April 1, 2012
The U.S. health care system is at a turning point, and no more so than in the nation's hospitals. They face increasing pressures to provide more and better care at lower cost. At the same time, revenue streams -- from Medicare and other sources -- are uncertain, as is the future of health insurance reform. New models are emerging for coordinating care and delivering it in a patient-centered way, as are new technologies, from new diagnostic and treatment methods to electronic health records. And the emphasis on demonstrated, measurable evidence of hospital performance has rarely been greater. Yet one thing is constant: health care is a distinctly high-touch, labor-intensive enterprise. And it depends in part on workers at the front lines of care: nursing assistants, housekeepers, medical assistants, unit secretaries, dietary service workers, and a host of others who work 24/7 to answer call lights, empty bed pans, pass trays, or draw blood. Today, some health care providers are discovering that investing in the education, training, and career advancement of these frontline workers pays off not only in dollars and cents but also in less measurable ways, including enhanced worker performance and skill, better functioning patient care teams, expanded pipelines for filling positions, and improved morale. The concept of investing in the frontline health care workforce is in good currency, but translating that into wider practice is not simple. At times, it requires overcoming the skepticism of decision makers, both private and public, about the value of long-term investments in human capital. It requires clear models, compelling arguments, and evidence to back them up. But in all cases, it requires engaging the leaders in the "C-Suite" -- chief executive officers, operating officers, financial officers, human resources officers, nursing officers -- in bringing the case to their peers in other institutions. This guidebook was prepared for CareerSTAT, an employer-based project to make the case for developing frontline hospital workers. It documents effective practices in leading hospitals around the United States, drawing on interviews with senior managers and executives. It presents the arguments that managers themselves make for investing in the training and education of less-skilled workers, along with the types of evidence and metrics that managers and senior decision makers find most persuasive.