Leveraging institutional partnerships to promote equity in the CHA workforce

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The frontline healthcare workforce at Cambridge Health Alliance is highly racially and ethnically diverse, but these employees historically have had fewer professional and educational advancement opportunities than other segments of the workforce. From July to December 2021, ICH engaged in the evaluation of a competency-based certificate program in Healthcare Management Fundamentals that aims to fill this need. This training program was the result of a partnership between MassHealth, who provided the funding, Southern New Hampshire University (SNHU), as the educational partner, and CommCorp, who provided logistical support and mentorship to participants. The certificate targeted employees of Accountable Care Organizations (ACOs), including CHA, who had not yet earned college degrees. Completion of the program is equivalent to half of an associate degree. 

Competency-based education (CBE) is an independent model of learning without formal instructors, which allows learners to progress through a set of competencies around their own schedule. Speedier and more accessible paths to credentials are critical for Black and Latino/a/x employees, who are not only underserved in higher education but also frequently encounter discriminatory employment practices that emphasize the need for a certificate (Long. C & Clawson. S, 2021).

To understand more about the implementation of this program at CHA, ICH collected and analyzed qualitative data from key informants, program participants, and their supervisors. We also analyzed demographic and employment data about the CHA workforce.

What did we learn?

CHA was very successful in recruiting employees to the program as compared to other ACOs, due to investment from leadership and multimodal communication about the program. Employees who identify as Black/African American or Hispanic/Latinx had a higher representation among program participants than the overall CHA workforce. This is an important equity consideration, as this group of employees often does not receive as many opportunities to participate in professional development/educational opportunities.

Key positive elements of the program reported by participants included the online platform, the flexibility of the program, and the fact ‌that it was cost-free (rather than reimbursed). Major impacts included educational and professional advancement for participants and increased staff capacity and retention. COVID-19 acted as both a barrier and a facilitator to participation. Some participants stated that the pandemic presented challenges such as navigating changes in protocol, work demands and stress, and complicated family circumstances. On the other hand, one participant stated, “I actually think COVID is what made me decide to do it.  I started working from home last March… So, ironically, COVID was a motivator, not a deterrent.”

Major program challenges included a high level of participant withdrawal, difficulties with the self-directed format of the program, and challenges with receiving feedback. As of Fall 2021, only half of the 35 participants were still active in the program. Reasons for withdrawal included the stress associated with the pandemic, general time management and balancing responsibilities, and challenges with the competency-based format. 

Recommendations

Participants cited a number of recommendations for future programming. Both participants and supervisors recommended expanded career development opportunities for employees in lower-level positions at CHA, particularly free opportunities:

“More training programs, more leadership development programs for supervisors, for middle management would be very, very helpful, especially with CHA’s goal to be more inclusive and be an equitable organization. So investing in those employees at that level, which is very diverse, will lead us to the changes that we want to see happen in terms of, do we have representation, are we an inclusive organization from the bottom-up.” (CHA manager)

Participants also recommended that communication about opportunities should be multimodal (emails, flyers, etc., and targeted outreach from managers), and that manager support is critical to employees’ success, including provision of protected schoolwork time for employees. 

Conclusion

The Healthcare Management Certificate through SNHU offered an educational opportunity to a diverse, frontline healthcare workforce that is often excluded from other educational and career advancement opportunities. Future similar educational and professional development programs would provide significant benefits to employees at CHA and elsewhere. This evaluation of the CBE program provides important lessons learned to address program challenges and strengthen future programs. CHA and ICH look forward to working with the State to continue this important infrastructure building over the next 5 years.

References:

Long, C., & Clawson, S. (2021). Competency-based learning can power an equitable recovery | Higher Ed Dive. Higher Ed Dive. https://www.highereddive.com/news/competency-based-learning-can-power-an-equitable-recovery/608228/

Roxanne James, MPH

Research Associate

Emily Hahn, MPH

Research and Evaluation Project Manager

Sharon Touw, MPH

Epidemiologist III