By Alefiyah Mesiwala, Jennifer Stewart, and Michelle Chang

Health Affairs Blog, July 5, 2017 —

Imagine a job-creation initiative in which an employee with just a high school diploma has a realistic chance of more than doubling his or her original salary while working for the same employer. Now imagine that the careers this initiative supports also provide some of the most in-demand skills sought by employers in the future workforce.

This opportunity and the immense potential it represents to help build the middle class exist in the health care sector today.

That is why, about a year ago, more than 20 major health care systems from communities across the nation joined together to capture this possibility, and the Health Career Pathways Task Force recently released its first comprehensive report, “Paving Health Career Pathways to the Middle Class.”

The report details the initial findings and practical recommendations for creating these career pathways.

Consider one success story of an entry-level worker who increased her earning potential to nearly five times her starting salary. Jessica (a pseudonym) began her career as a food service associate at Norton Healthcare, a health system headquartered in Louisville, Kentucky. Once employed—and with financial support and flexibility offered by her employer—Jessica pursued additional education, eventually becoming a registered nurse and then a nurse practitioner. Not only has she dramatically increased her earning potential, but she is also improving care for patients in her community with an expanding skill set that has served diverse needs along the way.

Jessica’s story is great—truly the American Dream—but for every Jessica employed by health care delivery organizations today, there are thousands of people who do not progress beyond entry-level roles or quit the industry entirely. Public- and private-sector stakeholders have a shared interest in helping these individuals move into more meaningful roles, with an approach that offers benefits to employers, employees, policy makers, and patients.

For health care employers, the need to fill entry-level positions is acute and effectively trained workers are essential to their ability to meeting the needs of an aging population with increasingly complex conditions.

The Bureau of Labor Statistics projects job openings in the health care and social assistance industry will grow three times faster than overall employment in the next decade, while hundreds of thousands of these entry-level and middle-skilled jobs are going unfilled in communities across the country. High staff turnover hinders employers’ ability to plan for their future workforce because they have to spend so much time refilling roles, and workers in these roles have a significant impact on patients’ experience with the health care system.

For policy makers, helping entry-level health care workers advance in their careers represents an enormous opportunity to grow the middle class while also improving the quality and efficiency of our health care system.

Most importantly, for workers, entry-level health care jobs are a viable launching pad for fulfilling careers that pay family-sustaining middle-class wages. A patient care assistant earning a minimum wage can take advantage of tuition support offered by his or her employer to pursue additional education. He or she can become a registered nurse and earn a salary well-above the median household income. Tying these roles to clearly defined career pathways can provide a meaningful opportunity for skilled jobs and a promising long-term career.

The New Initiative

Our current approach to addressing the disconnect between demand and supply for these roles has failed to produce a coordinated solution that addresses the needs of all stakeholders. We’ve generally tried to solve this problem in silos—with the health care industry and the education industry working separately to address concerns instead of collaborating on solutions. To facilitate a more aligned approach, the Advisory Board Company and the Hope Street Group created the Health Career Pathways Initiative, a private-sector effort that aligns private-sector stakeholders to break down these silos and expand and scale career pathways in health care.

The initiative aims to achieve three goals:

  1. collaborating among employers to identify the health care jobs and skills that are most in demand;
  2. improving training protocols to ensure potential candidates have the skills and experience most needed by employers; and
  3. supporting job seekers in advancing along established career pathways to a middle-class career.

The work of the group to achieve these outcomes focuses on two primary tasks: a health care employer-led task force charged with identifying strategies to expand and scale career pathways in employers’ communities; and regional pilots across the country to build the necessary partnerships and tools to sustain change in individual communities.

The Report: Strategies And Recommendations For Improving Entry-Level Employment Efforts

The task force report presents insights derived from an extensive research and discussion process led by the Advisory Board. The group’s recommendations are informed not just by the diverse experience of the health care employer and post-secondary education leaders serving on the task force but also nearly 200 research interviews with employers on staff recruitment and retention, and more than 2,000 survey responses addressing key questions posed to industry leaders and staff in the field.

The Supply-Demand Disconnect

The task force identified several barriers that contribute to the supply-and-demand disconnect health care employers and communities are facing. First, employers and educators often lack clear feedback loops to ensure that the skills students are developing meet the needs of local employers. In addition, inconsistent definitions and training protocols for many health care roles among different employers and training institutions prevent workers from moving between communities to meet market demand for services. Finally, employers are in need of proven programs that help entry-level workers progress into more advanced roles, creating the opportunity for long-term health care careers.

A Focus On Traditional Entry-Level Roles

The report also concludes that efforts to bolster the entry-level workforce will yield greatest value if focused on traditional entry-level roles. The new roles that are emerging as the delivery system moves toward population health and consumer-driven models will need attention in the future, but the lack of consistency around demand and requisite skills for those jobs makes it difficult to effectively plot a pathway at present.

Regional Collaboration

Importantly, the task force also noted that collaboration between stakeholders, ideally on a regional level, is an essential approach to effective entry-level workforce development. Regional efforts will be more effective than national standardization as regional stakeholders are best-positioned to understand local workforce needs and to tap into local workforce resources. This is especially true for entry-level roles, which may face different regulations in different states. Furthermore, collaborations should be built across the community, involving multiple employers, educators, and community stakeholders to ensure efficiency and consistent quality.

Initially, this may feel uncomfortable for stakeholders because it requires collaborating with competing organizations. But by bringing all workforce stakeholders together in one model or approach, a region can avoid the gaps of a patchwork approach and competing interests.

While this broad approach may initially be more resource intensive, the task force found that collaboration does not have to start with large-scale workforce planning. Some of today’s successful regional collaborations first focused on achieving an “early win”—a shared, tangible project such as a unified grants planning process or combined background checks system. After building collaboration through such a win, regional workforce development stakeholders can start the harder, messier work of integrating regional workforce planning efforts.

Employer-Educator Partnerships

Effective partnerships between health care employers and educators are critical to enabling more consistent advancement into higher-paying roles. Health systems often feel compelled to develop their own training programs because of variation in the skill sets of entry-level staff or because of urgent needs to advance more tenured staff. Here, local schools have an opportunity to partner in this training. Educators can increase their collaboration with employers to ensure that entry-level staff graduate from programs with the right skill sets. One way to accomplish this is through post-hiring surveys of graduates’ supervisors. This helps educators refine curriculum to better meet the needs of employers and helps employers reduce the amount of training needed for new hires to become effective.

Also prominent in the report are specific best practices for employers and educators. Moreover, because it recognizes the benefit of developing career pathways with both private- and public-sector resources, the task force report also includes policy approaches for supporting effective health-sector training and employment. For instance, by targeting funding toward initiatives that prioritize meaningful employer and educator collaboration or establishing programs to introduce health care roles to students prior to entering college, the public sector can enhance the effectiveness of community-driven efforts to respond to regional market demands and employee needs.

The Regional Pilots: Gaining Real-World Experience

The task force report represents just the first step in an ongoing initiative that must incorporate the experiences of diverse communities across the country. Our work is designed to not only take lessons from the expertise of leading employers and educators but to gain frontline experience through multiyear pilots.

Therefore, simultaneous with the task force activities, the Hope Street Group is leading regional pilots to implement competency-based career pathways in Grand Rapids, Michigan; Minneapolis, Minnesota; Sacramento, California; New York City; Charlotte, North Carolina; and Denver, Colorado.

These pilots are employer led and include more than 15 health care systems, 11 community colleges and systems, seven workforce boards, and 12 community-based organizations.

By offering an opportunity to use task force recommendations on the ground in communities across the country and expand upon those findings with new learnings, the pilot programs will provide an evidence base and practical experience to inform future recommendations and other workforce-related initiatives.

In January, these pilots moved from the planning stage to implementation and are already generating insights. It is our sincere hope that the work undertaken by both the task force members and the pilot communities can help unlock the many opportunities that effective career pathing in the health care sector can offer.


Alefiyah Mesiwala, MD, MPH, is a former senior policy adviser on health care on the White House National Economic Council under President Obama and Former Medical Officer at the Center for Medicare and Medicaid Innovation.

Jennifer Stewart is an executive director with the Advisory Board Company. In that capacity, she oversees the daily operations and research within the firm’s workforce terrain—including best practice research for the Nursing Executive Center and the Human Resources Advancement Center.

Michele Chang is vice president of the Hope Street Group. She has more than a decade of experience in the private, public, and nonprofit sectors. She served in the Obama administration in various roles, including acting chief of staff at the US Small Business Administration, overseeing the operations and strategic direction of the federal agency.