Building a Better Future for Caregivers

November-December 2018


Building a Better Future for Caregivers_a
Illustration by: Cap Pannell

Health care executives and human resource specialists must develop strategic plans that build an engaged caregiving community in light of the need for new skills, shifting venues for care delivery and a shrinking workforce. As the future of health care unfolds with great change and challenge, we are called to be employee-centric, innovative and consistently hopeful.

It is understandable that we, the human resources and clinical leaders of Catholic health care, feel stressed. There are powerful issues to weigh: Can we ensure people a secure, meaningful and empowering workplace for the long term? How do we demonstrate commitment to our values and to the contributions of our employees? How do we plan effectively with so much at stake?

At Providence St. Joseph Health, based in Renton, Washington, our answer to changing times is developing a strategy that responds to the needs of the health system's 119,000 employees, whom we call caregivers, because we believe that everyone — nurses, accountants, and food preparers in the cafeteria — is involved in caring for someone else. Our strategy must remain flexible for the future, and our focus is straightforward: clinical and non-clinical education, formation in Catholic values, and a pipeline that keeps tomorrow's leaders engaged in learning and sharpening their skills.

Let's begin with education as a big priority. Providence St. Joseph Health is a 51-hospital health system serving communities in seven Western states. We are fortunate to have a strong foundation in education, particularly for nursing, where the shortage for new hires does not show signs of abating. Much of the groundwork for nursing education was laid with our Nursing Institute, which sets standards, role expectations and clinical competency requirements for present and future Providence St. Joseph Health nurses. New nurses also participate in 17 "clinical academy" specialty residency programs immediately after graduation. Each specialty track provides new graduates with evidence-based and personalized support and clinical development through their first year at our health system.

Our robust education efforts greatly expanded in 2016 when we embraced an opportunity to partner with University of Great Falls in Great Falls, Montana. A Providence St. Joseph Health ministry sponsored since 1932 by the Sisters of Providence, the small Catholic liberal arts university specialized in instruction for nontraditional and rural students. In 2008, we collaborated with the university to launch a distance-learning program of registered nurse to bachelor of science in nursing program for our health system nurses. More recently, we added distance-based graduate programs in health care administration, nursing education and infection prevention/epidemiology.

Providence St. Joseph Health has committed to expanding its long-term educational pipeline for future caregivers by beginning a new partnership with the university in which faculty, administrators and the health system worked together to rebrand University of Great Falls as University of Providence, grow the School of Liberal Arts and Sciences campus and add a distance-based School of Health Professions. In working with the university team to develop programs, Providence St. Joseph Health considered its near and long-term workforce needs, as well as the educational requirements of caregivers and their dependents. Priorities included training for rural and urban acute care nursing, surgical technologists, medical assistants, nurse educators and nurse practitioners. A master's in health care administration program was developed, along with nonclinical training in informatics, chaplaincy and information technology.

University of Providence is blossoming into a school that "gets" health care's future. The nursing curriculum is innovative in content, delivery, learner experience and convenience. Although the core courses are taught through distance learning, clinical education is delivered by local faculty at Providence St. Joseph Health system ministries. Curriculum content is heavily focused on the future, with emphasis on population health, technology-based care and community wellness. The program also emphasizes development of world-class rural nurses. Graduates are prepared as expert generalists who can practice in nearly every acute care specialty within a rural or critical access hospital, often caring for high acuity patients with minimal supervision.

Although Providence St. Joseph caregivers get priority for places in the classes and programs, spaces are made available to other students, especially those from other Catholic health systems and strategic health care partners. Current Providence St. Joseph employees and dependents receive tuition discounts regardless of their intended major or career focus. Tuition subsidies and tuition forgiveness are available for other students if they matriculate into Providence St. Joseph employment in hard-to-recruit positions.

Bridging the pace of academia with the "need-it-now" speed of health care has its challenges. However, the health system is proud of its collaboration with academic colleagues, often across thousands of miles. Providence St. Joseph is overcoming organizational and cultural hurdles to achieve an innovative model for academia that stays true to our shared mission and values.

Not all workforce development is clinical or technical. At Providence St. Joseph, we know that caregivers succeed when they understand and embrace our culture and their contributions within it. When new caregivers join the health system — whether they come from Catholic universities or are completely unfamiliar with our traditions — we provide a formation program that offers immersion in values and heritage.

From day one, all caregivers receive training on expected behaviors, including how we communicate and relate to one another at Providence St. Joseph. Even our terminology for employees — caregivers — drives home the concept that mission is everyone's responsibility.

Formation for leadership is an intense, full-person experience, sometimes requiring up to three years of education. We like to say, "leadership is not from the neck up," which is why we ground our leaders in both the intellectual and spiritual meaning of their work. We understand that caregivers, especially those new to the organization, observe their leaders for how they live the values of the organization. For us, it is an absolute requirement that managers and supervisors get the culture right.

Cognizant that economic and market realities can easily derail a focus on long-term workforce development, we look to continuing improvement. For example in 2017, seeking solutions to help caregivers with burnout, we altered the employee assistance program to include compassion training.

In one region, all clinics closed for 90 minutes every other week for six months to discuss compassion, mindfulness and team-building. Participants remarked it didn't feel like a training session; it felt like caregiving to one another. Providence St. Joseph Health has found these types of initiatives are essential to help staff heal and prevent burnout. In fact, despite stopping work for our sessions, productivity soared in participating clinics.

The health system also recognizes that as older and intensely ill patients seek care, many caregivers will need training in end-of-life issues. Through the Providence St. Joseph Health Institute for Human Caring in Torrance, California, we educate caregivers in communicating with seriously ill patients and their families. To date, we have taught more than 700 clinicians in an interdisciplinary format that includes multilingual and multicultural communication techniques and intensive role-play. Results show that caregivers are less stressed about engaging in difficult conversations, and patients and families are more confident and satisfied with their treatment. The health system and the university are working together to develop an academic certificate program in end-of-life care.

With its deep investment in people, Providence St. Joseph Health maintains a strong preference for promoting from within. Therefore, another pillar of the development plan is identifying and nurturing high-potential future leaders. In addition to identifying near- and longer-term successors to the organization's top roles, Providence St. Joseph Health is looking deeper in the organization for a diverse set of high-potential talent. When identified, these high-potential leaders are put on accelerated development plans to get them prepared for future opportunities.

To ensure that the pipeline contains a strong contingent of nurse managers, Providence St. Joseph Health invited representatives from nursing into the strategic planning process. Nurse leaders and high-potential nurses were invited to contribute to operational and strategic workforce plans. These plans, developed from the insights and input of top and up-and-coming clinical leaders, identify drivers of change in nursing, which helps to establish workforce sizing numbers and plan for new nursing roles in the future. Because the plans are created in partnership with nursing, they are well-received and are being implemented by nurse leadership.

To stay successful and relevant, Providence St. Joseph Health assesses the tenor of the times to continually improve on an environment that welcomes and inspires a diverse workforce. As an example, we were intensely aware of the #MeToo movement and the events of the past year. Our response was #NotHere, letting caregivers know that harassment or abuse of any kind is not tolerated. We are using the hashtag in employee communication and externally, in media interviews and speaking engagements. More than just a social media hashtag, #NotHere is a long-term program to ensure the safety of our caregivers. It has led us to re-examine all facets of our organization, strengthening policies, training and reporting mechanisms. The goal is for all caregivers to understand the importance of bystander intervention and to speak up when they see or suspect harassment or abuse. The response has been positive, and caregivers say they are proud — and appreciative — to work in an organization that takes their well-being seriously.

As part of the commitment to well-being, the system puts a priority on holistic caregiver health that focuses on body, mind and spirit. The workforce plan addresses four key areas — avoiding burnout, whole person care, immunization/disease prevention and financial security. Caregivers are connected with health coaches who provide 24/7 access to a registered nurse advice line. At some Providence St. Joseph Health locations, caregivers have a walk-in wellness center where they can receive routine medical care or participate in weight-loss, stress management, nutrition and other lifestyle-enhancing programs.

There are no easy answers for responding to all caregivers' needs. However, employee satisfaction rates are up, and turnover rates are down. In a 2017 annual survey, caregivers reported high engagement despite the organization's merger the year before. Eighty-four percent indicated they plan on staying with Providence St. Joseph Health. Seventy-eight percent responded that they are positively engaged in their work. Additionally, after a decade of the RN to BSN program, 85 percent of the BSN graduates are still employed with Providence St. Joseph Heath, and more than 25 percent move on to complete a graduate degree. Also, first-year nursing turnover for new graduates of the Clinical Academy programs has been reduced from a high of 28 percent three years ago to approximately 8 percent now.

What is Providence St. Joseph's advice for workforce development planning? Identify skill and knowledge gaps, especially in primary, community-based, preventive care and other areas of expected growth. Also, strategically consider "make or buy" decisions — that is, whether to build from the ground up or align with others for education and training. Although the University of Providence is a valuable and successful asset, it will never meet all of the large-scale staffing needs for Providence St. Joseph Health. The system employs approximately 40,000 RNs, for example, and will continue to rely heavily on local academic affiliations and relationships, especially with Catholic and other faith-based nursing school partners across our regions.

Also, when partnering with academic institutions, never underestimate the influence of the respective cultures. They think, act, and decide differently, and the speed at which programs or initiatives are implemented and incentives often are dissimilar. Succeeding together demands listening, patience, constant communication and commitment to the mission and values the partners share.

Remember, too, the balance between recruitment and retention. There always are current caregivers eager for advancement. Ultimately, it is best to promote those who have made their contributions.

Despite so many challenges, ours is a future that is still unfolding positively. There have always been exceptional people who passionately seek the community of Catholic health care. We have every reason to believe this tradition will continue, and, with the right planning and programs in place, we will find and keep the very best caregivers to deliver on our sacred missions.

DEBORAH A. BURTON is senior vice president and chief nursing officer at Providence St. Joseph Health.

DEBRA A. CANALES is executive vice president and chief administrative officer at Providence St. Joseph Health, a national, Catholic not-for-profit health system comprising a diverse family of organizations committed to improving the health of the communities it serves.



Building a Better Future for Caregivers

Copyright © 2018 by the Catholic Health Association of the United States

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