By: Antoinette ‘Toni’ Gingerelli (MPP 2022), Adarsh Shah (MPP 2022), and Stephanie Taube
(Research Fellow, Harvard Kennedy School)
In March of 2020, the COVID-19 pandemic shook healthcare systems across the United States, including in the state of Massachusetts. As a result, healthcare employers and training providers rapidly developed new programs and initiatives to meet the needs of workers, students, and patients. While some of these workforce innovations will be temporary in nature, others will likely remain in perpetuity; identifying and sharing best practices of the most successful programs and initiatives can help inform healthcare employers and training providers throughout the country.
In the spring of 2021 the Project on Workforce, with the support of the Massachusetts Healthcare Collaborative, conducted an online survey of healthcare industry employers and training providers across the state. The objective of the survey was to uncover key workforce innovations that emerged in response to the pandemic in the training and employment of healthcare students and workers. Our analysis revealed four categories of innovations, and these findings will inform future phases of research on the changing healthcare workforce.
Methodology and Survey Data
The online survey was shared with healthcare employers and training providers across the state. A total of 46 respondents completed the survey, which was designed to be completed in five to ten minutes, and included both multiple choice and open-ended questions. The level of detail provided by participants varied, though many responses provided valuable insight into innovations in the training and employment of the healthcare workforce in Massachusetts. While there are several data limitations -- including the small sample size and the exclusion of some healthcare workers from the survey (such as frontline staff) -- the survey responses allowed us to conduct preliminary research to identify promising and widely cited innovations that call for further exploration.
Survey Respondents
Respondents worked in the healthcare industry throughout the state of Massachusetts, with the majority of respondents working at least some of the time in the Greater Boston region (52.2%). They worked for a variety of organization types, including hospitals, community health clinics, mental and behavioral health organizations, healthcare labor organizations, and universities as well as community colleges. Every respondent held a leadership role within their organization, and some had additional responsibilities in hiring and supervising staff, or training and educating students.
Findings
Four categories of workforce innovations emerged from an analysis of survey data, including: 1) Expanded Use of Technology, 2) New Training in Patient Care, 3) Changes to Support Worker Mental Health, Work-Life Balance, and Flexibility, and 4) Staff Redeployment and New Talent Pipeline Initiatives.
1) Expanded Use of Technology
Many survey respondents cited the expanded use of technology as a major shift in the healthcare workforce in response to the pandemic.
The vast majority of survey respondents indicated their organizations allowed at least some remote work, training, or learning. While some healthcare workers were unable to work remotely, 89.1% of all survey respondents noted that their organizations allowed at least some staff to work remotely or students to take remote classes. Several respondents indicated their organizations transitioned employee training to an online format. Some educators utilized virtual simulations to provide students with clinical experience.
Respondents noted both successes and challenges in transitions to virtual hiring and onboarding. The transition of hiring, interviewing, and onboarding to a virtual setting during the pandemic was cited as a significant change. There were nine references in survey responses on the implementation of virtual hiring or onboarding. One respondent described a new hiring portal that was designed to recruit and hire certified nursing assistants. Respondents also experienced challenges, including difficulties adapting interactive onboarding activities to an online format.
Telehealth was cited as a major technological shift, with respondents expressing enthusiasm on reaching more patients, uncertainty on new and changing regulations, and concern about patient privacy and lack of access to technology. According to surveys, of the sites where telehealth was applicable, 77.8% said they “deployed new technology for employees to interact remotely with patients.” Many believed telehealth should be implemented as a permanent option to expand access to care for patients. Some respondents expressed uncertainty on the changing telehealth regulations, and concern with the digital divide preventing some populations from accessing telehealth services. Others emphasized that telehealth should supplement, but not replace, in-person care.
2) New Training in Patient Care
Some survey participants described the development of new training for healthcare workers, designed to improve patient care.
Employees received new training to improve inclusivity and equity in patient care. Respondents indicated a heightened sense of awareness of inequities within the healthcare system; this is likely due to a recognition of the disparate effects of the pandemic on some populations, including people of color, in combination with the escalation of social movements for racial justice in 2020. Reforms included changes in training curriculums to emphasize the social determinants of health and cultural sensitivity training for employees, as well as outreach to patients from historically underserved communities of color and non-English speakers.
Organizations revised training and protocols on trauma-informed care, due in part to an increase in mental health crises during the pandemic. Several respondents expressed that their organizations increased focus on trauma-informed care during the pandemic. One respondent described training for frontline teams on the impact of trauma on patient health and “have educated over 400 employees on naming trauma.” In response to the increase in mental health crises during the pandemic, one community health center redesigned its suicide protocols to be completed by phone. To do so they “worked with the local police department and ambulance service to ensure when a patient expresses suicidal intentions, the behavioral provider could do [something to help] remotely.”
3) Changes to Support Worker Mental Health, Work-Life Balance, Flexibility
The survey results reiterated that the pandemic was incredibly challenging for healthcare professionals, especially frontline workers, and turnover rates among staff were high. As a result, several initiatives were developed to support workers in areas including mental health and work-life balance.
Many innovative initiatives were developed to support and retain employees during the pandemic. In surveys, 50 references were made to employer-developed initiatives to support and retain employees. Some of these initiatives included childcare networks for employees with children, hardware and technology to support working from home, and implementing 24/7 phone hotlines for employees to “receive just-in-time training and information related to PPE, infection control practices, human resource issues, employee health, and testing.”
As stress escalated among healthcare workers, employers provided resources to support mental health. Multiple respondents reported increased levels of stress among healthcare workers and their families. In survey responses, there were nine references to employer-developed initiatives to support workers’ mental health during the pandemic. For example, one healthcare institution began providing emotional well-being resources for employees, including yoga and mental health counseling. A long-term care facility implemented a peer support program to “promote self-care and coworker support.”
Many workers and students benefited from the enhanced flexibility provided by remote work and classes. Survey responses indicated that remote work supported work-life balance as well as team morale. Our analysis of survey data identified 23 references to the flexibility in schedule and location for remote workers and students, which was particularly important for those with caretaking responsibilities.
4) Staff Redeployment and New Talent Pipeline Initiatives
Many employers indicated challenges with hiring and retaining healthcare workers, as well as filling critical roles during the pandemic. In surveys, there were 10 references to the shortage of healthcare workers and 6 to redeploying workers into other roles. While many respondents found hiring, retention, and staff redeployment difficult, some innovations were developed as a result.
Healthcare workers were retrained and redeployed to fill critical roles in high-need facilities. Some healthcare workers were trained to serve in roles created in response to the pandemic, such as COVID screeners and PPE coaches. Others were redeployed to high-need settings; one respondent indicated that direct care workers were redeployed to clinical settings, and that ambulatory care workers were reassigned to hospitals with high in-patient volume. To manage the redeployment of healthcare workers, some organizations assigned HR staff or Task Forces to oversee the reallocation process.
Organizations developed innovative programs to encourage new healthcare workers to enter the industry. This included the creation of an after-school program for high school students to explore health careers, the implementation of a new apprenticeship program for direct caregivers, and the development of a new career ladder program for mental health workers. One respondent indicated their organization provided new employees with paid training to become certified nursing assistants, creating a “robust pipeline” for this essential role.
Employers took advantage of policies that allowed for flexible hiring of healthcare workers. Several State and Federal policies were modified to support the staffing of healthcare facilities during the pandemic. For example, employers were able to hire nurses who had completed their education, but had not yet passed their licensing exams. Additionally, respondents were able to hire out-of-state nurses to work in Massachusetts. One respondent describes these policies as being “extremely helpful and if permanent, would drastically include our staffing and care.”
Hiring practices are being examined and redesigned to improve equity. One respondent shared that their organization established a “Structural Inclusion Committee” to examine existing hiring practices for structural racism and to increase equity in the hiring of new employees.
Next Steps
The findings from this survey will inform future phases of our research on the changing healthcare workforce in Massachusetts. While survey responses revealed four categories of promising innovations, additional research questions emerged during our analysis, including: Which services were most successfully provided via telehealth, and for which populations? What topics are covered in employee training on equitable patient care? Will new initiatives supporting employee mental health be sustained post-pandemic? Have new talent pipeline initiatives been successful in improving equity in hiring?