Hello, and welcome back to the race to
value. We are glad you are here. I
am your host, Ashley Schwartz. And today we
have a very special guest joining us. Jeffrey
Roche is the son of a nurse, future
work an education expert, diversity, equity, inclusion and
belonging advocate.
Champion for transforming health equity and the host
of the Ed up health up podcast.
His professional career includes over 16 years than
h And higher education leadership as a strategic
advisor to the President and Ceo
and Department director of various departments.
Little These include business development planning, government affairs,
community health and public relations for Lehigh Valley
Hospital Pom.
At lebanon in Valley College in Harrisburg University
of Science and Technology,
he held senior leadership roles focused on strategic
partnerships.
Organizational strategy and business development.
As senior vice President, business and workforce development
at Dignity Health Global Education, he led a
diverse team focused on developing
institutional relationships with leading health systems,
while having national conversations and initiatives to develop
innovative diversity, equity and inclusion solutions for the
healthcare workforce.
With that, Jeffrey and I are going to
dive in the current state of the healthcare
workforce.
Focusing on a post Covid landscape where we
have seen how our healthcare professionals went from
heroes to essentially zeros,
In this episode, we are going to touch
on the education crisis, the significant skills gap
that is causing a drop in productive. Activity,
and the importance of ups skill your workforce.
Welcome Jeffrey.
Thanks, Ashley. Happy to be here. Activity Well,
thank you for joining us. So I kind
of want to turn it over to you
really quick just to give, like, a broad
overview of what is going on because we're
seeing it on Linkedin. We're seeing it on
the news.
We're seeing it
everywhere that the healthcare workforce is essentially, like,
in a state of
seeing shock and panic right now. And it
it seems to have been this way since,
you know, the pandemic and the rise of
traveling nurses,
the drop in
people
continuing their education in the health field. So
you are the subject matter expert, So I
really want to hear what you're seeing and
and what you think has essentially happened.
Yeah. So it's it's certainly
a very complex
problem, and certainly, to your point, we have
to truly unpack.
I I wanna first acknowledge
that even before the pandemic,
we,
in the healthcare care community had a ton
of insights.
So and even forecasting
that was helping us to understand that we
were gonna run into a supply and demand
gap challenge.
And what I mean by that is that
there was definitely a ton of data
that suggested that nursing programs,
allied health programs, even our leadership type of
programs,
we were expected to see this this drop
in enrollment
that would impact the future
workforce. So we knew that. Right? And then
obviously, the pandemic happened, which just kind of
exacerbated
and added to the problems.
And so the first thing I wanna acknowledge
is is we cannot
continue to blame this on the pandemic. We
have to actually look inward. And we have
to say why didn't we do more about
this? And when when I say that, I
mean, why didn't
education and health care?
Come together
to innovative
solve that. Now, obviously, we've done some things,
but we have a lot more that has
to happen.
The second aspect around this is when the
pandemic happened to your earlier point We saw
an early phase of people saying, wow, our
health care professionals our doctors, our nurses are
our, you know, our entire team.
Except not not actually holy. Right? Because here's
the reality. During the pandemic, there were actually
people that served on the front lines of
health care who were actually not considered essential
workers.
People don't realize that. So if you look
at, like, imaging professionals, particularly, they were not
recognized as essential workers. And so during the
pandemic and even after they have felt slight.
And so we have made, you know some
just bad decisions as a society when we
take care of our health care workforce, now
that ultimately has led them to say, you
know what? If I'm not gonna be valued
appreciated respected, I'm gonna move on. So that's
kind of the second thing I would say.
The third
is
recognizing we have this significant supply demand gap
challenge.
There's a few things that we've gotta do
a, we've gotta work together and I think
institutions like Western Governors University are doing that,
you know, as an academic institution with health
care systems.
But we also have to in healthcare
address culture.
We know that we see today, people are
choosing to serve in organizations based on culture,
they want to be there if they feel
valued or
appreciated perspective.
And so to your point,
what we've seen especially post pandemic.
Is individuals have realized that I can still
be clinical in work remote, I can still
be clinical and I can travel the country.
I can still be clinical and I can
work a couple days a week at 1
health care system and then work a couple
more at another healthcare care system.
And so it's a very different model. Some
would call it the gig economy.
Now we have the gig economy in healthcare
care. We've seen in other industries. We now
have it in health care.
And so we have a lot of work
to get used to this new normal,
and it's not going to change quickly, but
what we have to do
is we have to get back to addressing
those aspects of culture.
We also have to acknowledge we've got 5
generations in the workplace. Something very unique. Yes.
We've had other generations in the workplace before.
But this is a different time,
and let me just kinda finish
I'm sure you have some thoughts on as
well,
is that this is not just a United
States problem. This is a global
problem. Who as I do my work and
have the privilege to, you know, collaborate with
colleagues around the world,
this is a problem in the United Kingdom.
You know, this is a problem in in
the African countries. This is a problem in
Europe throughout. This is a problem
everywhere.
And what we've also started to see as
we all here in America have have acknowledged
is we've started to see more
strikes
among a healthcare care workforce in a way
that we have not necessarily seen as broad
and as large, and I'll give you a
couple examples. Kaiser Permanente is a good example
where we saw 1 of the largest rights,
you know, here in the United States, and
we've seen many in New York City.
And also, remember United Kingdom had a very,
very long strike.
Among their nursing workforce among their hospitals and
health care trusts. And so this is not
just a Us problem. It's gonna require a
lot of innovation, though.
No. Absolutely. And you brought up some really
interesting points that I do wanna touch on.
The first thing that really stood out to
me as a millennial is that there are
5 generations of
health workers and students right now in the
workforce. What issues are you seeing with that?
Because I find the whole generational
aspect to be very interesting
in general, like, in every aspect of life,
but it... It's interesting because you can go
on social media and you can go on
Linkedin and you can see post.
And
just by how,
the person looks, you can kind of tell
what their
insights are going to be. So how is
that affecting health care right now?
Yeah.
You know, so
so you you will regularly hear me
suggest to my hospital and health care system,
colleagues.
That
as leaders, we really need to harness
the potential, creativity,
action and purpose of each and every 1
of the generation.
The reality I think is that as a
society, we've done more critical
type of aspects of it versus
lifting 1 another up. And what I mean
by that is,
I'm a millennial as well. And obviously started
my career
in hospital administration was promoted at a very
young age a leadership role
and managed individuals that were significantly older than
me
And what I learned in that experience, particularly
was that, you know, there's a lot of
things that are stated about millennials and and
a lot of things that are stated about
you know, the younger generations today
that just are not true. We... As a
society like to kinda pinpoint things,
But now is not the time for that.
What we have to do
is we have to create a culture
that allows them to be the best that
they can be. Is that's what we needed
in healthcare care. We need individuals who strive
for excellence each and every day. And the
only way to allow them to strive for
excellence is to create a community
and culture
that allows them to thrive. And that means
they have to be appreciated respected valued herd,
And why I'd say that is that if
you look at the data
amount among generations. The younger generations millennials included,
study after study
clearly want to be recognized.
And so instead of saying, oh, wow, they
always want this recognition.
Stop with the cy,
and give it
because the reality of it is is that
if you do those things,
you will keep them, you will retain them
And now is a time in healthcare where
we cannot lose good people.
We need every
1 of them. And the reality of it
is to to that exact point.
Is that to your point, the younger generations
will turn to social media, they are not
gonna hesitate
to share their stories
And here's the thing. I know a lot
of people talk about,
you know, why would you go to Tiktok
and share this? And why would you go
to Instagram and share this? You know, Everyone
has to communicate in a way that they
feel fits them.
I'm not going to be 1 to judge
how people do that.
And what I've always asked, my colleagues in
health care to do
is
have some empathy. You don't know.
What they're dealing with. You don't know how
they're feeling.
Many of us in health care have been
there for a long time,
and we've served in a place where, you
know, we have such great benefits,
you know, decent salaries.
We didn't consider necessarily moving. Times have changed.
Those options are far
and plentiful.
And so at the end of the day,
we really have to look at, how do
we create the best culture that ultimately is
gonna retain each and every 1 of them
and
prepare them as the future,
generation of leadership. Because guess what?
The current leaders are heading towards retirement, and
we are seeing exactly.
Exactly. And I think too as somebody who
has
entered leadership roles at a young age, and,
you know, my career has always been in
health care.
I am interested to see how the culture
does shift as, you know, the the baby
boomers are
either retired or they're
almost there.
And
the gen x generation doesn't really seem to
have that much of an interest in leadership.
So I feel like it is the millennials
and
what's after us? The Gen z that are
stepping up into these leadership roles,
Are you
anticipating, like, a big culture shift as us
millennials do take over into these leadership positions
because
even though, you know, you and I might
function in a leadership role right now,
we are still primarily
working with that Gen and those boomer generations.
But
from the data that I've seen we are
anticipating a big shift in the next 5,
6 years with a lot of the the
baby boomers in healthcare being retired in,
not wanting to step up the plate
to the plate for these leadership roles. So
is there a date out there or
ideas of what
culture shift
is anticipated?
There is. And and, you know, let me
just say,
we have to create the culture and the
environment
that allows for the younger generations. To want
to see that they can be in those
leadership roles. I'm afraid we haven't.
We've we've historically in healthcare care
had a very top down
approach.
And, you know, this is why we must
in health care, and I say this all
the time,
at a board level at a trustee level
at an executive level,
we have to recognize
that fiduciary responsibility, which we often talk about
in health care, especially at the governance level
has to include people. Has to include culture.
And so,
because, ultimately, you can have care excellence, in
patient care,
excellence in patient safety,
excellence and quality
without every 1 of our people. Clinical, and
non clinical.
And so
my challenge always to those that are at
the executive and at the board and governance
level is is what are you doing each
and every day to take care of your
people. That's what leadership is about. We are
to take care of our flock, our team
our people.
And so,
to your point, I am very
afraid because we we see a significant
shift
particularly
from the vantage point of those that are
in middle management roles and leadership executive leadership
roles heading towards retirement and we haven't done
a great job of succession planning, and we
also haven't done a great job of preparing
for. And so the obvious,
question within that is what do we need
to do? And I think this is where
health leaders have to sit and think about
what are they doing to invest in their
people?
Historically,
health
like other industries, but but I can only
speak to the 1 I know best and
health care is that we haven't invested enough
in learning and development. We truly have not.
And when we have, we tend to invest
at the higher levels more than we do.
At the other levels that ultimately can become
the future of those higher levels. And so,
for those that are sitting in those seats
today in the C suite at the board
level. The challenge that I would give them
is think really hard about this. If you
wanna have a sustainable
organization at clinical levels at non clinical levels,
you need to partner with an academic institution
and truly build out a robust
at comprehensive
learning and leadership development program.
There's no way you can do it in
house. You just don't have the resources, the
infrastructure to do it effectively.
That's not to say I'm I'm challenging any
of my colleagues who I adore and learning
and development. They're all amazing, But they gotta
have support. And I think we have to
have
truly robust career mobility pathways.
We've gotta have, true ladder programs. I tell
people all the time that health care is
a place where we talk a lot about
this, But the reality is we don't have
crew mobility. We have shoots and ladders. We
don't have, you know, a great structure, but
we've got to. It's the only way we're
gonna be successful.
Right. And, you know, I think that as
you mentioned, like, the the latter approach that
a lot of healthcare care organizations like half,
So when I was a young leader, and,
you know, I would get a promotion,
I would move up... A rank
and get, like, a specific race. Like, it
wasn't a race that had anything to do
with my role,
my education, anything like that. It was just,
like, the standard rate. So if you moved
up XYZ rank, you might get 5 percent.
You moved up another rink, you might get
another 5 percent. But then my colleagues who
were coming in, working similar positions.
If As I was after my promotion in
my race, they were making
20 30000 dollars more a year than I
was. And Mh. I think you look at
that and you're like, but I am, you
know, you hired that person from the outside,
but here I am. I'm loyal to your
company.
I care about the company. I'm trying to
work my way up.
And now it's only been a... Like, for
me to be able to survive, and
The economy that we have today. I now
have to leave, leave the company I love
that, you know, when you've invested into me,
and I've invested into you, but now in
order to live
and be financially secure. I have to leave
this company to join an a different 1.
And to me that never really made
a ton of cents when the companies
aren't investing and their own employees.
Yep.
And I think I think the difference they're
right is is
is human resources
in our health organizations.
Yeah
you know, have to truly evolve
into a future of work model.
III
fear that in many, many cases,
where we are today in health care is
many
of those areas and those functions
are still acting as if we were, you
know, 10 years ago.
And so we've got evolved into a very
different model.
And
the other piece that I'll just say is,
you know, you can't just always go out
and hire consultants to do this, you know,
to fix these things that listen to your
people. The answers are truly among your workforce.
If you take the time
to to digest and hear from them, I
am absolutely certain that they can share with
you
solutions that will help move the bottom line
and more importantly, build a more sustainable future.
You can't just go hire, you know, the
consultants to do that. That that just
never has rubbed me the right way.
Because the reality of it is we know
through engage... Engagement surveys, we also know through
a ton of other analysis and data,
even dis rotations that doctor students have done
that when you listen to your people, you
get the answers.
Oh, yeah. Because...
The people you're... Who are
filling out those surveys,
they're going to tell you the good the
bad and the ugly of what needs to
be done and
I never understood, like, hiring out consultants. I
work for an organization that hired out deloitte
at 1 point and in my head, I'm
thinking for the money you paying for deloitte
come in to tell you things
that
your clinical staff are already, they already know
it. You could invest that money into your
staff to Absolutely. Them happier.
But instead,
we're gonna hire deloitte to come in. And
while Deloitte is great.
They're outsider. So I mean, I think consulting
sometimes can be important from, like an outside
perspective. But really, I agree with you. You
have to listen to your
your staff because they they do have the
answers
for for a majority of the problems.
Yep.
So I did kind of wanna segue
into education because I have... You and I
both have this unique. Perspective where we have
worked in health systems,
and now are
working in an educational
leadership role in some
way shape or form.
And something I've really noticed, and I've seen
the data on is that
we don't
with the amount of nurses who are going
to be retiring, so those gen and those
baby boomers, we are not seeing the
the increase in students
join... Going to nursing school. And so really
there is an educational crisis within the health
care sector,
you know, working for a college
and having a lot of friends in the
industry. What I've seen is that care we
don't even have enough clinical
spots because we don't have enough pre receptors.
Yep. To to do clinical. So
what factors do you think has really contributed
to the health care crisis? And
what are you seeing as the implications of
it? And After we discuss that, I kind
of want to go into
the entire, like,
ups, skill and continuous education and why that
is so important
for our students right now.
Yeah.
I think what what what we have to
truly understand on the limitations. And certainly the
the bottleneck that's certainly occurring from a clinical
experience level
is we have to
really... And we have to be thoughtful here.
Right? I mean, at the end of the
day,
I'm a huge fan of of rigor. I'm
a huge fan of quality, and I'm certainly
a huge fan of excellence.
But I but I fear that on the
clinical and on the health care end, particularly,
our crediting
bodies.
Also have not necessarily evolved and advanced to
where we sit in health care today. And
what I mean by that is that you
know, if you take just clinical simulation, for
example.
You know, nursing,
few years ago was approved up to 30
percent.
And they I know some states, boards
allow more, but I don't I don't believe
any are above 50 percent to my knowledge,
But then there are other aspects and other
Allied health areas where other healthcare care creditors,
for example, don't allow any
any
virtual
simulation.
It has to be 100 percent in person
clinical hours.
And so to your point, when you have
a a lack of pre receptors,
You have a lack of educators
in the health care system,
and you also have this workforce crisis, it
becomes very, very challenging.
To kinda help meet the moment of preparing
this... These students who are our future workforce.
And so I think you know, as I
say, these are those kinda...
We've gotta come to the moment. We've gotta
come to the dance as a creditor. As
our education institutions as employers, meaning our health
care systems, and we've gotta be able to
solve this. And we have to solve it
with a sustainable
thought in mind.
And so we're dealing with this crisis now,
but we also have the data that suggests
that it... It's it's gonna get worse before
it gets better.
And so we can't continue the trajectory
I And so my big thing is is
we've gotta get every 1 of those entities
together
and truly have...
What I would consider a student friendly and
a health friendly solution because ultimately,
it's gonna serve out well for all of
us. So that's that's where I see, you
know, the significant challenge, And I'll give you
a kind of a second example to that
where I know even Western governors has been
very
progressive on on the teacher side, which is
apprenticeship. You know, health care has been slow.
To do apprenticeship. And it's not that health
care doesn't.
It's truly that a creditors have not necessarily
made it
so that academic institutions and healthcare care systems
can advance this forward.
And when I speak with the creditors,
and I always challenge them respectfully on this.
We have got to have
apprenticeship in health care. It is a important
solution It is also a way to create
more equity, and I will also just say
I'm a huge fan and proponent an advocate
of us moving to an apprenticeship degree.
Offering.
You've gotta have absolutely. You have to have
a system
that allows people to learn and earn
on the job. We can't continue a system
where you have to choose between a job
and a degree. Not everyone has that same,
you know, sing
level of resources. And so we we have
a lot of work to do in this
space, but the key is how do you
make it sustainable
Yeah. Exactly. And you know,
I was a Western Governor's University student,
and that's
I loved about the organization
itself is that they make learning
easy for people who can't quit their jobs
to go to school. That's not sustainable.
And I feel like, like you said with
the apprenticeship programs,
it would be
so beneficial for organizations to work that out
because
I, you know,
let's take, like, a a Cna,
or a medical assistant, for example.
90 percent of those individuals, they want to
be Rn n bs.
Like, if you ask them, what do you
want They're like, I want to be a
nurse. Or, you know, even even something else
in the Allied health field, I want to
be a son photographer or I want to
do,
you know, they're be whatever it is in
health care. So they want that, but they
also have families to feed, families to support
and
they can't stop working
to to go to school. And even though
that if they moved into our end position
or if they moved into a son photographer
position, it would benefit
the hospital they were working for, the hospital
will still not work with them. They so
that they can go back to school. They
won't flex their schedule. They won't allow for,
you know, and I understand it's a business,
and they have a business to run and
there's patients to take care of.
But
at the same time, if you pour into
your employees and allow them to
excel
you know, you're... You could have a a
Cna
become your charge nurse. Yep. Yep. If you
work with them. So why why is that
why has it health care
realize how important that is? Like, I guess
that's where I get stuck. When we see
people who want to work. They want to
be in nurses, they want to be a
son photographer,
and we we literally cannot forge a path
either in education or
with their health care system an organization to
allow them to do that. When that is
what we need
or Yeah. I mean, it it really does
come down to both the creditor and the
licensing standards. Right? And so,
you know, we've seen some movement. Right?
But not not fast enough, and certainly, we've
gotta do more. So if you take, like,
your son, for example,
today you've got to,
you have to get the associate's degree
first than that you have to sit for
that national level certification. There's no other current
way
to get there.
Now the obvious example to your point is,
if you already work in Allied Health, why
should you have to go back for a
full 2 year? Why can't it be an
accelerated 2 year?
Because you already have stack credentials that allow
you to go quicker. That's the type of
work that I'm doing right now, and and
that's the type of work that I'm hopeful
we'll get both the creditor
and, certainly, the licensing in the imaging space
to to agree to and and Fingers Crossed
will will get some movement there,
we have got to do that across the
board. And I think to your point, this
is really where
academia,
and health care have to come together. And
we again, we have to go to the
creditor,
to the licensing boards
together,
we have to, you know, use the power
of our of our infrastructure to bring government
with us to bring philanthropic partners with us,
and really coalition build around this because this
is an issue that affects everyone. And in
America, we tend to not realize that until
it really affects us.
But but people are starting to. You know,
when you go wait for 8 hours, 10
hours, 14 hours in an emergency room,
you know, or you wait weeks to months
for an imaging study.
I think people start to really ask those
questions. But to your point, we can't we
can't just continue to kinda kick that hockey
puck down. We've gotta actually get to a
solution.
Right. And I... And I think that...
The solutions. It's it's almost like we're on
the cusp 1 and then something happens.
Yeah. And it's like,
like, the pandemic happens. It's like, everything shut
out and we had to figure that out.
And then now that we're post pandemic,
it's like, we need another solution, and it's
like, well, at what point can we just
put something into place and and move on.
To allow everyone to be successful.
And so I want to just kind of
throw it out there as we're wrapping up,
how
do you think we can, like, as as
we're looking ahead,
what do you envision?
As the future of the health care workforce.
I know we touched on this with, like,
the millennials kinda taking over to leadership positions
and,
you know,
the government entities and the education entities are
realizing that we need to come together. But
what steps do you think as a subject
matter expert
Can we take now with what we have
to ensure the health
workforce is stable at this point?
Yeah. I think,
you know, to everything we've talked about,
it's it's just incredibly important.
For every health care system to truly
be, you know, working in locks with their
academic partners at both the community college bachelor's,
masters
and so on level and and even around
certificates and certifications and such as well.
I'm encouraged and continue
to believe very strongly we've gotta do a
lot of work at the k 03:12 system
to also get
individuals interested to wanna a serve in health
care,
Historically, it's been... They wanna be a doctor
earners nurse. Right? But there's so many other
roles in health care. So we've gotta help
set them up for success early.
Show them all the opportunities and then and
then allow them to pick with guidance and
support from a some from a supportive network.
I'm super encouraged by, you know, the work
that Bloomberg phil is doing right now with
13 different health care systems where they're building
out career connected high schools.
In health care, that's that's the future. We've
gotta do more of. We've got... And we've
seen success in that Like, if you go
back, I mean, you look at
back in the Da text, you know, I'm
showing my age, but now called Career and
Technical Institutes.
You know, if you look at,
those programs, you know, I I look at
my late brother, for example,
you know, he went to our career in
technical institute and. Through that became a decent
mechanic. And that is what allowed him to
generate that interest.
If we do that more in high school
in health
through we will have,
a better trajectory of actually having individuals to
serve in health. And so that's the kind
of stuff we have to do is we've
gotta get into middle schools into high schools,
get them interested,
educate them, show them people
who work in health care that actually look
like them.
Help them understand that they can reach that.
And that I think is some of the
super important things. In addition, to all the
other stuff we've talked about.
Yeah. No I agree. And I actually have
an episode coming out. It's going to be
recorded in a couple weeks on diversity and
inclusion it. In health care and how much
of an impact it is
to see whether you're a patient or you
are somebody who wants to enter the workforce
how important it is to either be taken
care of by somebody who looks like you.
Mh. Or how important it is to see
someone who looks like you who could be
your colleague. And I do think that's so
important
for us to see. So I'm glad that
you touched on that because we are going
to be touching on that in a couple
weeks on a on a different podcast. So
Right. I think that's an important segue
into the workforce issues that we're seeing also
And and I think it helps build the
trust
between colleagues and also between, like, the doctor,
nurse patient, allied health relationships for sure.
So, Jeffrey, I wanna thank you so much
for taking time out your day, to join
us. You really truly are a subject matter
expert for the workforce, And I think
you know, with everybody
seeing so many negative things right now about
the health workforce. It's kind of nice to
know that there are people like you who
are working on this solution. So thank you
so much for joining us today.
Absolutely. Thanks for having me. Love having you.
So thank you for that, And for everyone
else, stay tuned because we will be releasing
episodes every 2 weeks. And like I said,
our next 1 is going to touch on
Ai and behavioral health. And the 1 right
after that is going to be diversity and
inclusion. So stay tuned for those episodes and
thank you for joining us on the race
to value.
And