The Apprenticeship Model for Healthcare

A Conversation with Sarah Currier, Director of Workforce Development

I interviewed Sarah Currier, Director of Workforce Development at Dartmouth-Hitchcock Medical Center for our health and hiring series, and she shared how Dartmouth-Hitchcock has implemented the apprenticeship model for various positions throughout their workforce—from surgical techs to secretaries—in order to build a long term pipeline of a loyal and thriving workforce. By reading this blog, you will be able to:

  • Understand the apprenticeship for healthcare
  • Experience how Dartmouth-Hitchcock Medical Center has begun the apprenticeship model in their organization through a case study
  • Gain practical next steps in initiating an apprenticeship model for your healthcare workforce

Chad Harrington

 
Image credit: Deposit Photos

Image credit: Deposit Photos

 

With the massive experienced nursing shortage and one million open jobs in healthcare alone, healthcare organizations like Dartmouth-Hitchcock Medical Center are finding great success with a new way of workforce development. 

What is it? The apprenticeship model.

 

Listen to sarah currier (2.5 min listen)

 
 

According to the Bureau of Labor Statistics in December 2015, 18 percent of the open jobs in the U.S. are related to healthcare. That means there’s a massive need for a larger healthcare workforce. 

U.S. Healthcare organizations must do something about their open positions in order to manage the health needs of the nation. Healthcare is in this for the long haul. That’s exactly Sarah Currier’s vision for the Dartmouth-Hitchcock Medical Center (DHMC): “Building a sustainable workforce.”

 

Dartmouth-Hitchcock Apprenticeships Overview

 
 

Taking principles from DHMC and applying them to your organization has the potential of launching a revolutionary method of workforce development in your area.

 

The need for the apprenticeship model

During my conversation with Currier, we focused on how to apply the apprenticeship model to healthcare. A major reason this is even possible is because the U.S. Department of Labor believes in the apprenticeship model for workforce development to the sound of over $175 million in awards

You can listen to the President’s announcement of the Apprenticeship Grant here (note: jump to 32:15 to start).

In this video, Obama says that $50,000 is the average starting salary for a worker who has finished any apprenticeship program.

The President also notes that, per capita, England has fifteen times as many apprentices as the U.S. and that Germany has sixteen times as many apprentices as the U.S. If they can do it, then we can too, he says.

 

Top 12 Reasons Healthcare Needs More Apprenticeships

  1. Workers get paid while they train
  2. Jobs are filled quicker
  3. Untapped demographics can work in healthcare
  4. High school graduates can gain college credit
  5. Workers don’t have to take on debt to get trained
  6. The training is vigorous and thorough
  7. Workers learn valuable skills
  8. Workers make a good starting wage
  9. Workers get real-world experience
  10. It Builds loyalty and a long-term pipeline of candidates
  11. Tuition reimbursement initiatives inspire workers
  12. Measurable competency for healthcare workers

Currier says, “The secretary of labor, Tom Perez, has been known to say that apprenticeship is the other college without the debt, and we have certainly tried to embrace that.”

 

Business and education working together

The U.S. Department of Labor advocates for the expansion of the apprenticeship model. They’re saying - in the words of Currier - that, “there are a lot of talented people out there, who with the right opportunity to do on-the-job training, would be great employees in our labor shortage market. The talent scarcity out there isn’t necessarily a people scarcity. It’s just a mismatch of skills and opportunities. If businesses and education work together a little bit more creatively, we can open up jobs to people.”

 

How Dartmouth-Hitchcock implemented the apprenticeship model

DHMC, where Currier leads workforce development, is coming up on their two year mark of practicing this model of workforce development in partnership with the U.S. Department of Labor (DOL). 

The DOL has advocated the apprenticeship model for traditional industries like manufacturing and plumbing, but now they are looking to champion the apprenticeship model for industries like retail, IT, and healthcare.

That’s why they have directly supported Currier’s DHMC as part of their implementation of the apprenticeship model in health care.

 

Who can join DHMC’s Ready to Work Programs?

Easy-entry positions include: 

  • Medical assistants
  • LNAs
  • Surgical techs
  • Secretarial roles
  • Administrative roles

Clinical positions include: 

  • BSNs
  • Nurses
  • PAs
  • NPs
 

Relode: What is the apprenticeship model? 

Sarah Currier: “The apprenticeship model actually builds off of the old fashioned view of apprenticeship to take someone who has an eagerness to learn and a gap in actual technical skills and put them into a job where they can earn while their learn.

“In some ways it’s a natural fit for healthcare, because that’s what we’ve been doing with our physicians and residencies for decades. It simply extends that to how can I take somebody and give them the book learning that they need to get started and then the opportunity to grow their skills in a hands-on learning environment.”

 

R: What’s your main goal as the Director of Workforce Development for DHMC?  

SC: “I’m no longer the Director of Recruiting Services. We’ve created a new position. I started as the Director of Recruiting Services, and as we really started to expand our workforce development, my title changed to now I’m the Director of Workforce Development. 

“We’re thinking differently about how we recruit. We have a Talent Acquisition team and a Workforce development team, and what we do in Workforce Development is look at generating long-term pipelines for high demand positions in the health system.”

 

The Magnus Effect & Healthcare

The Magnus Effect is a principle from physics about the effect decreased pressure on fluids has on the speed of those fluids (something I’m not qualified to write on, just read up on it). An example of the Magnus Effect is a ball spinning through the air—the spin changes how the ball moves through the air.

An example of this is a viral video that shows the Magnus Effect on a basketball, which was thrown off Gordon’s Dam with a spin. To watch the Magnus Effect of a basketball spin (start at 0:55): 

 
 

How the Magnus Effect applies to healthcare

SC: “If you drop the basketball, it goes straight down. But if you drop the basketball with a little bit of spin, it creates this incredible arc, and the basketball takes off in a totally different direction. The idea behind this is if we think a little bit differently, our investments in the apprenticeship program could be the tiniest spin on these individual’s careers. It’s the difference between someone who’s going to go nowhere, and somebody whose career can really take off.”

 

How to apply the apprenticeship model to healthcare

Currier took the example of how they work with their medical assistants to explain to me what the apprenticeship model looks like for them. Here’s what she told me two phases with a total of nine steps:

  • Phase One: Enrollment
  • Phase Two: Training

Phase One: Enrollment into the program (two weeks)

1. Orientation night

SC: “We move quickly. Our typical process with our apprenticeship on boarding is we do an orientation night, which is basically an open call. We advertise on the back of unemployment checks, in the newspaper, on the radio, and we put up flyers in the local grocery store, and we’ve had as many as 700 people show up for one of these orientation sessions. 

“We talk a lot about these positions, we talk a lot about how rigorous these classes are, we bring past apprentices in to share their personal journey. We answer questions and we have people sign up for assessment tests that evening.

2. Assess candidates with rigorous tests

“The next two nights we do assessment tests, which cover reading comprehension, and basic math, customer service skills, and the tests are designed not to be completed. So at the same time we’re doing the competency assessment, we’re also looking for how do people react under stress, under pressure. From the assessment tests, we then call people instantaneously the next day and say, ‘You passed and we’d like to bring you in for your first round of interviews.'

3. Conduct two rounds of interviews

“We do two rounds of interviews, and from orientation to the time they get the offer, it takes less than two weeks.”

4. Make the hire

Phase Two: Train apprentices (15 weeks)

1. Recruit people into the program

SC: “We recruit a group of people to enter the medical assistant apprenticeship program. When we do that, we’re looking for people who have

  • The right attitude,
  • The right aptitude,
  • But not necessarily someone who has past experience or skill or credential

2. Train them in a 10-week pre-employment program

“We then put them through a ten-week, rigorous pre-employment training program, where they learn medical terminology, basic anatomy and physiology. They familiarize themselves with our electronic medical records. They’re exposed to medical ethics, HIPPA, and the other rules and guidelines that shape the way we do work. 

3. Initiate shadowing

“As their classroom training ramps down, they get an increased exposure through clinical shadowing to what actually goes on in the patient environment. 

4. Implement a one-year apprenticeship with the Department of Labor

“They then graduate from that pre employment education and step into a year-long, registered apprenticeship through the U.S. Department of Labor. 

“To do this, we’ve developed a set of clinical competencies. What we consider a fully competent, fully performing medical assistant would be able to do everything on our competency checklist. And we ramp our new apprentices up, so that by the end of month one, they’ll be able to do one portion of these, by month two, they will be faster and have more competencies, and eventually by the end of their year-long apprenticeship, they’ll be able to demonstrate full competency in all these areas and will be a full-practicing medical assistant."

5. Increase wages as they achieve competencies

“Along with those competencies, we have stepped up wages that are attached to that, so the apprentices are absolutely motivated to grow and develop these competencies as quickly as they can because their wages will increase as their competencies increase."

 

Origins of their apprenticeship model for DHMC

SC: “What started our investigation and exploration into apprenticeship is that we just couldn’t find enough people to fill positions. As a general rule, we have between 45 and 60 open medical assistant positions across the organization. 

“We experience almost a 30 percent turnover in our pharmacy tech community. A lot of that is because our excellent pharmacy techs chose to go back to school and become pharmacists, but it’s also because there’s a lot of competition with CVS and Walmart and Target and Rite Aid—there’s a lot of demand for highly trained pharmacy techs and retail often has more flexible hours than a hospital setting. So we have a high turnover.

“If I can create a pipeline where people feel they’ve been invested in and they’re passionate about what they do and they’re loyal to the organization, we’re thrilled to be spending the time doing the training.”

 

R: What’s the model you’re replacing?

SC: “The biggest challenge we’ve had is the majority of medical assistants come out of a two-year associate's degree program. At least in the state of New Hampshire and in the state of Vermont, there are limited number of those programs and they graduate a limited number of students. We anticipated when we started this we would get some push back, some concern on the part of the colleges that we were taking away candidates that would be interested in pursuing these college degrees. But that’s not the case. 

“The average class of medical assistant graduates is usually 14 or 15 students of whom we hire 13 of those 15. We have put in the last 18 months 60 medical assistants through our programs and we’re still hiring almost every graduate who comes out of a two-year program in the region. So there’s just a much higher demand than there is a supply. 

“There also is a huge financial cost to go to a two-year associates program, and they graduate with a considerable amount of debt. That doesn’t work for everybody. There are a lot of people who are not in a financial situation where they can afford college immediately after high school, and there are a lot of people who can’t afford the time to go back full time. 

“We’re getting a lot of people in our program who are return-to-work, second career single mothers—people who go through the program who will say, ‘I’m incredibly thankful something like this exists, because I would have never made it through a two-year degree program.’

“Our medical assistants complete their one year of apprenticeship with 45 credits that they can transfer to burlington college, leaving them 15 credits short of an associate's degree. So we get them really, really close. At that point, they’re able to use their tuition reimbursement and we are encouraging all of them who don’t have their associate's degree to pursue their associates and beyond.”

 

Four keys to applying the apprenticeship model to your hospital

1. It takes a partnership.

This is possible because they’ve partnered with

  • Educators
  • Funders
  • Certified bodies

SC: “The first thing we’ve learned along the way is it takes a partnership. This isn’t something an employer can do alone. What makes this program attractive is our ability to partner with educators—colleges and certificate programs—to give people the credit for doing what their doing. 

“We also need to partner with funders, because most small hospitals don’t have a lot of extra money for training and most nonprofits don’t. Looking for ways to get seed money and ways to get started certainly helps. So having a close partnership with the government has helped to get the program off the ground.

“You also want to be working with certifying bodies to make sure your training meets the high standards that the medical profession sets for its technicians. You’ve got to work together; it’s not enough to do it alone. To make a different it really takes all of you working in collaboration.”

2. Economy to scale. 

SC: “Because of that, the second thing is there are economies of scale. Building a program like this would be very difficult for a small community hospital that says I’m going to put a program in place because I need to train two medical assistants every year. If we can find ways for us all to work together, what a fantastic opportunity for the small community hospitals to also take advantage of the larger hospital’s ability to build program like this and partner."

3. Continuity of care.

SC: “It also creates a huge amount of continuity of care. A lot of the people who come to the medical center have primary care doctors or their medical homes located in other parts of the state. If every medical assistant is trained to what we consider to be our high standard of quality, it means the patients are going to get that standard of care no matter where they go. That makes things better for everybody.”

4. You’ve got to be willing to think differently. 

SC: “The healthcare profession has a tendency to think, *we don’t teach that way, we don’t work that way, we don’t hire that way,* and that mentality has to stop. We put these barriers up for ourselves, and then we wonder why things don’t change. If we’re working with other hospitals and other healthcare organizations, we can really start to learn from each other’s perspectives and lenses.

“A fantastic example of this is we have not traditionally been involved in home health care, but recently we’ve been talking with him health care partners about what would an LNA look like who would operate in a home health care space? How do you take somebody who may not want to work in the hospital anymore and rather than lose them out of the healthcare system, give them the opportunity to reinvent themselves in the home health environment.

“My first goal is to keep you working for me, my second goal is to keep you working for the population who needs healthcare in the region—all boats float on a rising tide is the way we think about that.”

 

R: What are your top three pieces of advice for change management in recruitment?

1. “Just try it.”

SC: “My team teases me and says that my favorite phrase is, ‘Just try it.’ If it doesn’t work, we can always go back and change something—just try it! They refer to me as being relentlessly persistent, because you can’t take no for an answer. 

“As far as managing change in recruitment is that we can no longer expect employees to stay in a role for life. That is, I find a more pervasive attitude in healthcare than it was in my prior roles in consulting—there’s this expectation that once someone comes and starts to work is that they’re going to be there. Which isn’t to say that we don’t want people to stay for life, but you need to learn to embrace the current and understand that you need to know how much it costs you to invest in a search and training and how quickly you need to be reaching productivity and how you can continue to invest in them and grow them. 

“I am constantly talking to our nursing organization about the fact that it’s very difficult to get a nurse to come and stay in a job for ten years. But what do those nurses go do? They go and they grow into nurse manager positions or clinical nurse educator positions or they go back and get their MSN. How do I create a logical nursing advancement model, so somebody who wants to reinvent themselves as a nurse doesn’t have to go somewhere else to do it. 

“It’s embrace the current rather than the tide. The tide goes in and out; I don’t want people to go in and out. I want them to move, but I want them to move within my own organization in a smooth manner, which means you have to constantly be thinking about pipeline. If I expect these people to leave the organization, I expect to bring in at least as many skilled people in.” 

2. “Hire for attitude and train for skill.”

SC: “You hear people say that all the time, but what it really means is you need to be willing to grow your own, you need to be willing to invest into development to create the loyalty and then link it back to that career ladder and pipeline so people don’t have to leave you."

3. “Treat people like they always have choices, because they always do.”

SC: “As talent becomes a more and more competitive market, your candidates are going to be choosing every day from a broader and broader selection of opportunities, and we need to recognize that and treat them accordingly.”

 

“Apprenticeship Model Opens New Workforce” 

 
 

Final word from Currier on the apprenticeship model

SC: “I think it’s an amazing way to think about building a workforce. The people who come out of our apprenticeship programs tend to be incredibly loyal, incredibly enthusiastic about the work that they’re doing. They are more interested in being mentors, more interested in investing in the people that come in behind them. They have significantly changed our environment for the better. It really has been an infusion of enthusiasm. 

“We really couldn’t have done this without the U.S. Department of Labor and their push for apprenticeship. Anybody who’s interested in setting up a program like this should absolutely check out the Department of Labor’s website for their apprenticeship programs, because they are incredibly helpful about identifying non-traditional jobs that would qualify and helping organizations set up apprenticeship programs for them.”


Read full success stories of Dartmouth-Hitchcock apprentices here.

What’s success have you found expanding the apprenticeship model beyond physician training? Drop us a line here.

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