalent in health systems. In 2019 there could arise an “authority” certification to emerge as the gold standard of certifications. Penn Foster and the National Retail Foundation are working with a $3 Million dollar grant from the Walmart Foundation on creating a retail credentialing program now. Expect a health equivalent to follow this trend.

Retail in health may be more than just a mindset of employees and hospital strategy. Retail concepts may change actual brick-and-mortar building designs. For instance, the University of Minnesota Health Clinics and Surgery Center collaborated with Cannon Design to build a five-story ambulatory care facility inspired by Apple stores and other modern retail outlet designs. The lobby design doesn’t allocate space for a formal check-in or check-out area. Instead, patients are greeted by a staff member with a mobile device for checking them in, helping them to fill out health forms, finding their exam room and scheduling future visits.

3) Virtual Training for Employees
Virtual employee training will affect nearly every job category. As healthcare moves to smaller locations with quick care being a core theme, virtual training and self-taught modules will continue to be a key Upskilling format. Aside from merely showing employees best practices and social skills, digital/virtual training programs will be challenged to come up with authentic ways to evaluate these skills – perhaps through virtual group meetings, virtual role play, or VR interactions.

4) Automation Could Threaten Some Entry-Level Jobs in Healthcare
While frontline roles often require direct patient interaction, some are still subject to being replaced by automation, including cooks and information clerks. Twenty percent of companies have already deployed chatbots in the workplace and 57% are anticipated to do so by 2021. This technology could disrupt traditional hospital customer service jobs. Companies are using chatbots as personal assistants, for on-demand customer support, to mine data, streamline business processes, recover product information and to answer employee questions.

Interrupting entry-level employment situations at hospitals could interfere with traditional career pipelines to manager roles, so have development and succession plans ready, even at this level, in preparation for a more automated work environment.

5) Upskilling and Alternative Job Perks – (They Could be One and the Same)
Higher pay will always have appeal, but some hospitals are getting creative with alternative perks as a way to reduce turnover. For example, employee assistance with loans, free meals, time off, and affordable onsite childcare options can resonate.

As an example of alternative perks, Advocate Healthcare (IL) offers its Advancing Careers Through Education program which provides 100-percent tuition reimbursement for programs in high-demand specialties, such as nursing, respiratory care or health information technology. Another example hospital, Lurie Children’s Hospital in Chicago provides concierge services for daily errands. Plus employees with children on the college hunt can use Lurie Children’s college coaching program, in which a counselor helps families with the school selection, application and financial processes. And Lurie Children’s even offers up to $5,000 for adoption assistance and tuition reimbursement.

Upskilling will be increasingly important as technology/automation replace some jobs at hospitals. To prepare for this, healthcare facilities can take inspiration from AT&T, who reached out to employees in roles that were soon to be obsolete, and advised them to start taking action to learn new skills before roles were eventually eliminated. AT&T offered 100,000 employees in such positions corporate assistance and training to re-direct their employment to more relevant and long term roles.

Healthcare Employment Data 2016-2026, U.S. Bureau of Labor
“Seven Learning and Development Trends to Adopt in 2019,” Forbes September 24, 2018, Cameron Bischop/Forbes Human Resources Council
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“Top 8 Healthcare Predictions for 2018,” Forbes November 13 2018, Reenita Das