No Vacancy: How Dartmouth Health is Solving Workforce Shortages

00:00:00:26 - 00:00:40:11
Tom Haederle
We often focus on physician and nursing vacancies when discussing the shortages in the health care workforce. But Dartmouth Health recognizes that providing high quality care to their patients comes from developing both a clinical and a non-clinical workforce. As New Hampshire's largest private employer, serving nearly 2 million patients across New England through a network of hospitals and services, Dartmouth Health has established a robust set of apprenticeships and career pathway training programs to ensure a dedicated workforce now and for the future.

00:00:40:14 - 00:01:08:15
Tom Haederle
Welcome to Advancing Health, the podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. In today's episode, Elisa Arespacochaga, AHA’s vice president of Clinical Affairs and Workforce, sits down with Carolyn Isabelle, director of workforce development at Dartmouth Health, to discuss its approach to recruiting and retaining both for clinical and non-clinical roles within its workforce, making sure that patient and community needs are met.

00:01:08:17 - 00:01:35:17
Elisa Arespacochaga
Thanks, Tom. I'm Elisa Arespacochaga, vice president of Clinical Affairs and Workforce at the AHA, and today I'm really excited to be joined by Carolyn Isabelle, director of Workforce Development at Dartmouth Health. Today, we're really going to talk about how Dartmouth Health develops not only their current team members, but starts bringing in new team members in both clinical and non-clinical roles and enhances their experience to keep them in the organization and really help them grow professionally.

00:01:35:20 - 00:01:40:23
Elisa Arespacochaga
So, Carolyn thank you. And to get started, tell me a little bit about yourself and Dartmouth Health.

00:01:40:25 - 00:02:04:26
Carolyn Isabelle
It's wonderful to be here with you today. As you mentioned, I'm Carolyn Isabelle and I lead the workforce development function for the health system. And Dartmouth Health is a system of community hospitals, clinics and health care services across New Hampshire and Vermont. And our main academic medical center is located in Lebanon, New Hampshire. We are the state's largest employer with just over 14,000 employees.

00:02:04:28 - 00:02:27:25
Carolyn Isabelle
And I think one thing that really sets our system apart is that we are located in a really rural part of our state. So the majority of our workforce actually is coming between 30 and 60 minutes each day. We also don't necessarily have a large local talent pool to be able to draw on as we look to staff and recruit for our facilities.

00:02:27:27 - 00:02:55:04
Elisa Arespacochaga
You definitely have some additional challenges. I know when I've spoken to you in the past, you have a number of different training programs, career pathways within your organizations, both to bring in those new team members, but also to take the team members you have currently and continue to grow them throughout their career so that once, you know, you're sort of in the door at Dartmouth Health, you'll do everything you can to support those team members to retire from Dartmouth Health.

00:02:55:06 - 00:02:59:01
Elisa Arespacochaga
Can you share just a quick overview of some of those programs you have in place?

00:02:59:03 - 00:03:25:20
Carolyn Isabelle
Definitely. This is very near and dear to my heart. I've actually been a part of our workforce development team for just about ten years now, and a big part of our work has been operating The Dartmouth health workforce Readiness Institute. And this is an internally run licensed career school where we provide training programs for people looking to start or continue their career in health care. Through the career school

00:03:25:21 - 00:04:05:18
Carolyn Isabelle
we offer six different training programs and they're all structured a little bit different based on the profession. But we offer training for medical assistance, pharmacy technicians, surgical technologists, licensed nurse assistants, ophthalmic assistants and phlebotomist. Within those programs, three of those are actually registered apprenticeship tracks. So that's where you are doing some of the the course or the skill building and then you're learning on the job in the year that follows. In addition to some of the training programs that we offer through the Workforce Readiness Institute, we also have a number of training programs that allow people to advance their career.

00:04:05:19 - 00:04:34:11
Carolyn Isabelle
This could be a second step, but where we partner with an academic institution for a more specialized allied health technician role and the doctor content or the coursework is actually completed online through our college partner and all of the clinical training happens in our Dartmouth Health facilities. At the end of the training year, individuals complete the licensing or certification exam and transition to a full time permanent role as part of our workforce.

00:04:34:14 - 00:05:00:14
Carolyn Isabelle
Some of the really fundamental pieces of all of our programs, whether they be our training programs, apprenticeships or advanced career training pathways, is that these are paid training programs leading to full time benefited roles in our workforce. And I think as we think about all of these programs, our goal really is to help you to train and build the skills you need for today while positioning for future career growth in the health care industry.

00:05:00:17 - 00:05:26:05
Elisa Arespacochaga
That's great. So you're really partnering very closely with understanding what are the positions you need not only today but into the future so that you can start to position your own team members to fill those. So, I know you briefly mentioned one of the ways you supported some of this development was through apprenticeship programs, and I know there are a number of different ways to do that, whether it's your registered apprenticeship programs that are registered with your state and federally.

00:05:26:05 - 00:05:39:12
Elisa Arespacochaga
There are different advancement training programs, as you mentioned, where you move people clinically. How have you sort of decided which ones work best and how you pick which programs you should invest in?

00:05:39:15 - 00:06:08:22
Carolyn Isabelle
It's really important when we look at what the right training intervention is and working with our operational teams and departments. So kind of first and foremost, we're looking for roles where there's kind of a volume need. So for example, in all of our inpatient units, we are very reliant and have great demand for licensed nursing assistants. And so understanding that we're going to need kind of a steady influx of people joining the teams across the health system,

00:06:08:24 - 00:06:33:03
Carolyn Isabelle
that's an ideal place for us to layer in a training intervention and be able to bring people in by cohort to have them kind of train, prepare and then enter their new role. There are in some of the more specialized areas where the team and the capacity to train is much less. For example, in our medical laboratory, we have the ability there to take a much smaller cohort.

00:06:33:03 - 00:07:01:12
Carolyn Isabelle
So that's where one of the advanced pathway programs makes more sense, where we partner with an outside academic partner and then just do the clinical training internally. So I think it's really important to be able to assess kind of what is our internal training capacity, what is the demand for roles and the hiring cadence that we need to meet and that helps to inform on our end kind of what the right intervention is going to be. With our registered apprenticeship programs

00:07:01:12 - 00:07:35:27
Carolyn Isabelle
the model that we've really looked at is being able to layer the coursework or the skill development upfront in their training program with the understanding that they're going to build that foundational skillset. And we try to do that as rapidly as possible so that you can reach the point of certification and directly enter the workforce. We then understand that the proficiency and the true confidence in your role is going to be developed on the job with the support of a mentor or a preceptor, as well as the leadership team in that operational department.

00:07:36:00 - 00:07:58:11
Carolyn Isabelle
So it takes about a year through any one of our apprenticeship programs to really build that proficiency. But we've established both technical and professional competencies that all of our apprentices are evaluated on monthly with their supervisors, which keeps them really closely connected to their training plan and on a great path towards advancement.

00:07:58:14 - 00:08:20:07
Elisa Arespacochaga
I love the way you describe that. It really sounds like you wrap around each of your trainees, your learners, in a way that helps them really succeed in their programs. So it sounds like there's a ton of support. Let me ask you a little bit about both some of your greatest successes, but also some of the challenges that got in your way as you started to build some of these programs.

00:08:20:10 - 00:08:39:14
Carolyn Isabelle
Sure. I think there's two things that kind of stand out. In addition to the fact that over the last ten years, we've seen over 1200 people come through our training programs and directly enter our Dartmouth Health workforce. But when I think about the kind of the structure of our programs and what has set some of them apart, there are a couple of things.

00:08:39:21 - 00:09:10:27
Carolyn Isabelle
One, not only do we focus on the technical skill development, but we also focus on the professional development. Really, when we thought about our workforce and we looked at kind of what was setting someone up for success, most of the time, if they were not successful on the job, it was not necessarily tied to the technical skills. So in each of our apprenticeship programs, we have layered in a professional development curriculum that really focuses on the skills - we call them the power skills - that will set you up for success.

00:09:10:27 - 00:09:37:08
Carolyn Isabelle
And this comes back to communication, accepting and receiving and giving feedback. Your decision making, understanding kind of your own code of morals and ethics, but being able to really kind of start to define your own kind of brand as an employee and what you want to be known for as you enter the workforce has really been, I think, an element that added strength to our programs and set people up for long term success.

00:09:37:10 - 00:10:03:12
Carolyn Isabelle
The second thing that I'll mention is that again, with our apprenticeship programs, we have a long standing partnership with one of our regional colleges, Colby Sawyer College. And not only are they the Dartmouth Health Nursing School, but they've also worked with us in our apprenticeship programs to be able to provide a path to an associate's degree. And so, again, this is really unique in a lot of the workforce models that have been established.

00:10:03:15 - 00:10:26:21
Carolyn Isabelle
But students that are enrolled in our apprenticeship programs, they are earning direct college credit for their coursework as well as additional credit throughout their apprenticeship year. At the end of their program, they need to complete their remaining liberal education courses and they graduate with their associate's degree in health science. Almost all of this can be done at no cost to the individual.

00:10:26:21 - 00:10:34:09
Carolyn Isabelle
And again, it comes back to that underlying principle of setting you up for long term success in the health care industry.

00:10:34:12 - 00:10:56:15
Elisa Arespacochaga
That sounds amazing. Talk to me a little bit about some of the work that you do in addition to the training programs to help people sort of navigate where their next career opportunity is and how they can take advantage of those educational resources to start to identify their next step and their next step, hopefully within Dartmouth Health.

00:10:56:17 - 00:11:17:01
Carolyn Isabelle
What we've learned kind of going through this is that while someone has come in through one of our training programs, it's somewhat of an intense experience, and they are really focused on the immediate goal that's directly in front of them. So whether that's completing their medical assistant certification or their surgical technologist certification, that's where their mind is at

00:11:17:02 - 00:11:40:05
Carolyn Isabelle
and that's what they're they're really focused on. They're not necessarily always open and ready to be thinking about nursing school down the road, but we are thinking about that for them and with them. And so we've really been trying to think about where are the right intervals and when to engage with our alumni network to help them stay connected to next step opportunities within our health system.

00:11:40:07 - 00:11:56:19
Carolyn Isabelle
So while we may touch on those things throughout their training program, just to kind of plant the seed and have them build some awareness, it's really kind of as they get through their apprenticeship and starting to kind of open up and see the possibility and be ready to start thinking about what they need to do for next steps.

00:11:56:21 - 00:12:12:27
Carolyn Isabelle
We have a couple of career counseling and navigation services that we do make available to our employees. Again, just to help them get connected to the right programs, the right opportunity, any grants, scholarships and funding that could be available to make things possible, too.

00:12:12:29 - 00:12:38:09
Elisa Arespacochaga
Just sounds like such a great way to keep people engaged beyond the program in the time that they're spending in that sort of intense environment. So, as you think about this work and across the country who are looking for ways to develop their own workforces in both urban and rural environments, what is some of the advice you would share with your colleagues who are thinking, I need to create more programs like this?

00:12:38:12 - 00:13:00:08
Carolyn Isabelle
I can think of a lot of advice because after ten years of doing this, we've tried things in many, many different ways. And I think that's kind of the beauty of it. And what I will say and really give credit to the leadership team at Dartmouth Health. They've given us permission to try some different strategies and to build on what works and to pull back if something doesn't.

00:13:00:13 - 00:13:31:02
Carolyn Isabelle
But that's okay. We just don't always know exactly what the right intervention is going to be, but we'll usually get there. I think one really important factor is being able to have a committed operational partner. And when you are looking at establishing a training intervention, really understanding what is not only going to be needed in the training program and what skills need to be developed, but also what the plan is going to be when they start in their new role and what support will be needed to help people really kind of transition to practice.

00:13:31:05 - 00:13:58:07
Carolyn Isabelle
So that I think is probably one of the key kind of drivers of success long term. And then I think really making sure that when you're develop in the program, you're doing it in a way that can meet the students where they're at. In a lot of our classroom environments, we have a really diverse group of students, so we have individuals that have just graduated high school, but also many that are returning to the workforce or transitioning to health care from another industry.

00:13:58:09 - 00:14:25:23
Carolyn Isabelle
Also, often times there are students enrolled that have not been in a classroom environment for many, many years. So really thinking about how you tell your tailor your instruction and your your program content to to meet the needs of a professional learner and to think about how you can break that content down, incorporate technology, but also a lot of hands-on learning techniques that can connect the content to the individual.

00:14:25:27 - 00:14:32:25
Carolyn Isabelle
I think those really are kind of two pieces of advice that I would give as as you think about structuring some of these programs.

00:14:32:28 - 00:14:46:22
Elisa Arespacochaga
Well, Caroline, I want to thank you for sharing your expertise and all of the efforts you have made throughout this last decade of work at Dartmouth Health and all of the great work you're doing with your community. Thanks so much for sharing it with our listeners.

00:14:46:24 - 00:14:50:13
Carolyn Isabelle
You're very welcome. It was wonderful to be a part of the show today.

00:14:50:15 - 00:14:58:27
Tom Haederle
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