Developing a Clinical and Nonclinical Health Care Workforce with Dartmouth Health
Dartmouth Health| Lebanon, New Hampshire
The Background
Dartmouth Health, headquartered in Lebanon, N.H., employs more than 14,000 employees in New Hampshire and Vermont. In addition to its flagship hospital, Dartmouth Hitchcock Medical Center, the health system encompasses three critical access and three community hospitals, New Hampshire’s only children’s hospital, an NCI-designated cancer center, 24 Dartmouth Hitchcock Clinics and the Visiting Nurse and Hospice for Vermont and New Hampshire. Due to the predominantly rural nature of the health system’s service area, the majority of its workforce travels 30 to 60 minutes each day. With a limited local talent pool, Dartmouth Health had to get creative to fill clinical and nonclinical vacancies.
Workforce Readiness Institute
An essential element of Dartmouth Health’s workforce strategy is its Workforce Readiness Institute, an internally run, licensed career school that offers paid training for careers in health care. The institute offers six different training programs, each structured to meet the credentialing requirements and skills need for a nurse assistant, medical assistant, pharmacy technician, phlebotomist, ophthalmic assistant and surgical technologist. Of those programs, three are registered apprenticeship tracks, which require completion of the initial training program followed by approximately one year of on-the-job training.
Dartmouth Health also offers advanced career training program to allow current employees to further their careers in health care. For each of the Institute’s programs, the health system partners with an academic institution to deliver the educational curriculum via online. The required clinical training occurs at Dartmouth Health locations, making the program accessible for employees. At the end of the training year, students complete the licensing or certification exam and transition into their new full-time role, remaining part of Dartmouth Health’s workforce. Fundamental to all these career development programs is that participants earn a wage during training and have a full-time benefitted role in the system waiting for them upon completion. The goal is to help people train and build the skills today while positioning for future career growth in the health care field.
Over the past 10 years, Dartmouth Health has had more than 1,200 people graduate from the training programs and directly enter their workforce. Dartmouth Health attributes its success to pairing technical skills training with professional development training. The professional development curriculum is called “Power Skills” – a reference to the skills that will set trainees up for long-term success and growth, including communication; giving, receiving and accepting feedback; decision-making and understanding one’s own code of morals and ethics.
The health system has a long-standing partnership with Colby-Sawyer College, a local college which also serves as Dartmouth Health’s partner nursing school. The College worked with Dartmouth-Health to offer no-cost college credit for the courses that are part of the Institute’s training programs and additional courses offered during their apprenticeship year. This combination provides a path to Colby Sawyer’s associate degree in health sciences, as employees only need to complete the remaining liberal arts courses following their apprenticeship. The degree path positions individuals for continued growth and advancement in the health care field.
Career Navigation and Training
Dartmouth Health’s apprenticeship program can be an intense experience for trainees, which can mean that during the program, they are not focused on future career opportunities. For some, a longer-term career pathway, such as becoming a nurse, may be a goal, so Dartmouth Health considered what are the right intervals to engage with the alumni network to help trainees think about next step opportunities within the health system. General career information is provided during the training program to plant the seed and build awareness, so that once their apprenticeship year is complete, participants can start thinking about next steps. Dartmouth Health offers employees career counseling and navigation services, which includes sharing opportunities for grants, scholarships and other funding.
Community connections are important recruitment avenues. Dartmouth Health fosters relationships with employment agencies, local schools and community groups so training opportunities can be accessed by those seeking employment. Dartmouth Health also has built a comprehensive network with high schools, colleges, the New Hampshire Employment Security and NH Works to expose individuals to health careers and keep them connected to the health system.
Lessons Learned and Next Steps
Early on, the leadership team at Dartmouth Health encouraged staff to try different strategies to identify which approaches work best. They credit their long-term success to having committed operational partners and a strong academic partner in Colby-Sawyer College. It is critical to have an understanding which roles/positions to target, or which pain points that you will address with this type of training intervention. Operational partners need to be at the table and part of the building and implementation work for the program to have the most impact. Their feedback is critical to ensure the training program curriculum provides the necessary skills, there is support for apprentice learning, and to facilitate a smooth transition of apprentices to practice.
It also is important to develop the program that will meet students where they are, as there is significant diversity in trainees’ backgrounds. For example, there may be recent high school graduates, individuals returning to the workforce and others transitioning to a new industry. For participants who have not been to school in years, returning to training can be intimidating. Organizations need to consider how to tailor instruction and program content to meet the needs of various types of learners and how to break the content down, incorporate technology and use hands-on learning techniques that can connect the content to the individual.
Tapping into the next generation in a rural area is challenging. Dartmouth Health focuses some of their outreach on bringing awareness of health care careers to the high school population. Dartmouth Health developed its “spark” strategy for high school students to ignite an interest in health care careers. Clinical roles like physician or nurse are often what come to students’ minds first; however, there are numerous other opportunities in a health system to fill other clinical and non-clinical roles. Dartmouth Health brings awareness to students about career tracks in the medical laboratory, pharmacy, facilities, supply chain and other departments. Dartmouth Health is currently working to build a facilities apprenticeship to bring people into a trades track. In all its facilities, there are very complicated systems that rely on both preventative maintenance and technology upkeep. The goal is that everyone can see there is a place for them at Dartmouth Health. For a rural area, it’s important to show that high-impact careers are possible outside a larger city center.
In the high school education space, Dartmouth Health works directly with educators in addition to making student connections. In the fall of 2023, Dartmouth Health held an event for high school educators at its academic medical center in Lebanon, N.H. Close to 30 individuals comprised of center directors at career and technical institutes, teachers and guidance counselors went behind the scenes for a day at the hospital where they learned more about careers and pathways in health care. The educators left excited and with more information about what it takes to deliver high-quality health care. Dartmouth Health plans to repeat the event in the future with different groups of educators. For students, the health system offers in the summer the High School Foundations Internship, which gives teens paid employment, professional development and career exploration within health care. Carolyn Isabelle, system vice president for talent acquisition and career development shared, “With all of our experiential opportunities, whether it’s the summer internship programs or high school groups that are coming, the goal is to have them leave with a feeling of excitement about a future career in health care.”
Employee vacancies have hit the health care field hard, making it difficult to consistently provide the high-quality care communities expect from their hospitals and health systems. Dartmouth Health faced this problem head-on, establishing a robust set of apprenticeships and career pathway training programs to ensure their workforce is being professionally developed, and most importantly, retained. In this conversation, Carolyn Isabelle, director of workforce development at Dartmouth Health, discusses the health system's numerous approaches to recruitment, and the successful strategies that support a healthy and engaged workforce.