Assessment of the Frontline Health and
Healthcare Workforce and the Business
Case for Employer Investment in Systems
Change
Emmeline Chuang, AB
Jennifer Craft Morgan, PhD
Brandy Farrar, MS
Janette Dill, MA, MPH
Thomas Konrad, PhD
Frontline Health and Healthcare
Workforce: Who are they?
• High level of direct patient care and client services
• Bachelor’s degree or less
• Mean wage of approximately $32,000
• Lack clear career ladders
• 80% Female, 32% African-American or Hispanic
Why Frontline Workers Matter:
Industry Projections
• Frontline workers (FLWs) constitute half of the total
health and healthcare workforce
• Fastest growing segment of the workforce
• Job openings due to both occupational growth and
replacement need
• Replacement need accounts for more than a third of
average annual projected job openings
Data Source:
What is “Jobs to Careers”?
• $15.8 million national initiative of the Robert Wood
Johnson Foundation, in collaboration with the Hitachi
Foundation and the Department of Labor
• Skill and career development for frontline health and
healthcare workers
• Partnerships between employers, educational
institutions, and other organizations
• Employers include 9 hospitals and/or healthcare
systems, 5 behavioral health centers, 5 community
health centers, and 8 long-term care facilities
Data Source:
What’s available
• Grant proposals and web survey of 204 grant proposal
applicants, comprising 896 individual organizations
(Partnership response rate to web survey = 72%)
• 229 interviews, 26 frontline worker focus groups, and 22
frontline supervisor focus groups from the 17
partnerships funded through the Jobs to Careers
program
• Survey data on frontline workers of employers
participating in the Jobs to Careers program
(Currently have 544 respondents)
Demographic Characteristics of
Frontline Workers in Jobs to Careers
Gender
Race/Ethnicity
Female
Male
Spanish/Hispanic/Latino
White
Black
Native Hawaiian
Chinese
Filipino
Am. Indian/Alaska Native
Other
85%
15%
19%
51%
21%
11%
7%
10%
3%
7%
Demographic Characteristics of
Frontline Workers in Jobs to Careers
Annual Income
Education
MEDIAN
MEAN
S.D.
Less than high school
High School Diploma
Some College
College Degree
Graduate Degree
$23,712
$24,966
$5,368
9%
56%
28%
4%
3%
Problem Identification:
Negative FLW Job Characteristics
•
•
•
•
•
Low pay
Few benefits
Heavy workloads
Inadequate training
Frequently antagonistic relationships between
FLWs and supervisors
• FLW perception that they are not respected or
valued by their organizations
Barriers to FLW Advancement
• Lack of educational readiness
• High rates of poverty
• Competing demands associated with family
responsibilities and second jobs
Jobs to Careers: Overcoming Barriers
to FLW Advancement?
• Work-based learning
-Allows for on-the-job skill development
-Potential for academic credentialing in the
workplace
• Require investment in systems change
-Commitment to educational release time
-Tuition reimbursement or remission
-May require organizational culture change
Business Case for Employer Investment
in Work-based Learning
To what extent was the following a
motivator to invest in WBL…?
Not a
motivator
A minor
motivator
A major
motivator
Improve the quality of care provided
2%
4%
94%
Improve the skills and performance of
FLWs
2%
20%
78%
Reduce turnover rates
4%
22%
74%
Improve the recruitment of FLWs
2%
29%
59%
Reduce absenteeism
4%
43%
53%
Reduce shortage of mid-level staff
10%
40%
50%
Help increase revenues
27%
39%
34%
Business Case for Employer Investment
in Work-based Learning
• Improving the quality of patient/client care
• Improving FLW skills and performance
• Improving retention and recruitment
• “Growing your own”
Conclusion
• FLWs constitute a single workforce facing
common barriers to skill and career
development
• Employers have strong incentives to invest in
the systems changes required for FLW
development
• Organizational readiness for change and longterm sustainability of WBL remain unclear
Appendix: Supplemental Slides
Employer HR Policies
Does the organization have formal HR policies related to…
No
Child care or elder care
65%
Flexible work arrangements, such as self-scheduling
60%
Support for remedial skills development
50%
Paid leave
13%
Formal orientation for new hires that lasts longer than one day
13%
Overtime
8%
Health insurance
2%
Financial status of Frontline Workers
in Jobs to Careers
Financial Situation
I (or my family) depend completely on my paycheck
60%
I (or my family) can live better because of my paycheck
29%
I (or my family) do not depend on my paycheck
10%
Workers with a second paid job
15%
FLW Perception of Job Quality
Scale range = 1 to 4
Scale name
# of
items
α
MEAN
S.D
Coworkers
2
.80
3.29
.59
Autonomy – content
3
.65
2.87
.56
Workload/Intensity
3
.80
2.32
.63
Career Opportunities
3
.79
3.09
.60
Job Satisfaction
5
.87
3.11
.57
Business Case for Educational Org
Investment in Work-based Learning
To what extent was the following a
motivator to invest in WBL…?
Not a
motivator
A minor
motivator
A major
motivator
Meet employer needs
3%
7%
90%
Meet community needs for career
opportunities
0%
14%
86%
Improve the skills and performance of FLWs
4%
17%
79%
Meet the educational needs of a new pool
of students
3%
20%
77%
Increase student enrollments
19%
37%
44%
Increase revenues
19%
44%
37%
Business Case for Educational Org
Investment in Work-based Learning
• Meet employer needs
• Meet community needs for career
opportunities
• Meet the educational needs of a new pool of
students