Good Jobs: A Series Focusing on Workforce Development and Job Quality – Part II: Career Ladders


Part I of this series focused on how JVS partnered with Nursing Assistants who were trained by JVS and then worked in long-term care to enter a training opportunity at Beth Israel Deaconness Hospital that led to new jobs and a substantial increase in the quality of their employment. This entry in the series takes a look at how career ladders can be created inside one company to help individuals move into higher quality jobs.


Career ladders have long been pursued by sophisticated workforce development practitioners as a way to enable lower level employees in a company to better navigate and attain higher level positions in a company. In theory, fully developed career ladder programs pull together well mapped progressions of jobs, linked training so individuals can compete for those jobs and succeed if they attain them, and career coaching and navigation assistance to help employees develop personal career advancement strategies and then execute those strategies successfully.

In reality, successfully pulling all of these pieces together and successfully implementing them is very challenging and quite rare. Several factors make implementing career ladders very difficult. One barrier is dramatically different skill level requirements from one career ladder rung to another. For example, in hospital settings in the Boston area, most employees in lower rung positions like patient transport, environmental services, and dietary services are English language learners, often have limited education beyond high school, and rarely have well developed professional skills. Yet many target positions require excellent written and verbal English skills, good professional skills such as customer service and team problem solving, and post-secondary education. Another barrier is internal hiring culture. Many large companies are not organized to actively recruit from one department with higher level job skills, and in fact are often unwilling to consider “non-traditional” hires, even if they are from a department within the same company.

The Boston Children’s Hospital- JVS Career Ladder Program was designed to address these and other barriers and create a meaningful but practical career ladder initiative. Boston Children’s Hospital is a member of the JVS organized Healthcare Training Initiative (HTI).  The program, which is made possible with support from SkillWorks, a funder consortium, is a two pronged initiative with the goal of supporting incumbent employees in Environmental and Food Services at Boston Children’s Hospital to get hired into career ladder positions within the organization, and providing vetted and trained pre-employment applicants to fill their vacated positions. The program grew out of a desire of management in Environmental and Food Services to provide incentives and opportunities for their employees who were being asked to provide increasingly high levels of quality work with few incentives and supports in return.

The project began in 2015 with the convening of various stakeholders at BCH to garner support and buy in, as well as determine the appropriate positions to target with the incumbent worker training. Potential jobs to train for were discussed with the compensation team, recruitment team, and human resources consultants, and a data analysis of jobs in high need during FY15 was conducted. Once the three positions of Administrative Associate (AA), Patient Experience Representative (PER), and Clinical Assistant (CA) had been defined as the targets, interviews of hiring managers were conducted to gain more information on the skills needed in these roles.

Outreach and recruitment for the incumbent program was conducted and employees who were interested in the program completed applications, were interviewed, had skills assessments, and obtained a manager recommendation. Some employees were referred to existing programs (Workplace ESOL or Computer Classes) to develop their fundamental skills before being considered for the second cohort of incumbent training in 2017. These employees will also be connected with a coach after beginning classes to support them and help keep them on track.

The Career Development Training Program was launched with employees participating in a 58 hour training. The group was broken into two sections based mostly upon English proficiency, and the curriculum focused on goal setting, communication, teamwork, managing conflict, cultural competency, and preparing for a new job. This was followed by more contextualized and job-specific training began. The participants were re-grouped into a Clinical track (CA) and Non-Clinical track (AA and PER). Course content includes basic medical terminology and math, computer skills and technology, data entry, HIPPA, time management, speaking and writing, customer service, resume writing, interview skills, working with children, and a review of soft skills and cultural competency. This portion of the training lasts 10 weeks, during which time participants also work with a coach to prepare them to apply to job openings, and shadowing in areas where they hope to obtain positions.

The pre-employment program will follow the incumbent program to address vacancies that already exist in EVS and Food Services, as well as the additional ones created employees who successfully complete the Career Development Training Program and transition to new positions within the hospital. JVS and BCH will recruit, screen and prepare job seekers who are interested in entry level positions in EVS and Food Services, and enroll them in the pre-employment training program. Selected candidates will receive intensive and contextualized training first on-site at JVS and then on-site at BCH. JVS career coaches will be working with participants on resumes, interviewing skills and job shadowing opportunities. Upon successful completion of the training/coaching services, the Children’s HR team will work with graduates to support their candidacy for open positions in Environmental and Food Services departments in December and January.

While the program is still in its early stages, preliminary results are very promising, with some incumbent employees securing career ladder positions before the training component was completed. If the program continues to be successful, it will be an important model for a career ladder program that can grow out of actual company needs, engage key management decision makers, and deliver meaningful value for employees, managers, and the overall business. A successful career ladder program like the BCH-JVS project will also be an important demonstration of the feasibility of substantially increasing job quality within one enterprise.

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