Missy Hopson, PhD, Chief Learning and Workforce Development Officer at Ochsner Health: Retention through Moving Them Up 

Van Ton-Quinlivan

Hello, I’m Van Ton-Quinlivan, CEO of Futuro Health, welcoming you to WorkforceRx, where I interview leaders and innovators for insights into creating a future-ready workforce.

Persistent labor shortages in healthcare have spurred some healthcare providers, healthcare systems, to take a grow-your-own approach that involves upskilling current employees to supplement external recruitment efforts. A great example, of this is the internally facing Career Solutions Center at Ochsner Health Systems, which uses coaches and flexible pathways to guide employees in advancing their skills and careers. The leader of these innovative efforts is today’s WorkforceRx guest, Missy Hobson, PhD and Ochsner’s Chief Learning and Workforce Development Officer.

One goal of Missy’s work is to involve underrepresented groups in healthcare by opening up early pathways which aligns well with our mission here at Futuro Health. I’m looking forward to exploring Ochsner’s DIY workforce development efforts with you today, Missy. Thanks very much for joining us.

Missy Hopson

Pleasure to be with you, Van.

Van

Well, start by telling us the big picture of your talent philosophy called “outside in and inside up” and how it helps meet your needs.

Missy

Great. Starting back in 2013, we ran our very first workforce development program. It was locally based and focused on how do we look at the people who are in and around our health care facilities who are interested in on-ramps into health care careers? We ran a program for about twenty women who wanted to become medical assistants (MA), and what we found as we ran that program is there was a great desire for people within our communities to want to join our workforce. They were ready to do it. They just needed the door to open so that they had a way in.

That started us bringing “external in”: how can we supplement what our college pipelines were producing, what our local workforce development agencies within our footprint were producing in terms of our talent pool? How could we also, as an employer, be part of that story in helping to open doors sooner? So we ran that first program for twenty unemployed and underemployed women.

At the end of that program, when I came in and I visited with those women, I said, “What would you like to do next?” They said, “We don’t want this to be the landing place. We want it to be a launch pad.” And that kind of sparked in my head that this is an “outside in and inside up” approach because now I had a ready pool of talent that very much was invested in growing their careers in healthcare, and growing them specifically with Ochsner. How do we really make sure that we’re setting them up for long-term success so that they’re reaching their fullest potential? And that’s the outside-in, inside-up approach that we embrace within our workforce development arm.

Van

So, as you engaged these women and what they wanted to pursue at Ochsner, what were some of the learnings and what was some of the programming that you had put in place?

Missy

Yeah, it was an interesting piece because I had some of the women in the program who were like, I’m an MA now, an MA tomorrow, and I want to be an MA forever. Great. We’ve got a right fit for you. But there was a sizable group of those women who said, ‘I want to become a nurse. I love the work. I love serving patients and I want to be part of that continuum of care, but I also want to advance my career, and I don’t know how to do that when I’m going to be working full time as an MA. How am going to find time to become either an LPN or an RN?’ And their request was that to grow my career, I’m going to need some support from you as our employer to give me time to help me find resources so that I can move forward and advance in this profession without getting caught with ‘I’m going to have to quit work to go and get the degree I need or the certification or licensure I need in order to move into that next position.’

So, shortly after we had our very first MA program that we ran, we ran an LPN program where we said, alright, for the incumbent MAs who are with us today who really want to grow to be an LPN, how do we help you earn as you learn? As a result, we started an apprenticeship pathway and that really started our organization back in 2016 to say, we’ve got to grow apprenticeship programs because we’ve got these incredible frontline individual contributors — whether an MA, a certified nursing assistant, environmental services, patient transport — who are looking to grow to their full potential, but couldn’t do it while working sometimes two jobs.

We said we can create that flexible pathway that allows you to keep your benefits, continue to work in a clinic setting while we also have you doing your didactic with one of our local community colleges. So, we started then with really thinking about how do we grow incumbents up?

Van

And what was the hardest thing to solve internally when it came to implementing that apprenticeship?

Missy

It was shifting our managers’ mindsets. When we first did the very first MA program, it was a shift in mindset because your hiring managers are accustomed to doing the interviews, working with our talent acquisition arm so they have a ready pool of candidates they’re looking at. But we brought our hiring managers in on the front end and said, we’re selecting twenty individuals to join a training program that we’re going to fund. Help us select those candidates because after they complete the program, we want you to hire them. So that was a shift in philosophy, a shift in thinking for those managers. Thankfully we had twenty great managers who took us up on it and said, ‘I’m willing to do that. I’m willing to invest in somebody for a longer period of time before I have them come into my clinic.’ So that was a shift.

When we started the apprenticeship pathway, it was the very first registered apprenticeship in Louisiana in the healthcare setting. So there wasn’t a model we could look to in the state that helped us make a case to our managers that this is a good investment. You really have to have that mindset shift that we are a learning culture. We’re all in on development and the best thing you can do as a leader is grow your people. Grow them.  And what we promised our managers was that as we grew your MA to become an LPN, and we knew that you were going to have a little heartburn of letting go of that MA, you might have them working still in your clinic as an LPN or they might go to a sister clinic as an LPN, but we would also be growing somebody in that can backfill your person.

So, we kind of worked with our managers on what’s that sequencing look like, if our LPN program is thirteen months long, how do we, six months before that program closes, start our next MA program so that manager knows that when the newly graduated LPN leaves their clinic, they have the next person who has been made ready for the last six months to come in and backfill. That took that took us time to learn how to finesse that and to have those conversations with the manager. I think that was our biggest piece of how do you make sure you are bringing the manager into the story…that it’s not just that you’re giving them a ready-made talent, they’re part of helping to develop that talent.

Van

So what I heard from you in terms of overcoming objections was that you engaged a manager who would be receiving the new candidate, but you also assured that the ones who were supervising the employee while they’re training that they would get a backfill. I also heard that you were centrally funding. Can you talk a little bit about what you were centrally funding? Were you funding partial wages? Were you funding the education?

Missy

As an organization at our very first MA program, we applied for a local grant. So we had a grant coming out of the Greater New Orleans Foundation, New Orleans Works Collaborative. The backbone of that was Kellogg Foundation, Rockefeller, City of New Orleans Workforce Development. We had funding there to pay for the training with our local community college, so we were able to pay for that training. Then what we pledged was to hire 100 % of those who graduated the program. So that was our very first take.

When we started looking at moving into that LPN apprenticeship, we received a federal grant to help us pay for the didactic piece of the training, but we still needed to pay the wages for the apprentice and we wanted to make sure that as our incumbents were transitioning to become these LPN apprentices, we wanted to keep them whole to the stipend that would close the gap between the hours they could work and the hours they would be in training. That way their salary was kept whole as they continue to grow their skills, get ready to become that LPN.

We also subsidized their benefits. We said if you are currently on our benefits program, we didn’t want you to find it was a barrier that you might get knocked out of participating in a program because you’re going to lose your benefits because you were no longer a full-time employee in that clinic. So we said let’s make a special category of these student workers so that we had a way that we could sustain their benefits at the right level, gave them that stipend to keep them whole, and then they were paid for their time in clinicals.

Van

We’ve heard of arrangements, for example, like “Twenty/Twenty” — twenty hours you work in your regular job and then twenty hours you’re studying. What is the configuration at Ochsner?

Missy

It’s going to vary by program, especially as we work with our community colleges. When are they coming into clinicals? There’s a different time that somebody is then starting every Friday. I’m in the clinical setting, so I’m moving there. Very heavy in the didactic in the very first semester that they’re there. So we have a different way that we’re looking at it semester one versus when they’re in some of later nursing classes. That might make a shift in how they’re ratios look, so we flexed it along the way.

Every apprenticeship is slightly different. So when you’re looking at something like we do in our earn as you learn certified nursing assistantship pathway, that’s very different because so much more of the work is hands on, so they’re having more of their full time schedule and we are flexing them off on a Friday maybe for the didactic piece. We can flex with the program that we’re running.

Van

So, Missy, I’m delving deeply into these questions as I chair the California Council on Healthcare Workforce Education and Training, and there’s a number of obstacles in the way for employers to adopt these methods of growing their own. One of the tricky parts is the time mechanism that you mentioned. You know, for the individual, they may be working one job or two jobs, so they cannot afford to not have a job, or that much of a job. And if they’re reducing their hours, then they lose the benefits, right?  So, you’re supplementing the wages and benefits from a central pool so it’s not impacting the supervisor’s budget directly. Is that what I’m hearing?

Missy
Yes, you are correct. And one of the other barriers is different accrediting bodies who might have good intentions, but they have standards where maybe you can’t pay for clinicals. So we had to go in and have conversations with boards and make the business case on why this is the right thing to do to help us build and grow the health care workforce and that this is a win for the student, a win for the profession, a win for the industry, and a win for the patient.

Van

Now, when I first met you at the Healthcare Management Academy, one of the data points that you shared with all the other chief learning officer was the retention rate. I believe it was in the 90 percentile.

Missy

That’s right. When I said it’s a win for the business and a win for that individual, this is what I’m referencing. We looked back at our general pool of MAs who we had hired, and what you found is at the  eighteen-month mark, we had probably a 55 % retention rate at the time which is not uncommon in that MA pool. In the first cohort of our MA Now program where we invested in the individuals — and they knew that we were a learning culture, that this is your launch pad, and every day you’re in this program is an opportunity for you to learn and grow and build a future with us — at the end of our eighteen month period with that group we had a 94 % retention rate.

When we got that result, we very quickly realized not only is it a right thing to do, it’s a right business thing to do. So we ended up committing not to just having to go out and find grants to do this work, but how do we as an organization pay for this work because we know we actually save so much more on the retention piece and on the lack of turnover that we’re able to invest back into these sort of dynamic training programs that help to bring the inside up.

Van

Well, that leads me to the Career Solutions Center that you built. What practices did you incorporate into the Career Solutions Center as a result of your experience?

Missy

One of the questions you asked me a minute ago, was what learnings did we have on the end of that piece? Where did they want to grow? I said some of them wanted to stay in MA forever, some wanted to become LPNs. What I recognized is there was also a group within that first cohort who said, ‘I don’t really know what I want to do. I know I want to do this right now. I’m not sure after that.’ And as I began to work with more and more of our workforce development candidates over a handful of years, what I recognized is they didn’t have something that I took for granted: I had a mom who was a college professor. I knew how to leverage a guidance counselor. When I was thinking about career pathing and career growth, I had somebody I could go and talk to who could really help to shape my thinking about where I want it to be in three years, five years, ten years.

For probably 99 % of our workforce development participants, they’ve never had that. They may have had a conversation with a high school guidance counselor, which mostly was, ‘are you thinking about going to college?’ But it wasn’t really around career exploration, career interest. As I started reflecting on it, I knew it was beyond my workforce development participants. It was across the whole of our individual contributors.

What we could see on our Gallup engagement surveys was, ‘I want to be developed, but nobody’s talking to me about my career path. Nobody’s helping me get where I need to go or where I would like to go or I’m not even sure where I would need to go.’ We’d have managers reaching out to our learning consultants saying, I have a team member who’s so good and I know they want to grow their career. I don’t know how to guide them. So we started a Career Solutions Center with two career coaches in it to start, and those career coaches are for our individual contributors, mostly entry level frontline team members.

What those team members are able to do is what you may have done with a college guidance counselor, with a career coach in your life. They’re serving that purpose. So they’re running career and interest inventories. They’re helping you to look at what are the skills you have today, the licensures, the certifications, certificates, degrees, and what is it that you want to be doing. So let’s talk about how we shape your career plan. So, instead of an individual development plan, we now have these tailored career development plans that help a team member really think about where do I want to go? Is it in IS? Maybe I really love the technical side, so maybe we want to help you land opportunities there.

The other piece that triggered it was our head of recruitment arm said to me, you know, we have sometimes internal team members applying for eighty to ninety jobs. Our recruiters look at those individuals and bypass them because here’s somebody we know wants to do something different and wants to grow, but they have no idea what they want to do, and we can’t take a risk there. So we set up the Career Center in part to where our recruiters now have a space that if somebody is applying for multiple types of jobs in the organization, we put them with a career coach that can really help them find their fit and whether you have some gaps you need to close to get there. So then our career coaches can look at what’s your level of educational attainment today, what would help you move forward, what’s the timeline.

They can also demystify the world of benefits. What can we help you with, with respect to tuition assistance? What can we help you with in terms of entry into a workforce development program that we have? What are the college discounts at the colleges and universities we partner with within our footprint? Which of those programs might have some availability for you to enter into that could help you? It’s not one path that works for all, so we very much tailor it to the individual. And that’s a little bit about what we’re doing with that Career Solutions.

We also use it to run larger instructional pieces so you can come in and maybe have a group of a panelist of folks who are in a position and talk about their experience. For example, during MA week, we will bring a group of MA’s in and you can hear their stories, how they picked where they are. It’s a kind of kind of a job shadowing. I’m learning more about a position I might be interested in so I can make a more informed and impactful choice for my future.

Van

That’s so value added for your employees. I would imagine they are so grateful that Ochsner is investing so much in their career.

Missy

Thanks for that.

Van

So you also have a holistic support approach to workforce development that uses social workers and community health workers. Tell us about that.

Missy

Sure, they’re also in our Career Solutions Center. So those are our life coaches. So when you hear me talk about our licensed clinical social worker, our community health workers that are supporting our team members, we call those life or success coaches. What those life coaches are doing is we very much are aware that a lot of times people lose out at the beginning of their career journey with us in terms of time and attendance because there’s a life barrier that’s getting in the way. We can help you enter the organization, but if we don’t stabilize you and offer ways to help you navigate the complexities of life…and when those emergent needs happen, you often end up rolling out of the organization and we miss out on the opportunity of having that win-win relationship between the person who’s joined us and their future self. So we want to make sure that we’re doing everything we can to support our team members from a holistic approach.

So now you can think about both: can we put you with a career coach who can help you plan a career pathway that’s right for your circumstances, but if you’re also having some difficulties around food scarcity, maybe it is trouble paying an electric bill in a particular time of the month, your car insurance or something that happened where you’re like, ‘I got a problem here with transportation issues or domestic violence…now we have life coaches. Our managers can share that information with their team members when they’re seeing somebody who’s struggling and they know something else is happening there where they can come in, have a confidential conversation and we can look for what’s the underlying unmet need and is there way that we can leverage our own organizational resources — local philanthropic resources, state, national resources — that could be braided funding to help stabilize a team member?

I’m thinking of an example of a team member who was about to quit work because she was having to leave work early. And when we put her with a social worker, what we learned is the reason she was leaving work early is she had an adult special needs son who was in their apartment and they were going to be evicted from that apartment and she was struggling to think about ‘where am I going to live? How am I going to provide for my son?’ So she had this huge stressor that she was carrying into the clinic every day. So the social worker said, “Let’s go meet with your landlord and see what we can do.”

They met with the landlord. They were able to negotiate a new rental rate when the landlord understood what was happening there and the special needs situation that was causing some additional medical expenses for her at that time. We were able to link her to the right patient support resources for her son and we still have a great team member.

So, that’s the work that a life coach can do for your teams. They take that individualized treatment approach. It’s like you’re not just an MA, you’re not just a patient transport person, but you are the whole person and if there is something that we can do that can help to support you when something has gone awry, everybody is better for it.

Van

Well, good for you to apply some of those principles that we’re doing for patients and using them on our own employees.

Missy

Yes, absolutely. that’s why we have a life coach who’s a community health worker, right? It’s that same training on where I can help a patient to navigate resources, but we can do that for our team members. We can help navigate the right resource at the right time.

Van

You went from initially trying out some of the programming via grant funds or public funds or philanthropic funds, and then you were able to make the case that the work should be operationally funded. Talk through a little bit of how you made that case and what did you need in order to make that case?

Missy

I needed a CEO who was bought in and that’s where I will say I was very fortunate because when we started making the business case after that very first MA program where we could see that we had something considerably different — in terms of the retention rate, in terms of manager satisfaction because people had the right skills when they entered into the clinic — we shared that story internally. I had a CEO who one day came up to me as we were running our LPN apprenticeship and he said, “Do you want to make this work your full-time job?” And I was like, “Yes, absolutely.”

So it was nice, but I think it started with being able to put the outcomes into the language of the business at different levels from the hiring manager to the leader who’s going to have somebody serving as an apprentice, to the physician who is seeing an MA grow into an LPN in their clinic?  How do I make sure I’m making that business case? How do I tell the right story so that they’re wanting to become champions of this work? How do I make sure that that position becomes part of this story because they have something to do with helping to develop this individual to be who they need on their team?

So we did a lot of internal storytelling and especially having our participants tell their own stories. There were times at our system leadership meeting where we might have one or two of our graduates come on stage and speak to the room. We’d have our employee meeting days where they would come in and talk to our employees about what was their pathway, how did they get to where they are. So those sorts of pieces put that awareness into the organization of what the work is, why the work exists. Putting it back into the metrics of the business helped us to create a clear path forward, that it wasn’t just a nice to have, but it was a need to have these programs and to have these avenues.

Now our hiring managers will come to me, or they’ll come to my AVP for workforce development, and they’ll say, “Could I have a program on athletic trainers? If there is no pool in this market for this, can you help me think about how we grow that pool?” So we have now become a part of the fabric of the organization, not just running external programs, but now we’re part of where our operational leaders are saying, ‘you can help me do my business.’ And I think that’s been a very big part of why the organization is funding this work, is that we’re still thinking about how our work answers that business need. What we think about, is it answers the personal need too.

Van

Well, you’ve shared so many tips and best practices during this podcast. I’d just love to give you the final word on any remaining tips and best practices that you’d like to share with the listeners.

Missy

Thank you for that, Van. I’m going to guess that my favorite tip is that everybody wants to reach their full potential and if we really think about the talent working in the continuum of care, we’ve got a great part we can play as chief learning officers, chief learning workforce development officers, where we can really think about taking a holistic approach to how am I really going to set somebody up for success? Because when I can set someone up for success, they’re going to thrive and that’s better for our patients, better for our communities, and better for the health care outcomes that we’re seeking. You can’t go wrong when everything is working toward a better end for all involved.

Van

Congratulations, Missy, on your good works and thank you very much for being with us today.

Missy

Thank you, Van. I enjoyed the conversation. And good luck to all of you out there who are considering entering into this space. It’s well worth it.

Van

I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future focused workforce in America.