State's Labor Department Working to Increase Hawai‘i's Primary Care Workforce 20% by 2020

Abstract

Hawai‘i lacks the number of skilled professionals needed to meet current and future healthcare demands. In order to meet the growing needs of Hawai‘i's residents, the Workforce Development Council, a state agency attached to the State Department of Labor and Industrial Relations, is looking to expand the primary care workforce 20% by the year 2020. Using funds from a Healthcare Workforce Planning grant, the state formed several Healthcare Industry Skill Panels, a workforce development best practice from the State of Washington, to address the gap in healthcare services and healthcare workforce opportunities for Hawai‘i residents. Over 150 stakeholders—from employers, education, the public workforce system, economic development and labor—contributed their time and expertise to identify current workforce issues and develop action-oriented strategies to close industry skill gaps. So far these Skill Panels have developed a Critical Care Nursing Course Curriculum, a Workforce Readiness Curriculum and Certification pilot project, and a group to address specific barriers that are impeding Certified Nurse Aides (CNA). Upcoming initiatives include the distribution of a comprehensive statewide healthcare workforce development plan entitled Hawai‘i's Healthcare Workforce 20/20 Plan & Report: Addendum to the Comprehensive State Plan for Workforce Development 2009–2014, and the creation of HawaiiHealthCareers.org, a website to both recruit and support individuals interested in pursuing careers in the healthcare industry.

Background

In a recent status report for the Governor's A New Day in Hawai‘i Plan, the Abercrombie administration called the transformation of Hawai‘i's healthcare systems “our most complex challenge.”¹ Rising healthcare costs, an increasingly aging population and an insufficient number of skilled workers have contributed to a “critical condition” for Hawai‘i's healthcare sector. The state faces many challenges, including significant health disparities in groups such as Native Hawaiians and Pacific Islanders, rural residents, homeless families, and recent immigrants. These could be mitigated by expanding the primary care healthcare workforce. Healthcare employers in general have difficulty finding skilled workers in many occupations, especially in specialty positions where there are few or no local training resources. While there are many organizations working to assess and solve these and other challenges, until recently there has been no organization taking responsibility for creating a coordinated, statewide effort to address the issues through workforce planning.

Some of the state's major barriers to developing a skilled healthcare workforce include a lack of labor market information for high-demand and particularly “specialized” occupations, the high cost of living and transportation that inhibits training for neighbor island residents, and rural and isolated areas where residents have limited access to healthcare services. As described elsewhere in this journal, when compared to average US healthcare utilization rates, these and other barriers have led to an estimated 20% lack of primary care providers in the state, as well as shortages in many other healthcare occupations.

Long-term projections show an increasing demand for health occupations. Citations include: “Personal care and service occupations are expected to lead growth with 20.4 percent” and “healthcare support will expand significantly by 19.0 percent, followed by healthcare practitioners and technical occupations with a 15.0 percent growth.”² In addition, the Hawai‘i Comprehensive Economic Development Strategy 2010 Report noted, “Health services will likely show the sharpest growth, with the number of workers increasing nearly 54 percent from 2007 to 2035.”³ If the state does not have enough skilled healthcare professionals, it can never meet the growing healthcare needs of Hawai‘i's residents.

The US Department of Health and Human Services (DHHS) is charged with implementing many aspects of the Affordable Care Act of 2010. Within DHHS, the Health Resources and Services Administration (HRSA) created grant opportunities for Healthcare Workforce Planning and in 2010 Hawai‘i was one of 22 states awarded a $150,000 grant. The Workforce Development Council (WDC), attached to the State Department of Labor and Industrial Relations, is the lead agency for the grant's implementation.

The WDC is a private-sector led body responsible for advising the Governor and Legislature on preparing Hawai‘i's workforce development infrastructure to support economic development and employment opportunities for all. The WDC is also the Statewide Workforce Investment Board for purposes of statewide oversight and direction of federal job training dollars funded through a formula fund from the Workforce Investment Act (WIA) of 1998. Additionally, the WDC assists the Governor and Legislature in developing and updating the state's comprehensive five-year strategic workforce investment plans and oversees workforce investment activities in the state.

Under the leadership of WDC members representing Hawai‘i Pacific Health, the Hawai‘i Primary Care Association, the University of Hawai‘i Community College System, the Chamber of Commerce of Hawai‘i, and in partnership with the John A. Burns School of Medicine's Area Health Education Center and the State Board for Career and Technical Education, the WDC had already implemented a sector-based approach known as Industry Skill Panels to identify and resolve specific workforce issues for Hawai‘i's health care industry. The panels brought together stakeholders throughout the state to identify barriers and solutions. This initial work was one of the reasons Hawai‘i was well positioned to win the grant under the Affordable Care Act.

By using broad-based collaboration, leveraging resources and aligning state efforts, the grant report, Hawai‘i's Healthcare Workforce 20/20 Plan & Report: Addendum to the Comprehensive State Plan for Workforce Development 2009–2014 (the “Plan”), was published in December 2011 to identify and address workforce shortages, especially in high-demand occupations. This Plan has a primary goal of increasing the primary care workforce in Hawai‘i by 20% by the year 2020, where primary care is defined as occupations which provide or support basic health services, based on the extensive definition of “required primary health services” from section 330(b)(1) of the Public Health Service Act.

Methods

Industry Skill Panels were first pioneered in Washington State in 2000. Since then, Washington has launched more than 40 panels and the concept has expanded geographically and within industries. Some of Washington's successes include reducing the vacancy rate of Invasive Cardiovascular Technicians by 100% between 2003 and 2007, and initiatives of the original four Skill Panels leveraging over $18 million in additional investments (30 times the public funds invested).

Industry Skill Panels can be described as private/public partnerships working to ensure employees in key industries have the skills needed to meet the changing needs of businesses quickly and competently. These panels harness the expertise of leaders in business, labor, education, economic development, and other sectors to identify workforce development strategies while closing skill gaps in a specific industry. Industries using Skill Panels in other states have included healthcare, construction, agriculture and food processing, information technology, electronics, energy, transportation, aerospace, and advanced manufacturing.

Skill Panel leaders build consensus, prioritize their local and regional industry workforce needs, and are better able to mobilize partners and leverage resources to make the greatest impact. Additionally, their mutual efforts are more influential with government, businesses, associations, and educational institutions, than filling workforce needs alone within silos.

Results

Using this best practice framework, the WDC formed a number of Healthcare Skill Panels to address the gap in healthcare services and healthcare workforce opportunities for Hawai‘i residents in nursing, long-term care, primary care, technical disciplines, and work readiness (see Figure 1: Anatomy of Industry Skill Panels). Over 150 stakeholders from employers, education, the public workforce system, economic development, and labor contributed their time and expertise to work toward desired outcomes that would benefit the state as a whole. Participants identified current workforce issues and developed strategies to close industry skill gaps.

Figure 1.

Anatomy of Industry Skill Panel

(Source: Evaluating Industry Skill Panels: A Model Framework, June 2008)

A major issue identified at the first group of Skill Panel meetings was that while statistics show a large increase in healthcare occupations in the coming years, current Labor Market Information (LMI) has been misleading. For instance, in the past five years, statewide LMI has shown a high need for Registered Nurses (RNs). However, this data was not segregated to show which types of nurses were most needed. Therefore, many nursing schools began training RNs as quickly as possible to meet the upcoming workforce needs. Unfortunately, many of these RN were gaining the bare minimum credential, an Associate's degree, and were not meeting the needs of employers who required Bachelor's degrees with specialty experience. Therefore, many new RN graduates were compelled to take jobs below their level of training and expected pay grade or move away, while employers were driven to hire expensive temporary RNs from outside of the state until their current employees could be trained to fill the available high need specialty positions. Had the LMI been segregated into more detailed data segments, this consequence may have been avoided. This and other LMI issues that must be addressed in order to create a healthy workforce are further described in the Plan followed by stakeholder inspired solutions.

Though much of the Plan's success will take place in the future as funds are secured for implementation, there have been a number of “quick wins” from the Skill Panel sessions, including:

• A Critical Care Nursing Course Curriculum, an initiative of the Nursing Skill Panel, is a collaboration between several employer and education organizations which surveyed employers to find the highest need nursing specialty area (identified as Critical Care), and then collaborated to develop specialty training for current RN and new graduates in order to fast-track them into these high need critical care specialties. This Critical Care pilot program is expected to launch in April 2012 with a total of eight participants, two of whom will be recruited to participate through local colleges and universities. If this pilot is successful, best practices from this employer driven model will continue to guide future healthcare curriculum development for additional high need specialty areas;

• The Ready, Set, Grow work readiness curriculum and certifi cation pilot project is partially a product of the Workforce Readiness Skill Panel. Employers at the first Skill Panel session indicated that workforce readiness was a top priority. The UH Community College system identified an appropriate curriculum and testing vendor and is conducting the pilot project using blended funding from several sources. While the pilot program uses a broad platform, the curriculum is adaptable to the needs of healthcare employers and can be customized as needed. A total of 92 students enrolled in the pilot course from summer through the fall of 2011 at either Windward Community College (WCC) or Leeward Community College (LCC). At this point, no students have taken the National Career Readiness Credential (NCRC) test, but once the set-up and contract for the testing site have been completed, the program aims for at least 60 percent of participants to earn the NCRC. More information about the pilot can be viewed at www.readysetgrowhawaii.com; and,

• The formation of a group of stakeholders to address specific barriers that are impeding Certified Nurse Aides (CNA). The group has been actively working with state agencies to identify and find solutions for issues such as recertification, safety and oversight, training, and testing. As Hawai‘i's aging population grows, the need for skilled CNA will only increase. Some of this group's recommendations can be found in the Legislative Barriers section of the Plan.

Information from an Initial Skill Panel Report as well as months of gathering additional data and feedback from stakeholders has led to the development of the Plan, which will be utilized by all collaborating partners to address the identified needs. The Skill Panels began as statewide groups focused on specific industry interest areas (Primary Care, Long-Term Care, Technical Disciplines, Nursing, and Workforce Readiness), yet over time the Skill Panels recommended that Local Workforce Coordinator positions be created to facilitate the coordination of local Skill Panels to be formed in each county, which will meet regularly to address unique regional workforce issues. Each Local Workforce Coordinator position will also have a specialty focus—Human Resources, Health IT, Academics (including Facilities and Preceptorships), or Long-Term Care. Other goals of the Plan include: improving LMI data through the collection and analysis of more detailed LMI; completing, maintaining and regularly updating the HawaiiHealthCareers.org website as a recruitment strategy; and organizing “Aloha Committees” to welcome new primary care professionals, particularly in rural areas, for increased retention.

Discussion

The four main strategies to reach the Plan's goal include:

• Strategy 1: Create an early warning system for impending workforce shortages.

• Strategy 2: Fill gaps in education and training.

• Strategy 3: Strengthen the pipeline into health careers.

• Strategy 4: Leverage resources to maximize their benefit to the state as a whole.

The Plan has been discussed at length in Skill Panel meetings in each county as well as through individual outreach and conference calls with Skill Panel members to ensure maximum statewide stakeholder support. The Plan was published in December 2011 and made available to all stakeholders, legislators, and the general public. The plan is viewable online at: http://hawaii.gov/labor/wdc. Funding for implementation of this plan has not yet been procured. However, federal funds may become available for a subsequent Healthcare Implementation Grant such as is currently operating in the State of Virginia. A funding request for the Affordable Care Act: State Health Care Workforce Development (SHCWD) program has been included in the President's proposed budget for FY2012 for approval by Congress. WDC will continue to seek other federal, state, and private funds to implement the Plan leading to a final impact of increasing Hawai‘i's primary care workforce by 20% by the year 2020 while improving LMI for all health careers to fill current and future workforce gaps.

Conflict of Interest

None of the authors identify any conflict of interest.