A core component of any outside-in program is having a geographic focus on economically under-resourced areas. Targeting specific zip codes for recruitment ensures that resources are focused on the communities most affected by un- and underemployment. Focusing on particular neighborhoods concentrates impact, as intentional, outside-in pathway programs can reach a measurable percentage of individuals living in those areas. Often these same neighborhoods already have economic development efforts underway that can be leveraged, either through community-based organizations and intermediaries with existing networks in the community or through other hospital-led efforts. Having a geographic focus is a way to align investments across the health system and across institutions.

To serve low-income individuals successfully, training programs should include specific strategies to address the challenges posed by inadequate, or lack of, income, which often prevents participants from joining or completing a training program. Strategies that directly mitigate these financial barriers include offering training at no cost to participants, offering a training stipend to participants while they are in the program, providing bus tickets or ride vouchers so people can get to training, and providing resources to help with childcare, housing, or other basic needs.  

An intentional outside-in pathway program should not be designed in isolation. It is critical that the end point for a particular applicant is not the position they are hired into, but instead, that there are pathways for advancement within the institution. Explicitly connecting outside-in pathways to future career pathways can be an important recruitment tool. This is a critical strategy of Hawaii Pacific Health.

Another healthcare system that uses this strategy is the University Hospitals in Cleveland. Jobs that do not offer possibilities for advancement are not selected for training programs. At times, advancement first involves a lateral move—or opportunity move—to a position with greater career ladder opportunities. This is the case for University Hospitals’ pathway program, which helps prepare environmental and nutrition services staff to move into patient care positions. In these cases, employees still have the ability to move into higher-skill and higher-wage positions and are made aware of the process for advancement before they are even hired.

“Soft skills,” or “foundational skills” is a category of skills that refer to a person's ability to work with other people, engage in critical thinking, communicate effectively, solve problems, and manage time. Intentional, outside-in hiring pathways should provide comprehensive training that addresses a range of workforce skills, including communication skills, understanding and managing workplace norms, technical skills, time management, problem-solving, and conflict resolution.

One health system, for example, provides a combination of job training, career development, and soft skills training to the young adults who participate in its workforce development initiatives. The soft skills component includes instruction on communication norms in the workplace, such as how to write an email and how to communicate (what to say) if you're going to be late to work; how to manage time and realistically plan a schedule; how to follow privacy norms and dress codes; and how to build empathy and manage emotions, including when interacting with patients for those on a clinical job-track.

Cohort models can reduce outreach, recruitment, and screening costs for hiring departments by relying on workforce intermediaries to do some of that upfront work. However, unless entry points for cohort graduates are clearly defined and well understood by all parties, these benefits may not be fully realized. One strategy is to set up processes and systems to identify graduates of a cohort program and guarantee them interviews. If recruiters and hiring managers are able to identify program graduates and interview them for the positions for which they’ve been trained, it can decrease the time to fill a position, identify qualified candidates, as they’ve been trained for the position, and increase engagement in the program, as other potential program participants will see that going through the program results in employment. 

Hiring managers are critical actors in the implementation of an intentional, outside-in pathway program because they ultimately make the decision on whether to hire a particular candidate. Without their buy-in and input during the program design stage, even the best training programs can stall. Adjustments will need to be made to hiring processes in order to facilitate more inclusive hiring, and many of these processes apply directly to the role of the hiring managers. Therefore, hiring managers should be involved in designing training programs in order to ensure that programming is able to meet their workforce needs.

Involvement of the hiring managers should extend past initial feedback and program refinement into the implementation of the program itself. The benefits are twofold: candidates have the opportunity to gain experience with interviews and interface with managers, and hiring managers become familiar with particular candidates. This can help increase managers’ enthusiasm about the program because it enables them to identify individuals they are particularly excited to hire. One health system regularly brings talent acquisition leaders to meet with workforce intermediary partners to help them better understand partners' work and advocate for candidates trained through these programs with other recruiters and hiring managers. The talent acquisitions team then notifies hiring managers whenever a workforce intermediary is ready to refer candidates who have completed a training program, along with information about what it means to hire individuals from that community and the advantages the candidates will bring by coming through that program.

One of the major obstacles to entry for applicants that face barriers to employment is that due to the sheer volume of applications, automated recruitment processes make it likely that an application will be screened out before it even gets to an initial recruiter interview. Involving hiring managers in the training process ensures not only that candidates get time with those who have the power to hire, but hiring and departmental managers and recruiters can assist with mock interviews, provide information particular to the institution, help with job-specific training, and explain the application process.