A Glimpse at System Change in the Flint Healthcare Employment Opportunities Sector Initiative

An Interview with Norma Hagenow by Serena Unger

The Flint Healthcare Employment Opportunities (FHEO) Sector Initiative began in 2002 as a project of the Greater Flint Health Coalition (GFHC) in collaboration with over 20 local partners. FHEO works with healthcare employers to make entry-level positions a stepping stone to a better life for Flint’s low income, and primarily African-American residents. FHEO works with residents to improve employability and occupational skills, and works with employers to restructure hiring, retention and promotional practices to help reduce turn-over and meet hiring needs. With GFHC managing the initative, all industry, educational, and community-based partners collaborate on planning, implementation, and management. As an industry-led initiative, three major employer partners, Genesys Health Systems and McLaren and Hurley Regional Medical Centers, have the primary role of defining training needs.

Norma Hagenow is Chief Executive Officer of Genesys Health Systems, a regionally integrated health care delivery system comprised of a complete continuum of care with operating revenues of over 410 million. As Chair of the FHEO Implementation Committee (which also serves as FHEO’s board of directors), Norma has been a key player in promoting the project among other local employers and has shown how important employer buy-in and employer engagement is in turning out what she calls “win-win-win” outcomes for a sector initiative. In my interview with her, we talked about the concept of systems change. The case of FHEO shows that systems change is a process that progressively produces deep rooted results. FHEO demonstrates how a sector initiative moves from identifying resources to develop the initiative, to clearly defining a vision, to building partnerships and breaking down silos, to changes on the employer side, and eventually changes in the ways in which the larger workforce development system attempts to close the gaps of the labor market and ultimately reduces poverty in a community.

Key themes of system change in the FHEO project include:

• The power of the vision in moving partners out of their silos

• The observation that creating career ladders for workers (most clearly a worker benefit) is a win-win-win benefit for all constituents

• Policy change and the creation of the right metrics are areas for system change

• A key impact of system change (creating the structure that gives people in the Renewal Community support for moving up) changes participants’ attitudes and perspective

• Effectiveness requires change in employers’ policies and practices

• The workforce system and the state have used FHEO as a model and replicated it

Serena: Tell me where FHEO is right now as it approaches five years?

Norma: The original program is still there in terms of recruiting people from the Renewal Community into soft skill training and into entry level jobs, and then onto a career latter once they’re in the health care industry. This is the most foundational purpose of the program in that you take someone right from the community that really has a lot of odds against them and help to create a sustainable career for them, not just an entry level house keeping job, but one where they can keep moving up the career ladder. We wanted to have an approach to finding funding and finding ways to create career ladders. So that led to an LPN program with a workforce development group here in town. Then there was a need for more teachers so there was a grant from the state for nursing programs. One thing built upon another. The labor department has come up with funding so that has helped to create soft-skill training.

Serena: Did FHEO start out with a clear vision?

Norma: What was so unique about our vision is that we weren’t just going to create entry level jobs in health care but we were going to create sustainable health care careers. That became a very powerful vision. There’s something about someone living in the Renewal Community, maybe they’re a single parent that doesn’t have their GED and is trying to make something of them self but faces too many barriers. The fact that we were able to martial the energy of so many forces to create a career for that person—that was very powerful.

Serena: What were the practices needed to be in place for that vision to play out?

Norma: We needed to have the stakeholders that would be involved (creating the curriculum, the training, the recruitment, the soft and hard skills). What we had to overcome first is we didn’t know what one another did. We took the first six months to try to create synergy at a time when we didn’t know what we’re doing. So we had presentations and everyone listened to one another. What are the needs of the hospitals in terms of front end workers? Where are the openings and the opportunities as you move up the career ladder? The second barrier was to keep everyone aware of what the vision is. The vision is to create sustainable healthcare career that makes for win-win-win for the community, the individual, and the health care industry—the whole economic community. This win-win-win vision was very powerful in keeping people out of their silos.

Serena: What system changes came about as FHEO implemented its vision?

Norma: Systems change is needed to overcome the tendency to remain in silos. And this is done by learning about each other. It’s really about learning. First you begin to understand each other, and then there’s working together. How the partnership is able to work together is important in moving toward the vision.

Then we broke it up into the categories of work to get done. First we had to recruit people. Faith Access to Community Economic Development (FACED) said that with their inroads into the churches and community, they’ll work on recruiting and develop the interview process. This is how we reached out for people to get into the program. Then there was a second group. The curriculum development was done by the Technology Center and Mott Community College. The health care representation worked on hiring requirements and how employment would actually begin and how we would train and develop managers to accept this new group of people to hire on. So we also worked on leadership development. We divided the work into segments and brought it back to the larger team as our process, then developed policies so that we could accept the first class in the program.

Another powerful thing is that out of the vision we developed how we would measure the outcomes. We wanted to be very clear about what win-win-win meant so we set up criteria for the metrics. How many did we lose in the first phase, how many did we have to recruit to have “X” amount in the first class, what kind of drop rate was there? Ultimately—how many participants had a job? Were they performing satisfactorily? And how in many months would they be going on for high level training? Is it sustaining over each year? The bottom line outcome is sustained careers. To break through to systemic change, the program has to be metric oriented.

Serena: So systems change happened at the institutional level by having a clear vision, learning about the capacities of each of the partners, breaking down silos, and then creating a structure (like policies and metrics) that provides opportunities for people to move up and succeed. What effects of this system change do you see?

Norma: The idea that you have a critical path, that people can come into the healthcare field and move up the ladder. That’s pretty dramatic. At our meetings sometimes people come to us and tell their story and there are tears in the room because you’re hearing stories of someone who thought they had no hope. They were given soft skills, meaning how to dress, how to talk to one another, how to get to work, how to be polite, how to relate to people, handle conflict—just an understanding of self. They tell their story of how they went to work, how they interacted with their managers. It’s pretty amazing. I think that’s the effect of system change. Taking people without hope and giving them a hand and they’re doing marvelously well. Lives have changed.

Serena: Tell me how FHEO has effected system change in business practices and the influence businesses have had on FHEO?