In order for outside-in strategies to be successful, internal systems, processes, or policies may need to be implemented or changed to ensure that individuals who successfully complete training programs are able to transition into full-time roles. Sometimes program graduates are lost to “the system” when processes and policies have not been put in place to identify these graduates. Recruiters need to be aware of the program and know how to identify and process graduates. Recruitment systems should be evaluated for general applicants also. Even the most prepared candidate may face additional barriers to hire unless systems, policies, and processes are reviewed for unintended barriers.

One common barrier is job descriptions that are written at a reading level above the literacy level of applicants when the job does not require that level of literacy. Another common barrier is lack of access to technology by potential applicants, and only accepting online applications, without providing support and resources to those who lack the technology. Some solutions to these barriers could include analyzing job postings for reading level and partnering with community organizations to help candidates with online applications.

Often, to the applicant, the recruitment process of a health system is opaque. When a person goes to apply, they often have no idea what happens after they press the “submit” button on the webpage. They do not know how long they will wait to hear from a recruiter or even if they will hear back at all. They do not know how many interviews they might have and how long it will take to receive an offer, if accepted. This lack of transparency can reduce the number of qualified applicants for an opening because people are discouraged from applying. By creating more transparency in the hiring process and explaining to applicants what happens after they apply for the position, a level of confidence in the system is built and people will be more likely to apply.

Obtaining and maintaining a job often requires a person to have attributes beyond the explicitly defined skills and experience for a particular position. Sometimes these attributes fall into the category of “professionalism”. Standards of professionalism have evolved over the years, and have conformed to what the employer deems to be acceptable workplace behavior, dress, communication, and other ways of presenting oneself at work.47 

Creating an inclusive workplace begins with acknowledging and addressing the implicit biases that exist within the institution around the concept of professionalism, and recognizing that there may be instances where the standards of professionalism may be discriminatory to people from other cultures and backgrounds.

As organizations committed to connecting residents of economically under-resourced communities to quality jobs and career pathways, it is essential for healthcare anchor institutions to assess how certain unspoken expectations may affect recruitment, hiring practices, promotions to higher-wage positions, and termination decisions. This includes determining which qualities of outward-facing appearance and demeanor are deemed essential to the specific position. An example of changing the nature behind the idea of “professionalism” can be accepting different hairstyles in the workplace as professional. The way that an individual person does their hairstyle often reflects the individual’s culture or religion—which can be legally protected rights.

Connecting outside-in pathway programs to existing organizational goals—in particular those related to creating a workforce that can best meet the needs of the populations it serves—is key to building a successful, long-term impact workforce strategy.

Defining a focus for an organizational impact workforce strategy can start with a landscape analysis to understand critical workforce needs and pain points across relevant departments, such as cultivation, hiring, retention, and representation. “Start with [asking], ‘What's our primary objective as an organization?’” recommends Seanna Ruvkun, workforce planning consultant at Seattle Children’s Hospital. “Leverage what you have in place already, and take advantage of emerging opportunities.”48 Conducting an assessment of existing organizational goals that could be impacted by impact workforce strategies can help to narrow the focus. For Seattle Children’s, an organizational priority to cultivate a workforce that supports the diverse needs of the patients and families served by the health system has been a key driver for its impact workforce programs.

Workforce efforts are an important strategy for community/population health and community benefit departments. Explicitly linking impact workforce efforts to community health departments can bring additional resources to the table, particularly for measuring impact. The act of documenting unemployment and underemployment as health needs can also help make the case for local hiring efforts. At institutions serving large uninsured populations and with high rates of uncompensated care, this becomes especially strategic. Linking community residents to employment not only provides greater economic stability, but also connects more residents to health insurance.  

A crucial first step in designing programs is ensuring communication between human resources, talent acquisition, and workforce development. This ensures that staff in all these focus areas have knowledge of important factors such as turnover rates, predicted vacancies, and skills gaps. Coordination in these areas will result in a more synchronized and efficient program. Moreover, making sure that organizational development and learning teams have this information will help them to share it with workforce intermediaries and training partners as they design new programs. Susan Salomone, assistant vice president for executive and workforce development at Ochsner Health, stresses the importance of workforce planning and forecasting as part of this work. “We ask ourselves, what will we need five years out [to maintain our workforce]?”53a This is also a key strategy employed by The Johns Hopkins University and Health System in Baltimore, Maryland, where forecasting, training, and human resources are coordinated as part of its larger workforce development strategy. 53b

Another interdepartmental collaboration that can help amplify an organizational impact-workforce strategy is between the talent acquisition and supply chain teams. Supply chain managers can include local hiring provisions in requests for proposals (RFPs) to ensure that vendors create intentional hiring pathways for local candidates. Local hiring can also play a role in contract negotiations.