States Are Laboratories of Workforce Development Innovation: Jennifer Davis, Senior Policy Advisor on Human Services, Wyoming Governor’s Office

Hello, I’m Van Ton-Quinlivan, CEO of Futuro Health, welcoming you to WorkforceRx, an exploration of innovation shaping the future of learning, work, and care.

There are many players in the ongoing effort to combat healthcare workforce shortages, including health systems, education institutions, federal agencies, and nonprofit organizations like Futuro Health. But one of the most important stakeholders are state governments because of their critical role in providing healthcare services for residents.

Today, we’re going to check in with one of the states leading national efforts to find solutions to this problem by talking with Jennifer Davis, Senior Policy Advisor on Human Services to Wyoming Governor Mark Gordon.

Jen has been instrumental in Wyoming’s robust efforts to increase the healthcare workforce, particularly with regard to the providers of mental and behavioral health services. I think the work she’s done is inspirational, and I’m so pleased to have her on the podcast today to learn more about it.

Thanks so much for joining us, Jen.

Jen Davis

Thank you, Van, for having me. I’m excited to be here.

Van Ton-Quinlivan

Well, before we get into your current work, Jen, I want to note that you have a background as a clinician and I’m wondering how you ended up on the path to becoming a policy advisor and how your work as a physical therapist informs what you do now?

Jen Davis

That is a great question. I have had the pleasure of having lots of great experiences in my career. I started out as a physical therapist over twenty years ago, really passionate about children. I’ve always worked as a pediatric physical therapist and had the opportunity in different roles in pediatrics to really have some amazing experiences with families and through that work, I saw that there was a bigger need for some policy changes that I couldn’t do just as a physical therapist.

I really had an interest that started off in policy around child welfare and went into working in a non -profit as a director of an agency that helps support child welfare in the state of Wyoming. From there I had the opportunity to move into more of an advocacy role for prevention of child abuse and neglect and how all of those connections come into play with the very beginnings of healthcare at birth, which was really a passion that I had. And then had an amazing opportunity to apply for this job and was lucky enough to get selected to really help to shape policy for all of the clients that I served when I was doing private practice and really realizing that there’s so much more that healthcare means than just the hands -on experience that I was giving as a physical therapist.

Van Ton-Quinlivan

Well, the policy world and state government is really lucky to have someone with your background in this role. Thank you for serving.

Jen Davis

Thank you.

Van Ton-Quinlivan

So, I mentioned that Wyoming has built a reputation for very energetic efforts in addressing the workforce shortages through executive orders that came out of Governor Gordon’s office, as well as legislation and other efforts. What’s driving all of this activity and what are the underlying strategies that you’re employing, Jen, in your state?

Jen Davis

So we have really been struggling with healthcare workforce shortages for a very long time. Wyoming is very large geographically, but there are very few members of our population. We have really always had a difficult time recruiting physicians and other healthcare workforce who understand the rural, frontier nature of our state that want to still be part of providing healthcare in that environment because it is very different, so we’ve really spent a lot of time focusing on how can we grow our own.

After COVID, like many states, we lost a lot of our healthcare workforce and really struggled to find ways to bring more people into healthcare. And as we know nationally, we have a lot of people exiting the healthcare professions due to retirement, due to burnout, and all kinds of different things since COVID. So, we really wanted to take the time to dive into what did our healthcare workforce needs really look like. We didn’t have a good sense before, so we really needed to be able to have a way to look at our data in a more meaningful way than what we’re currently collecting. We also needed to look at how our educational system was aligning with our licensing and then how was that coordinating with our educational institutions to see could we in fact actually grow our own in Wyoming? Is that even a possibility? And in areas where it’s not, how can we really be more intentional partnering from a regional perspective with some of our surrounding states?

So this has been really important for Governor Gordon. He established a healthcare workforce task force under executive order and through that, we are focusing on two of our biggest needs in the state that we’ve identified, which is our nursing pipeline and then our behavioral health pipeline. His executive order was really intentional to look at three different things in workforce.

One was to have the licensing boards meet with industry to really determine are there any barriers that are prohibiting people from entering the workforce in a timely manner and how can we overcome those. That involves looking at some of the flexibilities in licensing that were granted during COVID and did we adopt those? And if we didn’t, why not? And should we?

Then also he wanted us to look at better data collection from our licensing boards. As I mentioned, we anecdotally know that we have a workforce shortage issue, but we didn’t have all of the data to support that. So in that, he is requesting that all of the healthcare licensing boards come together and collectively determine what points of data that they all will start collecting to better understand our workforce in Wyoming.

And then lastly, the requirement was to come together and focus on developing a educational workforce pipeline for behavioral health. So that’s kind of where we’ve landed in focusing these efforts.

Van Ton-Quinlivan

Jen, for those individuals that don’t come from your world, when is the executive order a good tool to use?

Jen Davis

So, I think the executive order is a really great tool that our governor uses actually very sparingly. He takes that power very seriously. What we have done in this case is pull together a variety of different state agencies into a conversation and direct them to a certain goal, and that’s where he utilized the executive order. Many times states executive order power differs for their governor. Ours is pretty limited in Wyoming but where it does not supersede any legislative action, then he can draft an order.

Van Ton-Quinlivan

And you mentioned licensing bodies. If I could just dive into that for a moment, what were you hearing about the licensing body as sort of a barrier to growing your own? I mean, what are the themes that were surfacing from these meetings?

Jen Davis

So some of the things that we heard that were barriers to licensing is just timeliness – how much time passed between when they would submit an application through actually obtaining their license. One of the barriers that we heard in there is over the last few years we’ve passed a lot of legislation on background checks and those take quite a bit of time to come back before people can get into practice. So, we heard that as a barrier.

We also heard about another barrier that I think has really been elevated, prior to so many state licensing compacts, is the fact of transferring your license from one state to another. Maybe you didn’t have all of the same coursework or maybe your curriculum looked a little bit different in another area. And so we heard barriers in that space that people were just not able to transfer in a timely manner or had to take something additional. We particularly heard that a lot around addictions.

So, those were some of the big barriers that we heard were really impacting getting into the workforce quickly.

Van Ton-Quinlivan

And Jen, I was wondering, why do those barriers not cure themselves?

Jen Davis

Van, that’s a great question. I think one of the things that happens is, you know, we get really dedicated to the work that we’re doing and don’t always take a moment to stop and reflect about is this still really working for us? And if it isn’t, why not? I think we’re not always asking enough “whys” when we’re digging into these topics. I think if we’re not asking those on a regular basis, it’s easy to just think about those as something that we just always do and not question why we’re doing them.

It’s really important to be continually questioning. The fields change all the time, especially in behavioral health. There’s new professions coming on all the time. There’s different requirements with the new opportunity for virtual learning that’s just exploded across the nation. It’s really changed some of that curriculum and pathway and licensing. So, we really need to be asking those questions so that we make sure we’re doing the best and that it doesn’t just sit there and we don’t take the time to dig into it.

Van Ton-Quinlivan

That’s really good advice and not just for someone in state agency but for any type of organization. Why do we do the processes that we do?

One program I’m curious about is the Wyoming Innovation Partnership, WIP, that worked with the state’s community colleges to create new echocardiography program and expand opportunities for certified nursing assistants. Tell us how that works and if you have plans to build on that model.

Jen Davis

Yeah, so I’m so lucky to work here. Governor Gordon is a very progressive governor. He really is very innovative, and has an entrepreneurial spirit, I think. One of the initiatives that he created is the Wyoming Innovation Partnership. His reason for doing that was in Wyoming, we only have one university and we have eight community colleges and some of the things we were hearing from students is that their credits weren’t always transferring from the community college to the university. That’s a problem when we only have one university and students aren’t able to have a seamless transition from our community colleges.

He really wanted the industry partners to come together around economic development and industry needs, come together with the community colleges and the university to really ensure that we were all working together collectively to determine the needs of the communities and the industry and do that in a meaningful way with making sure educational pathways and opportunities were highlighted.

In the WIP initiative, there’s different groups and one of them is healthcare. That healthcare group came together and talked about some of the gaps that we were seeing across the state and community colleges then had the opportunity to put forward educational programs in partnership with all the other community colleges and the university about what the needs were, who’s the best to stand up that program and what does that look like?

So, we have a radiology program and a sonography program at one of our community colleges. And there was an opportunity there of looking at echocardiograms since that is another growing area that we could meet through the community college level and give people additional pathways into healthcare fields in Wyoming. And so we continue to leverage those opportunities with the WIP partnership. We are getting ready to go into phase three of that, and healthcare is still at the top of those priority lists.

Van Ton-Quinlivan

You mentioned the echocardiogram program. Was there any model behind the certified nursing assistant program that you wanted to share?

Jen Davis

We have several colleges who had CNA programs. What we were seeing, especially after COVID, is the difficulties with hiring CNAs in our long -term care facilities, the difficulty with hiring nurses across the spectrum. We really wanted to ensure that our community colleges had CNA programs that were really acting as entry points for individuals interested in nursing type professions, especially in long -term care, but then also could kind of set the pathway if they want to continue on with their nursing degree either at a community college for their LPN or RN or move into the BSN program at our university. So, that was just a really important thing that we did so that more CNAs were available across the state.

Van Ton-Quinlivan

Good for Wyoming. Jen, I’d love to hear about some other examples of the work the state’s doing that you find particularly promising.

Jen Davis

Boy, there’s a lot of exciting things happening right now, which is really great to see. We are working in the Governor’s Health Task Force and we have multiple subcommittees. Some of the areas that we’ve really focused on that are considerable needs in Wyoming is OBGYN care. We’ve really been trying to focus on finding some innovative solutions that we could implement in Wyoming to upscale, hopefully, some of our family practitioners to be able and be more comfortable with doing labor and delivery and doing it safely. We have in some of our areas really small volumes, so it’s hard for people to be able to keep their skills current, so we’re trying to figure out ways that we can leverage technology to help support physicians and other providers in those skill building areas.

We’ve also been doing some focused work around EMS. EMS has been a big challenge in Wyoming just due to our rural nature and we’ve seen some difficulties with sustainability of the infrastructure, so we’ve been trying to look at innovations there. We’ve worked with the Department of Workforce Services to provide funding to get more people into that pipeline and really helping them to see the benefit of that, working to see if there’s ways we can regionalize some of that care so that it can be more efficient and effective, especially in these really rural parts of Wyoming that are really far apart from any sort of area where health care services are available.

Those are some of the other things that we’ve been focusing on.

Van Ton-Quinlivan

You mentioned several times the rural and frontier nature of Wyoming. I would just love for you to kind of give us a flavor of the challenges or perhaps the difference doing workforce development in those geographies compared to maybe an urban geography.

Jen Davis

Sure. I think rural and frontier healthcare is everywhere in our nation, right? Every state has some rural areas. In Wyoming, pretty much the whole state is rural or frontier. To give an example, we have two major interstates that run through Wyoming: Interstate 80 and Interstate 25. Interstate 80 has a lot of commercial truck traffic that comes through Wyoming. And so one of our small communities there that has a rural hospital where they were doing OB services and have now ceased to do that, because they didn’t have enough volume to keep that service line viable in their hospital.

One of the things that you see in rural areas is now if you live in that community and you’re pregnant, it is 100 miles in either direction to reach services. That particular interstate, that stretch of highway, was closed fifty-four times last winter. So when you look at not only the rural nature but you look at the weather environment in this area, not only do you have an access issue of just having number of providers, but you also have an access issue of can you even get to where you need to go to access the services. And that’s a real challenge for some of our communities.

There’s some communities where it’s hundreds of miles before you have access to another medical facility and in that span — that 200 miles that 100 miles — there is nothing else in between there. So, your risk is really high in that rural health environment for potentially not having access to services, even emergency services.

I think one of the other things that is really challenging to understand about rural and frontier health care is if you’re a physician in some of small communities, you may be the only one and so you are everything to everyone. That’s really hard to recruit to. Especially if somebody has done their training in a more urban area, you know, they may be delivering a baby and maybe that baby needs to be intubated and they can call in a team to do that. In Wyoming, if you do a delivery and they need to be intubated, guess who’s doing it? You are.

So, your skill sets need to just be so much broader in rural and frontier medicine compared to urban areas and that’s intimidating for some. So, it’s really hard to say, “Come live in this community where it’s very small and you’re everything to everyone 24-7.”  It’s difficult to do. And then when you have specialty services, like OB, you can’t have just one because of on- call, and so it’s hard to recruit just one, let alone several. So then those service lines end up going away in some of those really rural areas of the state because you just don’t have enough volume to sustain it and the facilities can’t afford to offer those services.

Van Ton-Quinlivan

That’s a very vivid description of the challenge that may face the rural and frontier communities. Thank you, Jen.

Well, we met through the National Governors Association because Wyoming was selected amongst a handful of states to work address its healthcare workforce with innovative strategies. I would love you to share what is going on with that work.

Jen Davis

Yeah, it’s really exciting, Van, that we got to meet you through this opportunity with NGA. We’ve been partnering with NGA for the last couple of years in healthcare workforce and had the opportunity of meeting you and learning about what you all have done in pipeline development and supports, and knowing that that is an area in Wyoming where we have struggled, it presented a great opportunity for us to continue to work with NGA and engage Futuro Health.

We have been really focused right at the current moment on the behavioral health workforce pipeline. We’ve been doing several things around that. We had the pleasure of having you all out in Wyoming a couple of months ago, which was amazing, and that kind of set the groundwork for us to dig into a few other areas. We did some mapping of the professions that we actually have in Wyoming that are currently licensed and there are eighteen of them in our mapping. In some of those, we only have one or two people who are licensed and so it’s really forced us to have a conversation about, A, what do we want to be? And then B, based on that, what do we currently have? What is working in that and what is not? We’ve really started to dig into those conversations.

We’ve now had some industry stakeholder calls with our licensing boards to just hear about barriers and opportunities with all of the different behavioral health licensing entities. We have a survey out to all of the current behavioral health licensees, just asking a little bit about their experience with licensing and their experience with education. Did they get that in Wyoming? What were any barriers that they experienced? And then we also are doing some interviews with industry leaders throughout the behavioral health continuum about their hiring processes to really dig in to find out more information of what are they actually looking for.

Then we’ll be able to bring all of that back to center and say, okay, here’s what industry is saying that they need. Do we even have the right professions in the state? Do we have the curriculum and the program for them to get it here? Do they need to go out of state? Do we have a license for that or do we need a license for that? So , we’re really hoping to bring all of that together.

The other thing that we’re doing is cross walking the curriculum for each of those entities that are in the mapping that we did to see where there’s overlap. At our first look, it looks like we have overlap in some of those professions that we’re licensing and so we’re really trying to clean that up and see if we need all four of these or is the curriculum similar enough that, you know, maybe we only need two of those and the rest fall into one of the other two categories. So, that’s kind of where we’re at right now is just doing some more information gathering.

We have a tight time frame in the governor’s executive order to do this because we’re coming up on our general session for the legislature, which will start in January. The governor really wanted this group to work fast and furious to determine if there’s any legislative action that we need for this upcoming general session because Wyoming’s general session is only every other year, and the off years is our budget session. So, this is the general session where we would want to move any of those types of pieces of legislation that would be better to address during this time.

Van Ton-Quinlivan

Well, Jen, as you know from the gathering of the twenty-six states at the National Governors Association convening, every state is having a struggle with the behavioral health workforce. You’ve talked to a wide range of stakeholders, you’ve looked at a lot of data and curriculum, you’ve benchmarked other activities in other states, so I wonder what would you advise the self that started this journey versus the self that you are today about growing the Wyoming workforce?

Jen Davis

Boy, there’s so many things that I think that have been good lessons learned and things that I think we would probably do different and things that we didn’t do that we would want to do.

One of the things would be, I would wish we would have been a little more intentional in our effort at the beginning because I think we made it so broad and so open. There’s just so much information and trying to bring that all together. But at the same time, that’s kind of what happens when you do systems work, right? It’s big, it’s complicated, it’s messy. So I think if we could just be a little bit more targeted in that, that would have helped us a little bit more to funnel some of this information.

I think some of the other lessons learned is you never know what you don’t know.  I think you need to always be asking questions and be curious because as we’ve done that, we’ve learned so many more new things. We kept hearing that we didn’t have any professions or pathway in our behavioral health system below a master’s degree. But in fact, when we actually mapped that out, we actually have quite a bit. That really should keep us curious about asking, well, why do people not know about these? Why are people not accessing these? What are the barriers? How is this one better than another? I think you need to make sure the right people are at the table for those things.

I think the other lesson learned is having the executive order by the governor really did help this because it really engaged our community colleges and the university to come to the table with the presidents with the highest level of ensuring that they’re bought into the process. So, I think that’s definitely something worth repeating in our effort because it really has been able then to get the right people to the table for the conversation. Even if it wasn’t that president, they were the conduit to get their other individuals to the table to be part of the meaningful conversation.

I think another lesson learned for me would be that as we start out, I talk a lot about “the why” and asking other people, but I don’t know that I always start out with the best describing of “the why.” And so I probably needed to dig in a little bit deeper on “the why,” particularly with our licensing boards so that it doesn’t feel threatening, because that’s not at all what it was meant to do. It’s just meant to open the door and look at and question what we’re doing. So, I think If we’re not better at our why questions, then I think it puts others on the defensive and that’s just not a good place to be.

Van Ton-Quinlivan

I want to invite you at this moment to do any call-outs of great practices or good system designs that other states have had as you’ve been learning about how others do this work. Is there any state that jumps out in particular?

Jen Davis

Well California, I think, has done a lot of great work with educational pipelines and behavioral health professionals. Colorado has done a lot of great work with rural health and looking at behavioral health in that space and access. I think Alabama has been a state that we’ve looked at for the way that they’ve really addressed some of their licensing with their healthcare professionals and thinking outside of the box and opening up opportunity more.

Goodness, we’ve worked also a lot with the Virgin Islands and America Samoa and have learned a lot from those two areas who are also rural access areas as well, and have really gotten a lot out of those conversations.

One of the other states that we’ve looked at, particularly in our OB area, is Alaska. There’s tremendous work that they’ve done on their maternal health in Alaska that’s very inspiring that we’re looking at in Wyoming. Are there ways we can replicate some of those efforts in rural Wyoming? Because, boy, if anybody’s rural, it’s Alaska.

So, I think there’s a lot of great lessons learned both from some of our more populated states as well as some of our more rural states. It’s just been an amazing adventure to learn about what others are doing because you don’t have to recreate the wheel. It’s out there and other states are doing a phenomenal job.

Van Ton-Quinlivan

Well, why don’t we close by doing a little bit of a look ahead at the future of care in Wyoming. Where do you think Wyoming and its healthcare workforce will be in the next five to ten years?

Jen Davis

Well, I’m going to be optimistic and say that we are going to have more streamlined pipelines for educational and workforce development in the state of Wyoming…meaning that we have better entry points for kids even down into the K -12 system that can really learn about healthcare opportunities and then provide them a pathway where they can get involved at the high school level and be able to complete their educational journey, at least the majority of it, right here in Wyoming and get an opportunity to experience rural healthcare.

I think the other place that we will be is really finding a path forward about how we are going to retain that workforce. I think it’s important — both recruitment and retention. And so I think we’ll be at a place where we will have better industry buy -in that the workplace environment and retaining employees is beyond just the financial incentive of working, but really how do we build a culture in Wyoming?  I see us doing that in the next five to ten years, too.

Van Ton-Quinlivan

Well, I know our listeners have learned a lot listening to you and so we’re wishing you well in your efforts in Wyoming. Thank you very much, Jen, for being with us today.

Jen Davis

Thank you so much. It’s been a pleasure, and thank you, Van, for everything that you’re doing.

Van Ton-Quinlivan

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.