Northeast Louisiana: Health Care Partnership

July 2018

About the Next Generation Sector Partnership Model

Next Generation Sector Partnerships are regional collaborations of businesses, from the same industry and in a shared labor market region, that work with education, workforce development, economic development and community organizations to address workforce and other pressing competitiveness needs of a target industry. While the concept of public-private partnerships or even workforce sector partnerships is not unique, Next Generation Sector Partnerships are distinct in three ways: 1) they are industry-driven; 2) they are community supported; and 3) they are comprehensively focused on workforce and economic development. Partnerships launch when industry leaders in one geographic region (such as northeast Louisiana) come together to identify their biggest shared opportunities for growth, then prioritize the most important requirements to capitalize on those opportunities. In response, educators, workforce boards, chambers of commerce, community-based organizations and others coordinate with each other and partner with the industry to address these requirements.

The Next Generation Sector Partnership model strongly reflects an “open-source” approach to workforce and economic development. No individual person or organization owns it—industry sector business leaders own it with their community partners. Partnerships act as an operating system by serving as a platform for discourse, analysis, decision-making, coordination and innovation for the benefit of industry, the regional economy that hosts it and the jobseekers and workers who reside in the community.

While it may be counterintuitive to some that industry leaders would work with their competitors, they come to the table because they recognize that some of the industry’s most important requirements for growth and competitiveness span the region and their industry, and issues cannot be resolved independently. For more information about the model, see the Next Generation Sector Partnerships website and the publication “Regional Talent Pipelines: Collaborating with Industry to Build Opportunities in Texas” by the Federal Reserve Bank of Dallas and Center for Public Policy Priorities.

Northeast Louisiana: Emerging Next Generation Health Care Sector Partnership

Workforce Development boards 81 and 83 are northeast Louisiana’s regional workforce boards. The entire Workforce Region 8 is an 11-parish region that includes two workforce boards—81 and 83. Workforce Development Board 81 covers the urban parish of Ouachita, the region’s largest parish centered around the cities of Monroe and West Monroe, and Workforce Development Board 83 covers 10 rural parishes—Caldwell, East Carroll, Franklin, Jackson, Madison, Morehouse, Richland, Tensas, Union and West Carroll. Health care sector jobs are prevalent from entry to advanced levels and exist in both the urban and rural parishes—at hospitals, long-term care facilities, and home health, hospice and behavioral health organizations. As a result, the health care sector is prominently featured in the region’s workforce development plan. This sector also matters to economic development simply because of the number of quality jobs it provides.

In 2016, Workforce Development boards 81 and 83 were awarded a regional Sector Partnership (SP) National Emergency Grant. This grant jump-started the region’s work in Next Generation Sector Partnership building. The opportunity to build a health care sector partnership was particularly opportunistic in order to leverage an existing $14 million Health Profession Opportunity Grant from the U.S. Department of Health & Human Services Administration for Children & Families, intended to provide demand-driven health care occupation training throughout the region.

To begin work however, the two workforce boards made no assumptions about which industry most warranted coordinated, formal support in the form of a Next Generation Sector Partnership. The boards first conducted research on the labor market demands in the region. Working with Bob Eisenstadt, director of the Center for Business and Economic Research at the University of Louisiana Monroe, the boards brought together over 24 stakeholders from Louisiana Delta Community College, independent school districts, various workforce training programs, multiple chambers of commerce and other economic development organizations to review data together. This exercise was important to build early buy-in into a potential target industry sector. It was no surprise when the group agreed that the health care industry was a leading industry supporting and driving the region’s economic and job growth. The health care sector employs an estimated 20 percent of the total labor market and is forecast to grow by 14 percent by year 2024. The boards continued to convene community partners and stakeholders to assess their appetite for working together on a new Next Generation Health Care Sector Partnership. These partners included Louisiana Delta Community College, universities, economic developers, chambers of commerce, community-based organizations, the nonprofit workforce intermediary NOVA, the U.S. Department of Health & Human Services Administration for Children & Families and K-12 representatives from local school boards. All of these partners pledged their support, so in August 2016, the workforce boards launched the partnership, with over 30 CEO-level health care leaders in attendance.

Forming a sector partnership has been a game changer according to Terri Mitchell, executive director of Workforce Board 83.

“Before this partnership, we were working in silos. Now we’re all talking to each other, including each other at our tables, strategizing and planning together. This is definitely one of our early wins,” she said.

Overview

Originally, per the Next Generation model, CEOs were invited to launch and lead the partnership. C-suite leaders still make up the partnership’s steering committee, and quarterly meetings remain targeted at C-suite-level individuals. However, the partnership has evolved at the committee level to appropriately include human resources directors and nursing supervisors to weigh in and serve on committees related directly to the worker pipeline, recruitment, retention and advancement issues. Currently, about 10 industry leaders are actively engaged in driving the partnership. They are from University Health Conway, St. Francis Medical Center, Glenwood Regional Medical Center, Franklin Medical Center, Union General Hospital, Plantation Manor Nursing and Rehabilitation Center LLC, Louisiana Physician Hospital Association, Oak Woods Home for the Elderly, ARCO (for developmentally disabled individuals), Louisiana Extended Care Hospital (a long-term care facility) and P&S Surgical Center. The partnership is continually attracting new participants and regularly shares updates and information with a broader circle of health care organizations throughout the region.

“We post our meeting information on our website and through social media. People are hearing through the grapevine about our alliance and calling to ask about it. This is exciting because together we have a stronger voice than apart,” Mitchell said.

The partnership currently works together as the Northeast Louisiana Healthcare Alliance, a name and brand created by its Steering Committee, which is responsible for driving the ongoing work of the alliance across three committees. Its Policy and Regulations Committee addresses local, state and federal legislation and regulatory issues that are barriers to the health care industry’s ability to stabilize and thrive. The Education and Training Critical Occupations Committee is responsible for developing a skilled labor force pipeline for health care employers. The Acute Care Network Committee is working to create clear and shared protocols to better use rural facilities for acute care patients, leveraging already-existing shared treatment protocols, advantageous rural Medicaid reimbursement rates and nurses that already work in both settings. It is noteworthy that the three committees are not just focused on workforce issues, but instead are focused on the top issues that the industry agrees are worth their attention. This was critical for the industry members of the partnership to initially gel together; in other words, industry leaders needed shared action and wins in multiple areas to get to the point of feeling like a true network that was worth sustaining. It is also worth noting that each committee has immediate and downstream implications on workforce needs, including the Policy and Regulations Committee (agreement and recommendations on shared licensed practical nurse and registered nurse licensure renewal policies, for example) and the Acute Care Network Committee (creating an inventory of specialty nursing skills across urban and rural organizations, for example).

There are clearly identifiable business leaders promoting the alliance efforts and encouraging other businesses to participate. University Health Conway’s president and CEO chairs the Policy and Regulations Committee and is also active in the Steering and Acute Care committees. The CEO of Franklin Medical Center, a rural hospital, chairs the Education Committee and is active in the Policy and Regulations and Acute Care committees. St. Francis Medical Center’s CEO chairs the Acute Care Committee. The Northeast Louisiana Physicians Hospital’s president chairs the Steering Committee.

A recent emerging champion for the alliance is Plantation Nursing Home. Plantation Nursing Home was not an original attendee of the launch meeting but has become an active member representing nursing home issues and workforce needs, demonstrating the alliance’s success in working on issues that cross the many subsectors of the health care industry in the region.

The ‘Nuts and Bolts’ of the Partnership

The support partners (nonindustry organizations providing backbone support) of the alliance have developed a cadence and momentum in working together by having quarterly breakfast meetings. Heads of the workforce boards, chambers of commerce, universities/community colleges and other community partners didn’t meet together before, but their work on the alliance led to a memorandum of understanding (MOU) to communicate and coordinate regularly—a new level of joint commitment to a regional effort.

While the larger group meets quarterly, supervisors at the workforce board and chambers of commerce meet monthly to design meeting agendas and facilitate alliance committee meetings. Currently, Workforce Development Board 83 is serving as the alliance’s main support—coordinating meetings, ensuring that activities are executed and monitoring progress. The Monroe Chamber of Commerce, the West Monroe–West Ouachita Chamber of Commerce, Louisiana Delta Community College and Workforce Development Board 81 act as co-conveners or core support partners to the overall alliance, with each helping to lead different committees.

The MOU has helped ensure that no single organization owns the partnership—that multiple organizations see the partnership as the shared table to collaborate with one another and industry. The MOU has helped streamline the administration function, providing a communications and accountability, or reporting, template. Streamlining administrative tasks is particularly important because the workforce boards and chambers of commerce have not yet been able to hire staff to directly support the partnership full time.

Impact of the Partnership

The alliance’s areas of focus are directly reflected in their three previously mentioned committees: Policy and Regulations; Education and Training; and Acute Care Network.

The Policy and Regulations Committee has leveraged strong interest across health care organizations, and in 2017, focused on issues such as local patient transport, as well as Medicare credentialing and standardization between the health plans in the state system. The committee, facilitated primarily by the West Monroe–West Ouachita Chamber of Commerce, hosted a legislative luncheon in July 2017, which brought the state legislative delegation and sector partners together to discuss common issues of concern.

The Acute Care Network Committee began with a focus on disparate Medicare reimbursement rates across rural hospitals and larger regional or urban hospitals. The committee also discussed the misperception that patients will get better care at a large hospital than at a local rural hospital, and the burden this puts on larger hospitals, resulting in them being stretched thin and patients sometimes waiting in hospital hallways to receive care.

Health care leaders wanted to directly address these disparities and realized a potential win-win solution: bed-sharing agreements. When larger hospitals don’t have enough space for patients, they try to help them receive needed care closer to their homes at rural hospitals. If larger hospitals could better access bed space and skilled nursing staff in rural hospitals, patients would be better served. An added bonus of this arrangement is that rural hospitals often not only have the bed space, but they get reimbursed at higher Medicare rates. The committee immediately went to work on inventorying bed space, facility specialty skillsets and equipment. It also created transfer protocols and helped the Policy and Regulations Committee address barriers to local patient transport.

Now, hospitals are beginning to work together on a more regular basis to create a bigger data-sharing network related to space, skills and facilities. An additional and unexpected outcome is more effective, immediate access to care for patients picked up by ambulances. Emergency responders now know which rural hospitals or regional hospitals to go to because they are potentially able to talk with an emergency room doctor or triage contact to determine which hospitals have the expertise needed to address the patients’ specific needs and which of those hospitals have bed availability. Before the alliance was established, the emergency responders and hospitals did not know the patient bed and skilled staff capacity of rural hospitals. Through the alliance, the Acute Care Network Committee developed a resource guide that indicates each hospital’s capacity, so the alliance partners now know which hospital(s) is the best fit for each patient.

Patient transport problems are not only driven by patient misperceptions and data-sharing issues but also by local ordinances. In northeast Louisiana’s largest parish, there is an ordinance that allows for only one ambulance provider. This ordinance places a tremendous burden on hospitals when they receive and deploy patients to nursing homes, for example, because they have to wait on a single ambulance provider. Compounding this problem are the parish’s 911 requirements. The parish is required to limit time on 911 emergency calls, which means those calls take priority over transport issues because the ambulance provider must prioritize those patients for transport over patients in hospitals waiting to be moved to nursing homes or other hospitals. Therefore, patients wait extended periods of time in ERs or on the floors of the hospitals. The Policy and Regulations Committee of the Northeast Louisiana Healthcare Alliance is lobbying to address these problems.

Mitchell notes that as committee work evolves and achieves some wins, “there is some duplication of efforts by the committees, so the alliance may elect a president and vice president to streamline our efforts.” This is an example of how important it has been for the alliance conveners to be flexible and allow form to follow function appropriately.

Customer care satisfaction is another focus area of the Northeast Louisiana Healthcare Alliance, via its Education and Training Committee. Hospitals’ and nursing home facilities’ reimbursement rates now are based on patients’ perception of the care throughout their hospital stay (reimbursement rates depend on patient satisfaction under the Affordable Care Act). Hospitals and nursing home facilities were not receiving the highest positive feedback, so they surveyed patients about situations where their expectations were not met. They learned that some of their employees lacked strong communication skills and skills to handle crisis situations well. The hospitals noted that in general, patients seem to be sicker when arriving at the hospital now than they used to be, theoretically making it harder for staff to effectively address their increasingly challenging needs consistently and compassionately.

In response, the alliance partners teamed with Louisiana Delta Community College to develop customer care and satisfaction training. The college’s division chair for practical nursing spearheaded this effort to help ensure the training is realistic, relevant and corrects the problems that patients identified in their satisfaction surveys. The training could not have been designed without the industry members of the committee directly providing detailed information about what it takes to be “compassionate” in a health care setting, including categories of needed customer care and real scenarios. Part of the resulting training is geared toward medical scribes, whose data now include patients’ experiences with hospital staff. Training also includes role playing to show students appropriate and inappropriate behavior. This 15-hour patient care and satisfaction curriculum is now being piloted at Landmark Nursing Home. Part of this pilot is the health care employer’s guarantee to accept this credential and interview the training graduates for employment. If the graduates meet the employer’s existing needs, they will be given priority over other job candidates. After evaluation of pilot outcomes, the alliance hopes to establish a Northeast Louisiana Healthcare Alliance certification that will be recognized regionally by health care employers. This certification would guarantee job interviews to these students and could give them hiring priority when appropriate.

This training can also be used for current staff as a shorter-term professional development module. Landmark Nursing Home piloted this training for its staff in August 2017. The facility is tracking customer care and satisfaction and will report patients’ perceptions of care to alliance partners. Workforce Development Board 83 also is requiring that students enrolled in the certified nursing assistant training program—whose training is funded by the U.S. Department of Health & Human Services Administration for Children & Families Health Profession Opportunity Grant—complete this training. The alliance hopes the state of Louisiana will eventually certify this training as an industry-recognized credential so that the skills, knowledge and competencies taught in the curriculum become part of the industry norm.

Another success is that the regional workforce boards (81 and 83) and Louisiana Delta Community College are notably more collaborative. Colleges and universities are required to have advisory committees for their curricula and are now encouraging their community partners to connect with them through the alliance. This will prevent industry representatives from being overwhelmed by the number of requests to engage with each higher education institution in their own respective meetings. By extending an invitation as an alliance, the community partners are more effectively communicating with industry about who they are, how they work together to address industry needs and who industry representatives should call within each organization to address specific needs. This is important because industry partners have said at alliance meetings that so many people contact them but the alliance partners (employers) don’t know what that organization does. The alliance has helped them identify who each community partner is, what each partner does and who to call. The workforce board notes how it also has benefited from the alliance.

“This is the first time we’re included in strategies and initiatives of our community colleges and industry partners. Now we’re the first people they call. The Next Generation Sector Partnership model has been very powerful to us,” said Mitchell.

Louisiana Delta Community College also cites this model as transformational. The college has altered its business engagement practices to better support or take advantage of sector partnership activities. Now the college is letting industry partners tell it what they need instead of the college telling industry what it offers. The college added Workforce Development boards 81 and 83 to its advisory committee to help communicate what the college is doing to meet industry needs.

Breaking Ground in Coordinated Industry Engagement

The still-young Northeast Louisiana Healthcare Alliance represents early success on a number of fronts, as well as an honest assessment of the time and effort these types of partnerships take to cultivate. The real outcomes of the alliance committees’ work are indisputable, as is the power of the health care organizations created as a result. The alliance has become the “go-to” for health care organizations needing to connect together, as well as for education, workforce development and economic development entities needing to understand and leverage real demand from the industry. The adjustments along the way, including how the conveners and support partners are formalizing how they communicate and operate together, demonstrate the flexibility and evolution needed to continue growing an authentic industry-driven, community-supported partnership that ultimately benefits the regional community.

Note

This publication is based on information gathered in summer/fall 2017.