Case study application THE ALASKA WORKFORCE COALITION The low supply of health c
ID: 349189 • Letter: C
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Case study application
THE ALASKA WORKFORCE COALITION
The low supply of health care workers in Alaska was constraining the industry’s abil- ity to deliver care. In addition to the usual forces driving change in the industry, including health care reform, aging workforces, rapidly changing technologies, and new deliv- ery models, Alaska’s remoteness, harsh cli- mates, vast geography, and small population complicated the challenges of developing, recruiting, and retaining an adequate and quali- fied health care workforce.
As an industry, health care accounted for 8% of total employment and around 16% of the state’s economy. Moreover, health and social service jobs in Alaska were projected to increase 31% between 2010 and 2020, driven in large part by a projected 89% increase for the population age 65 and older over the same time period. But the lack of health care workers left many rural communities without access to health care services and resulted in health care costs that were among the highest in the nation.
Most health care organizations felt the pinch of too few workers, but had limited expe- rience working in a coordinated manner to address them. For more than a decade, individ- ual health care organizations worked on solu- tions they could advance on their own. Some of these efforts worked, such as the University of Alaska’s initiative to double the number of nurses educated in state; but the breadth and depth of health care industry demands vastly outpaced such efforts. While other industries, such as construction, were gaining statewide visibility and investments, the health care industry was making only incremental gains.
Individual solutions might have helped individual firms, but it did little to help the state’s problems. Although various surveys had provided episodic data describing point in time needs, sometimes for a subset of health care workers, data sources were typically used in isolation and were difficult to assess holisti- cally due to inconsistent terminology. Inte- grated and accurate health care workforce data was not available to focus industry efforts. In the early 2000s, a promising coalition
emerged among three public sector entities to build a behavioral health workforce, how- ever no one had ever developed an industry wide projection with occupational priorities that would enable greater focus of efforts. Absent a collective effort, policy makers and funders lacked a complete understanding of health care workforce issues, resulting in lim- ited investment and influence.
One catalyst for change occurred in 2009 with the passage of the American Recovery and Reinvestment Act (ARRA). This federal program included funding opportunities to states for workforce development in high- demand industries. However, without a state- wide plan, a coordinated set of priorities, and an appropriate entity to guide the work, access to such funds was unlikely. The ARRA funding opportunity served as a trigger that brought individual groups together quickly.
At the same time, the Alaska Workforce Investment Board (AWIB) had long recognized health care as an important and growing indus- try, and they called for a statewide health care workforce plan. The AWIB’s call was motivated by its prior involvement with industry coalitions. For example, the oil, gas, and mining industry’s Alaska Process Industry Careers Consortium (APICC) had addressed a variety cross-industry needs and attracted new investments. A work- force plan specifically for the development of a natural gas pipeline was an important comple- ment to their work. The construction industry also formed a nonprofit foundation, implemen- ted new programs, and attracted additional resources from the state. These industries modeled the value of partnering to define industry workforce priorities, identifying skill standards, and attracting targeted investments in selected workforce development programs and strategies to meet their needs. Similarly, a joint effort by public sector partners had been established to build a qualified behavioral health workforce, led by the Alaska Mental Health Trust Authority (AMHTA), the Alaska Depart- ment of Health and Social Services (DHSS), and the University of Alaska.
The Alaska Health Workforce Coalition (AHWC) was formed in 2009 to ensure an ade- quate and qualified health care workforce for hos- pitals, nursing homes, clinics, and public health service throughout Alaska.
THE COALITION’S BEGINNINGS
In response to these triggers, a leader at Provi- dence, the state’s largest health care system, who had previous experience leading Alaska’s workforce development through roles in both industry and key state agencies, invited several key stakeholders to exploratory conversations about collaboration. Her experience suggested that industry needed to take a lead role and she had existing relationships with many of the stake- holders. Thanks to corporate support, personal experience, and reputation, initial meeting invita- tions were well received.
She targeted these invitations at the formal organizational leaders representing health care employers, educators, policy makers, and funders. They included the Alaska State Hospital and Nursing Home Association (ASHNHA), representing the state’s largest private sector health employers; AWIB, through its private sector chair who happened to also be the Chief Financial Officer for Fairbanks Memorial Hospital; the University of Alaska as the state’s leading health educator; and Alaska’s DHSS, which served a dual role as a significant public sector health employer and a key player in shaping state health policy. Each of these organizations had worked together in the past. In the relatively small population of Alaska, individuals can readily identify the key partners required to move quickly into action.
The initial meetings and conversations explored the opportunity and confirmed interest in creating a statewide health care workforce plan. The concept of an organization to sustain the work was acknowledged, but the general feeling was that the first priorities should be to use the existing people and resources to develop a plan and to submit a proposal for funding to an ARRA grant opportunity.
Additional partners were soon engaged based on their ability to enhance the plan’s development. New partners included the AMHTA, the Alaska Native Tribal Health Consortium, and the Alaska Pri- mary Care Association. The group also increased its
level of commitment by shifting from teleconfer- ences to face-to-face meetings every month or two. This required partners to travel at their own expense and commit to full days of work to guide development of the plan and proposal.
Early meetings benefited from good cross- sector attendance and rich, respectful conversa- tions that deepened collective understandings of current issues as well as specific opportunities that interested individual partners. However, with so many needs in the industry, there were too many options and it was clear the participants had to prioritize to gain traction. They elected to focus on strategies and actions that could be best achieved because a coalition existed versus actions that individual entities could accomplish under the status quo. The term “net new” emerged in the dialogue to distinguish new or expanded value-added strategies and actions that were unlikely to be achieved without a collabora- tive effort and which benefited multiple partners.
Still, some topics were inherently more difficult to advance due to the innate competitive issues among employers. Collaboration on statewide recruiting was seen as an opportunity, but had been a challenge to implement. Each employer invested a great deal to attract potential employees from outside Alaska to fill critical vacancies, but large employers with more resources could lever- age their relative advantage in recruiting. However, partners knew from the success of the Alaska Sea- food Marketing Institute and the Alaska tourism industry that they could be more effective and effi- cient in marketing a concept versus a company. For example, the Alaskan quality of life is appealing to many medical professionals and the coalition saw the merits of a statewide, coordinated campaign that could be more impactful than what individual firms could achieve. This approach is gradually gaining momentum with a shared website, www. alaskaphysicianjobs.net. In addition, one of the coa- lition’s key successes in the first two years was the funding of a new loan reimbursement and incentive program that benefited multiple
employers in their most critical shortages.
FORMATION
To guide, reflect, and reinforce the positive group norms that began to emerge, an organizational
charter was developed to ensure clarity for its diverse members on the purpose, principles, and intended outcomes of the coalition. For example, the group’s operating style did not involve formal leadership roles, such as a chair or officers. At the heart of the coalition’s success was an adaptive process guided by six principles: inclusive, coordi- nated, cooperative, strategic, adaptive, and results focused.
A core team emerged consisting of roughly 15 people from nine organizations. This group developed an overarching four-part framework to organize and develop the workforce plan: engage, train, recruit, and retain. For each theme, a set of potential strategies was identified, although they lacked specificity in the early stages. Occupa- tional priorities were also developed with avail- able data. They were organized into three tiers representing the relative priorities. The upper tier included more than 15 occupations, and the coalition worked to define the top six occupa- tional priorities. They included primary care provi- ders, nurses, direct care workers, behavioral health clinicians, physical therapists, and pharma- cists. The occupations were both highly needed and there were pertinent strategies that the coalition could advance.
BUILDING THE COALITION
A significant opportunity to engage more stake- holders in prioritizing and organizing the plan was offered by ASHNHA. They had begun to plan a workforce summit for their hospital and nursing home members. With the plan frame- work and high-level set of strategies and priorities established, the summit was an ideal time and place for the core group to share information and gather input from a much wider audience. It was also a good place to begin discussions about the kind of organization needed to sustain efforts in the future.
More than 60 participants at the summit heard plenary presentations about similar efforts and entities working on health care workforce issues in others states, and from other industries in Alaska. They provided tangible evidence of what was possible. The core group members shared
the plan’s framework and initial data about work- force gaps. Participants contributed to the develop- ment of initial strategies through small group and round table discussions. Core group members aligned the topics with the framework and then used a modified Open Space approach that allowed people to refine ideas in strategies about which they were most passionate. Core team members facilitated each table, gathered informa- tion and insights, and presented the results in a plenary session using simple planning templates. The overall feedback from the summit was very positive and supported the idea of continuing the effort to develop a statewide plan and a new cor- responding entity/organization to guide the efforts.
Following the summit, the core team worked diligently on outreach. Over several months, they engaged as many stakeholders as possible from the health care industry, policy makers, and fun- ders as well as education and training providers. Nearly a dozen presentations were made, always by at least two members from the core team to demonstrate shared ownership. A subteam led by the University of Alaska worked closely with the Research & Analysis Section of the Department of Labor and Workforce Development to refine occupational priorities through presentations with diverse audiences and with an online survey. The core team created a website and a contact list to communicate with the wider coalition of interested stakeholders.
In parallel with the outreach process, core team members continued to meet monthly. They discussed and integrated what they were learning from stakeholders, and strengthened their resolve to produce a well-written strategic plan summariz- ing the compelling and complex workforce needs of the health care industry focusing not only on occupational priorities but also on systems change and capacity-building strategies. Funding offered by three of the larger partners was pooled to hire contract resources to assist with writing and print- ing the plan. The AWIB endorsed the Health Work- force Plan in early 2010—making it the first significant product from the AHWC. The plan was well received and helped to achieve significant visibility for health care industry issues, priorities, and possible actions. However, it 630 PART 6 STRATEGIC CHANGE INTERVENTIONS
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was not specific enough to drive collective action. The group’s logical next step was to follow up the plan with a targeted, four-year Action Agenda. They also recognized the need to address organiza- tion development and sustainability issues. The founding individuals and organizations had devel- oped the initial plan through informal processes and volunteer contributions of time and resources. To sustain the effort and reap the benefits of the plan would require a more formal approach and organization.
CONTINUED COALITION DEVELOPMENT
Over the next year, the AHWC became larger and more formal. In part, this was enabled by a plan- ning grant from the Health Resources and Services Administration (HRSA). This grant provided one year’s worth of funding to support the research and development of a four-year Action Agenda, greater alignment of health care workforce data, and contractual support for staff, organization development, and sustainability efforts. During this time, the AHWC welcomed the opportunity to join forces with related groups where their goals were aligned and they could support one another’s efforts to go further together than either might achieve alone. For example, the Alaska Health Care Commission (HCC) recognized work- force shortages as a priority when they were initially formed, and rather than conducting inde- pendent research and developing their own recom- mendations, the HCC aligned their direction with the AHWC, endorsing the work of the coalition as their own. Similarly, the AMHTA had several years of experience advancing their Workforce Focus Area focused on home and community based behavioral health services. They realized that sustaining their efforts and participation in the AHWC could be aligned with the Focus Area to create a single, unified approach. As a result, the two efforts merged in 2011 to unite health care workforce planning and action for Alaska, inclusive of the distinct needs of the AMHTA and its beneficiaries.
The coalition researched alternative approaches to forming a sustainable organization to advance their goals around health care workforce issues.
A number of models were identified and explored using the principles from the initial charter to guide the process. The core group determined that con- tinuing their loose collaboration without formally establishing a new nonprofit entity was preferred. The individual who provided support to the Work- force Focus Area on behalf of the AMTHA, DHSS, and the University, had her scope of work extended to include AHWC activities in late 2011, bridging the staff needs from the planning grant to full operations. Organization development consult- ing support has continued to provide additional resource and continuity with coalition and core meetings and activities.
EVALUATION
The creation of the Alaska Health Workforce Coali- tion has resulted in several benefits to its members and to the Alaskan health care system as a whole. These include:
• An industry-led workforce plan with tangible ac- tions, accountabilities, and committed resources • The use and integration of data to establish
occupational priorities • Actions focused on occupational and systems
change priorities that drive health care work- force activities and investments by members and other stakeholders
• A unified approach to advocacy for policy changes and funding opportunities
• Increased resource commitments, actions, and emerging results that all serve to build the Alaska health care workforce
In 2012, the coalition documented a retrospec- tive of early achievements by AHWC in response to requests by other industry groups. The coalition also elected to undergo a “strategic refresh” pro- cess in recognition of the completion of several Action Agenda objectives and the actual or planned transition of several leaders. The AHWC coordina- tor and OD consultant interviewed each core team member to gather feedback on the greatest achievements to date, alignment with each organi- zation’s priorities, update to occupational and sys- tems change priorities given the changes to the health care industry and suggestions that would enhance the effectiveness, relevance, and impact of the coalition going forward.
The data suggested that success has been achieved through the attention and balance of two equally important aspects:
• Content, action, and results. The coalition convened on the premise of shared need and the desire to take collective action. This was achieved through a strategic plan that defined the workforce goals to engage, train, recruit, and retain a qualified health care workforce for Alaska. The coalition developed a correspond- ing Action Agenda with objectives to drive action in six occupational priorities and six sys- tems change and capacity-building efforts.
• Process, relationships, and respect. The coalition emerged through relationships and shared need. Individuals with loose relationships
agreed to begin exploring the merits of common- goals and collaborative action. The processes have been thoughtfully guided and intentionally nurtured throughout the first three years to build respect and strengthen relationships across the organizations and individual leaders.
The results also helped the core team to update the Action Agenda priorities as well as refine their processes of engaging with one another. The pro- cess of evaluation and continuous improvement confirmed the need to retain and nurture strong rela- tionships among key partners—particularly when decisions and direction are needed. It also con- firmed the need for dynamic strategy and priority setting processes given the uncertainty faced by the health care industry and the resulting changes in care models that lead to new demands for the health care workforce of the future.
Study the case deeply and write about it.it should be in following steps
Introduction’
Background
Proposed solution’
Alternatives
Recommendations
Explanation / Answer
Introduction:
Alaska has been facing several workforce challenges related to it's large geographic size but proportionately small population. Hence, the Alaska Health Workforce Coalition (AHWC) , a public-private partnership was formed to facilitate, implement, nurture and support a system, to ensure Alaska has a competent and dedicated workforce to meet current and latent health care needs of its people.
It’s focus was to target issues and resolution for policies, affordability, and learning and development, training and professional development and accessibility to these for its people, even in remote locations
Background:
Previously, the Coalition's work was financed by a Health Resources and Services Administration which was a state healthcare workforce planning grant. Now this Coalition is reinforced by the partner organizations. Objective was to ensure Alaskans will continue to receive access to better health care services. So the Coalition work was to continuously monitor and pro-actively participate in Alaska’s health workforce via training, recruitment and reducing attrition with proper engagement driven activities.
Proposed solution:
Priority tasks identified based on current requirements and forecasted future needs related to recruitment difficulties, reduce attrition problems and importance to the health care service delivery:
Alternatives:
Recommendations:
Above is a continuous improvement process and can’t be achieved overnight or in a month even. Hence fostering a strong relationships with people of Alaska as well as key partners, is critical for the purpose of apt and right, moral decisions for the good of all. Advocacy for above services and issue resolution is needed to appear by the people and partners. Any sort of miscommunication or misalignment is either to be avoided or addressed on priority basis.