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Impact Workforce

Income and employment play a significant role in shaping the health and well-being of individuals and communities. The Impact Workforce strategy involves anchor institutions committing to local and inclusive hiring and workforce development that connects individuals from nearby economically disadvantaged neighborhoods to quality jobs and career pathways. Anchor institutions commonly adopt a targeted recruitment strategy, focusing on zip codes where communities are experiencing the greatest health and wealth disparities, or populations within those communities that face barriers to employment—for example, justice-involved individuals or immigrants. Strong relationships between anchor institutions, community-based organizations, and workforce intermediaries can help to build a sustainable community infrastructure for workforce development, and catalyze local job creation and career development.

When done well, Impact Workforce strategies should help accomplish broader workforce objectives to address worker shortages, reduce turnover and recruitment times, and create a better prepared staff that is reflective of their community.

Impact Workforce strategies are defined by three core approaches: outside-in, inside-up, and institutional commitments.

Outside-in

Outside-in strategies prepare residents experiencing barriers to employment for jobs at anchor institutions by offering training and skill development, and providing specific entry points for these candidates. Traditional hiring practices are often designed to whittle down the applicant pool, hindering the consideration of applicants with backgrounds or experience deemed nontraditional by the employer. By partnering with community-based organizations, workforce intermediaries, and education providers to create intentional, outside-in pipelines to hire, anchor institutions can improve the efficiency of their own recruiting and hiring processes, and expand employment opportunities for residents who may face barriers to hire. Examples of outside-in strategies range from providing job training and support services to residents, to cohort training programs focused on high-need positions, to paid “earn and learn” programs and apprenticeships.

Anchor institutions should identify where additional recruitment efforts and training programs are needed to develop a targeted and impactful workforce strategy that aligns with the hiring needs of hospitals and the job seekers in the community. Rather than seeing similar job needs as an area of competition, anchor institutions can collaborate to implement training programs that prepare residents for jobs that are needed by all participating institutions. This can help to shift the mindset from fighting for the same employees and driving up costs for employers, to creating a more sustainable talent pool that all institutions can draw from. In addition, implementing shared training and cohort programs can generate cost efficiencies when the program and staffing costs are split across multiple institutions.

For example, Cleveland-based health systems University Hospitals, Cleveland Clinic, and The MetroHealth System—all members of the local Healthcare Sector Partnership—partner with Towards Employment, a nonprofit workforce development organization, to implement a Career On-Ramp initiative that prepares local residents for entry-level roles in nutrition services, patient transport, and more. Participants receive training in soft skills, professionalism, healthcare work culture, and interview skills, and are guaranteed an interview upon successful completion of the program.

Key partners in developing sustainable talent pipelines:

  • community-based organizations

  • workforce intermediaries: public or nonprofit organizations that help connect residents to job opportunities and provide wraparound services

  • education providers such as community colleges and vocational and technical schools

  • job placement agencies or community-based organizations that offer job search and placement services

  • workforce investment boards: regional entities that direct public workforce development programs

Community-based organizations and workforce intermediaries can help connect residents to jobs through training and wraparound support such as childcare and transportation assistance, and they often have established ties and relationships with specific populations—such as justice-involved individuals—that anchor institutions may not possess.

One way to leverage these partnerships is to create a shared resource or information clearinghouse to make it easier for local residents to find job openings at participating anchor institutions. Information about job opportunities and career pathways at participating organizations can also be shared through in-person events such as job fairs. For example, members of the St. Louis Anchor Action Network (STLAAN) use an outside-in strategy to reach residents across 22 zip codes in St. Louis city and county that have been impacted by more than a century of systemic economic, racial, and spatial inequities. STLAAN hosts career expos and hiring events, utilizing an online platform designed to connect residents of these geographies to open positions within the participating hospitals and universities. As of 2023, more than 50 residents of the focus zip codes have been hired into positions at anchor institutions as a result of such events.

A comprehensive outside-in strategy should include intentional pathways into entry-level jobs as well as jobs that require certifications or continued education (less than a bachelor’s degree). Many anchor institutions partner with training providers and education institutions to subsidize the costs of education, training, and credentialing for specific roles. For example, University Hospitals in Cleveland, Ohio, partners with New Bridge Cleveland, a community-based training organization, to implement a training program for Sterile Processing Technician roles, available to residents of Cleveland’s Greater University Circle. Training is offered at no cost, and participants are prepared to sit for a certification exam following completion of the program. In New Hampshire, Dartmouth Health partners with Colby-Sawyer College to implement an apprenticeship program for the Pharmacy Technician role, which requires an associate’s degree. Participants earn an hourly training wage and college credits towards an Associate of Science in Health Science, and upon completion of the program, are transitioned into full-time roles at the health system.

Steps for getting started on an outside-in approach:

Below are some steps that anchor collaboratives should consider when planning an outside-in strategy that focuses on access, opportunity, and targeted outreach, to ensure that no one is left out of the economic potential of roles at anchor institutions:
  • Conduct a landscape analysis to understand the pain points in hiring and retention across the anchor institutions, and identify what could be positively impacted by a coordinated Impact Workforce strategy with intentional pathways to hire, such as paid internship programs and earn-and-learns for high-need roles.
  • Measure your workforce baseline. Anchor institutions can examine application and hire rates across demographic groups, starting wages for new hires, retention rates, employee satisfaction, and the time and costs associated with recruitment and training. Further detail on sample metrics is included later in this section.
  • Implement a targeted cohort training model for specific high-need positions shared by participating anchor institutions, and foster partnerships with local education institutions and community organizations to cultivate a talent pool that can meet employers’ needs.

Inside-up

Local hiring initiatives do not end at the moment of hire. Inside-up strategies help entry-level and other incumbent employees reach their full potential through accessible learning opportunities, job coaching, wraparound support, and clear pathways for career advancement within the institutions. Collaboratives can collectively employ or share career coaches who help new and current employees across anchor institutions understand and recognize career development opportunities. Anchor institutions might cross-promote opportunities for advancement that arise within their peer organizations, or open internal training opportunities to staff at other anchor institutions.

Building an internal culture that encourages all employees to envision long-term careers with space for advancement is an essential strategy for retention and can help anchor institutions meet organizational goals for diversity, equity, and inclusion. Internal career pathway programs that help employees to advance professionally in the organization include: bridge skill-building programs, apprenticeships or other earn-and-learn programs for current employees, short-term certification training, soft skills training, English and literacy programs, among others. Key to retention is regular communication with entry-level and incumbent employees about training and education opportunities available to them, as well as wraparound services that can help them to address issues such as transportation and childcare.

One of the benefits of the inside-up approach is that it can create a measurable impact on employment and wages in particular neighborhoods by supporting lower-wage employees’ movement into higher-paying roles. These efforts can help to improve the overall health and wealth of the community by increasing economic security and resilience over time. In order to further sustain the investment in their employees and communities, leadership across members of the anchor collaborative should help employees achieve financial stability. Anchor collaboratives can establish financial assistance funds or provide services to help lower-wage employees achieve financial security and avoid taking on debt. Examples include tuition advancement for degree or certificate programs (prepaid financial support for education), or creating cohort training programs for specific positions within anchor institutions.

Steps for getting started on an inside-up approach:

Below are some steps an anchor collaborative should contemplate when creating pathways for career advancement and increased retention:

  • Provide new entry-level employees with job coaching and mentoring for professional career development and support navigating various systems that may be unfamiliar.

  • Offer tuition advancement or grants to entry-level and incumbent employees for certification and skill-building programs (such as English or literacy classes, college preparation, medical coding, patient care, etc.).

Embedding institutional commitments

Embedding institutional commitments involves advancing systemic change in hiring and workforce systems to eliminate bias in hiring and advancement and build an organizational culture of belonging. Collaborative members should complete a comprehensive assessment of their organization’s internal policies, practices, and culture to determine the extent to which they promote accessibility, racial equity, and inclusion. Actions to shift organizational practice and culture into alignment with the goals of Impact Workforce strategies include:

  • Edit job descriptions to remove unnecessary education and experience qualifications.

  • Educate hiring managers and supervisors about more inclusive hiring through skills-based hiring.

  • Ensure hiring practices and processes are inclusive and transparent (e.g., accessibility of job postings across diverse applicant groups, clear application instructions and user-friendly portals, diverse interview panels, and standardized application processes).

  • Engage talent and development and benefits teams within human resources departments to market initiatives that promote employee advancement and parity in benefit utilization among employees.

Anchor institution staff from human resources, talent acquisition, community engagement, and diversity and inclusion teams play vital roles and should proactively collaborate to create organizational accountability (e.g., creating shared performance indicators). Internal buy-in from executive leadership, hiring managers, and supervisors can build a sense of ownership and active participation in inclusive, local hiring initiatives and drive success as these initiatives become integral components of the organization. When executing upon these different components, collaboratives may choose to create and engage working groups that can manage goal setting, strategy development, and collective impact outcomes for each aspect of impact workforce efforts. This is discussed further in section 3.3 Effective Governance.

Assessing Internal Hiring Barriers, The South Florida Anchor Alliance (SFAA)

SFAA sought to understand systemic barriers and implement changes to hiring policies to advance racial and economic equity within anchor institutions. Following an internal review of policies, anchor institutions identified the following barriers: hiring websites were not user-friendly and applications were difficult to complete without assistance, especially for those without internet or computer access, or by individuals who did not speak English as their primary language; obtaining letters of recommendation from previous employers was challenging; and requiring candidates to pay for background checks was an added and unnecessary barrier. In response, one anchor institution is building a new user-friendly hiring platform that addresses these barriers, with the hope of modeling this structure as a best practice for others to adopt.

Anchor collaboratives’ impact workforce efforts have predominantly focused on outside-in strategies—partnering with job training programs and community-based organizations to prepare and recruit residents for quality jobs at anchor institutions. Some collaboratives have embedded inside-up and systems change strategies within their organizations as well.

Sample metrics for Impact Workforce strategies

It is beneficial for anchor collaboratives to establish a starting point and targets for monitoring Impact Workforce strategies (see section 3.6 Quality Data and Impact Measurement for more information on approaches to data collection and measurement). Below, we provide examples of specific and measurable metrics that health systems and anchor collaboratives use to track their impact workforce strategies.

Example baseline metrics:

Percent of employees earning at or above the local living wage.

Requires submission of two data points:

  1. Total number of employees across anchor institutions by race, ethnicity, and gender.

  2. Number of those employees earning at or above the MIT Local Living Wage for a 2-Adult (Both Working), 1-Child Household by race, ethnicity, and gender.

    While no single indicator can comprehensively account for the complexity of real world phenomena, the MIT Living Wage is a robust and reliable tool for estimating the local wage rate that a full-time worker requires to cover the costs of their family’s basic needs where they live. The MIT Living Wage calculator was chosen for its geographic availability (estimates are available for all US counties, metropolitan statistical areas, and states), regular and ongoing publish cycle (annually recurring to track over time), conservative household budget items (does not account for entertainment, restaurant meals, vacations, and other leisure activities), and its ability to calibrate for household size.

Example Impact Workforce goal:

Within the next five years, impact hires within member organizations of the anchor collaborative will reach at least 10 percent of new hires annually.

Definition(s): Impact Hires are individuals hired from historically under-resourced communities or through community-based hiring programs, into jobs that require less than a bachelor's degree, pay a living wage, and offer benefits including health insurance, paid leave, retirement benefits, stable schedules, and growth opportunities.

Important note about Disaggregation: For each anchor strategy, the goal is for members of the collaborative to report data that is disaggregated by race, ethnicity, gender, and other socio-demographic measures that reflect the collaborative’s commitments to racial and economic equity. Stated best in the Racial Equity Toolkit by the Collective Impact Forum: “Disaggregated data can help you see how different groups are doing relative to your goal and help you tailor efforts to meet the needs of different populations based on your understanding of how structural forces impede on the opportunities of some groups and accelerate it for others.”

Anchor institutions may not have systems that are set up to collect data at this level of granularity. Indeed, the effort to collect disaggregated data is a significant endeavor that is consistent with the collaborative's (and HAN's) intentions around positive systems change. While the collaborative may not be able to collect disaggregated data from its members right away, putting it forward as a goal helps provide a unified point for the group to work toward.

Examples of Impact Workforce strategies by anchor collaboratives

The Employee Professional Pathways (EPP) program facilitated by WSU and its anchor collaborative partners in Chicago, Illinois, is an example of an inside-up approach. The program offers career training and supportive wraparound services for new and incumbent entry-level employees at no cost. Program participants complete courses, receive hands-on training, and earn credentials for professional advancement into careers such as certified nursing assistants, medical assistants, phlebotomists and health IT professionals. The EPP has partnered with several educational partners to develop specialized courses, offering additional wraparound support and a more efficient, structured approach. Over the three-year implementation period of the EPP programs there have been many lessons learned. In its first cohort, one lesson learned was the need to support applicants to pass college placement exams. WSU addressed this by implementing the Readiness Program, which helped prepare individuals for placement exams. Additionally, WSU worked with hospitals to revise policies, enabling them to reimburse for remediation courses even when they are not part of the required credits for certificate or degree programs. The program has continued to evolve with each iteration, deepening the level of impact each participant experiences. Since 2018, approximately 100 people have been hired into anchor institutions through WSU workforce programs, with a 90 day retention rate of 97%. To connect with West Side United, please visit their website at westsideunited.org.

MMDC’s Hire Local program uses an earn-and-learn model to equip people with the skills and confidence to start a new career in healthcare. The program increases access to quality jobs with benefits packages for low-to-moderate income residents. In 2023, Hire Local served over 200 residents through programs ranging from training, career mapping, transportation or tuition assistance, stipends, and referrals to community services. Priority consideration is given to individuals living in historically disinvested neighborhoods within proximity of the Medical District. Program participants are majority Black (89 percent), female (86 percent), and between the ages of 17-34 (68 percent). In total, 100 residents completed training, job shadowing, and interviews across five local hospitals in the district, with forty-six residents starting living-wage jobs with benefits. Meet some of the graduates of MMDC’s Hire Local program and to learn more, visit memphismedicaldistrict.org.

SFAA partnered with community-based organizations on a pilot that linked residents to training programs and employment opportunities at anchor institutions. The programs focused on providing navigation support and linkage to certification programs in order to connect individuals from under-resourced communities who are unemployed or underemployed to positions that are hard to fill across anchor institutions—including bus drivers, security personnel, custodial staff, and substitute teachers. These positions (excluding substitute teachers) are full-time and offer health insurance and other benefits. As of 2023, 143 people were hired for full-time positions through the program. For more, visit southfloridaanchoralliance.org.

WMAC has developed a robust Impact Workforce strategy with plans to expand in 2024. In partnership with the MassHire Hampden County Workforce Board and Baystate Health, WMAC will launch four workforce pipeline programs that address employment barriers through a shared services hub, training for job seekers, wraparound services, and the expansion of employer commitments to worker-friendly jobs. Anchor institutions commit to recruit within specific communities, examine and revise hiring policies, and submit aggregated workforce data including employee retention and promotion rates and proportions of staff earning a living wage. Through these efforts, WMAC aims to hire several thousand people over the next five years. For more, visit westernmassedc.com.

Through its Walk to Work program, SINA employs a career navigator who manages a collective partnership between several local community organizations in Hartford, CT to connect individuals to jobs at anchor institutions. The career navigator provides resume assistance, career coaching, and interview preparation, and has helped match and place 120 Southend Hartford residents to careers at Hartford Hospital, Connecticut Children’s, and Trinity College. For more, visit sinainc.org.

Southwest Partnership initiated a program called Southwest Works to connect residents with quality jobs through recruitment events and strategies that prioritized applicants from priority zip codes in Southwest Baltimore, MD. SWP has served 330 community members, referred more than 240 individuals to positions at local anchor institutions, and placed fifty-one people in employment as of 2024. SWP attributes the success of Southwest Works to the strong partnerships and dedication of the anchor institutions involved. For more, visit swpbal.org.

[29] Chetty et al., “The Association Between Income and Life Expectancy in the United States, 2001-2014.” JAMA 315, no. 16 (2016): 1750, accessed February 1, 2024, https://doi.org/10.1001/jama.2016.4226.

[30] University Hospitals: The Evolution of Step Up to UH and Earn-and-Learn Programs (Healthcare Anchor Network), page #3, https://healthcareanchor.network/wp-content/uploads/2023/08/University-Hospitals-Hiring-Training-Case-Study-August-2023.pdf.

[31] Dartmouth Health Workforce Development: Building sustainable talent pipelines in rural communities (Healthcare Anchor Network, n.d.), page #2, https://healthcareanchor.network/wp-content/uploads/2024/01/DARTMOUTH-Case-Study_121423.pdf.

[32] Dominique Samari and Paul Schmitz, Racial Equity Toolkit: A reflection and resource guide for collective impact backbone staff and partners (Collective Impact Forum, 2023), page #16-19, https://collectiveimpactforum.org/resource/racial-equity-toolkit/.

  • Inclusive, Local Hiring Toolkit, Healthcare Anchor Network (2016)

  • Case studies of HAN members’ Impact Workforce strategies (ongoing)

  • Aspen Institute’s Workforce Strategies Initiative identifies, evaluates, and promotes promising and successful practices and policies that help workers attain stability and mobility, including through training, education, and broader systems change.

  • National Fund for Workforce Solutions maintains a robust library of tools and resources that can assist employers, workforce practitioners, and community leaders in their efforts to create a more equitable workforce. CareerSTAT, its network of healthcare and workforce leaders, offers peer learning, technical assistance for frontline workforce development, and impact analysis.

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