Inside-Up refers to internal strategies that connect entry-level workers to pathways for career advancement within the institution. These strategies include infrastructure and resource investment dedicated to career development, programs designed to provide employees with additional skills so they can move into higher-paying jobs, and policies and system changes to support and encourage employees to develop their careers within the health system.

Intentional, outside-in pathways do not end at the moment of hire. The success of outside-in programs lies in employee retention and employee advancement, not only to fully capture the benefits of the hire for that particular position, but also to ensure that more entry-level positions open up for local residents, thus keeping the flow of people moving in and up through the health system. Furthermore, health systems can maximize their investment in training programs when jobs that are the focus of training programs are connected to career ladders, and employees have opportunities to gain experience and skills and then advance to higher-skill jobs with higher wages. Tracking the number of impact promotions, or employees who are promoted into a higher-skilled, higher-wage position—or a lateral position with greater career ladder opportunities—due to an intentional career pathway program is a key strategy for demonstrating impact.