The cohort model is as effective for inside-up training programs as it is for outside-in training. Training employees in a group setting reduces costs and more efficiently fills critical skills gaps. An example of this approach is the Pathway to Patient Care Nursing Assistant (PCNA) program at University Hospitals (UH) in Cleveland, Ohio. In the Pathway to PCNA program, interested employees apply to the program, and, if selected, are hired as PCNAs and then paid to complete the necessary training. All selected candidates complete training together, which reduces costs and allows UH to fill many vacancies at once. There are also cost savings associated with hiring internally as opposed to recruiting outside candidates.69 In addition, at UH, the PCNA can go through the LPN Earn and Learn program as a cohort, where students remain full-time employees at UH while completing LPN courses and training at Lorain County Community College or Central School of Practical Nursing. The partnership works well due to the collaboration between the organizations in placing the graduates into positions and relying on one another’s expertise.70

Providing resources to support employees, especially low-wage employees, who are experiencing financial hardships or other challenges that could impact their ability to arrive to work on time and be fully engaged will help health systems build a quality and stable workforce. Qualities such as timeliness may be impacted by second jobs needed to make ends meet, lack of reliable childcare, or lack of access to reliable transportation. Limited financial resources prior to a new hire’s first paycheck and general financial instability can affect access to job-appropriate clothing or uniforms. Health systems can avoid losing quality employees by providing employees with supports to help overcome these challenges.

Workforce intermediaries and community organizations frequently have access to wraparound supports that can help low-wage employees address some of these barriers. In 2021, the Ohio State University Wexner Medical Center and Health Sciences (OSU Wexner) established an Employee Resource Center (ERC). The ERC is dedicated to supporting its staff by providing emergency assistance and ensuring access to essential supplies and resources during challenging times. OSU Wexner promptly addresses urgent requests and connects staff with both internal and external resources, including their food pantry, school supply giveaways, and winter coat distributions. Additionally, they offer transportation assistance, uniforms, and temporary emergency housing solutions.72