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The health care industry is surging. It is the country’s fastest-growing industry and produces the highest demand for middle-skill jobs—positions that require some postsecondary training but not necessarily a four-year degree. Middle-skill jobs can mean higher wages, job satisfaction, and the next step on a career pathway for low-skilled workers in entry-level jobs. The health care industry is ideal for developing a pipeline to move lower-skilled workers into middle-skill jobs.

Current research suggests that to be successful, employers should play an active role in developing these pipeline initiatives. Many employers have done so over the past 10 years through investing in entry-level skill training, developing current worker training, or providing retention specialists and coaching.

Our report focuses on the different perspectives employers had of their role in workforce initiatives that create pipelines for middle-skill jobs. Better understanding employer perspectives can help workforce organizations, employers, and funders engage other health care employers in similar efforts to improve outcomes for workers while better meeting employer’s needs.

Motivations for engaging middle-skill pipelines

Health care providers involved in middle-skill initiatives believe they play a key role and that their input into developing these workforce initiatives is essential. Employers noted economic motivations for their engagement, including

• worker shortages or an inability to find workers with appropriate skills,
• high turnover or difficulty retaining workers in certain jobs,
• desire to build a diverse and culturally competent workforce, and
• the need for new or different skills to meet future changes in health care delivery.

Many employers were motivated by these reasons in combination with a mission to serve their community.

Value of industry partnerships

Employers believe industry partnerships play a vital role in building an effective middle-skill jobs pipeline. Industry partnerships bring together employers from across a region’s health care sector to address common workforce challenges and achieve mutually beneficial goals. Partnerships help employers and other partners share ideas, leverage knowledge and input, create and maintain relationships, develop initiatives, and raise funds. Employers value industry partnerships because partnerships

• can develop new initiatives while relying heavily on employer input;
• keep track of the players in the workforce system, building and maintain relationships;
• make it easy for employers to participate in new initiatives, from raising funds to structuring involvement to facilitating reporting requirements;
• provide a venue for developing employer collaboration and exchanging information with nonemployers; and
• facilitate employers working to create systemwide change beyond individual initiatives.
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Lessons for building successful middle-skill job pipelines

The perspectives interviewed employers offered have several implications that can benefit any employer or organization seeking to create pathways to middle-skill jobs.

• Be knowledgeable about health care employer needs: To encourage employer interest, potential partners need to know employers’ needs (e.g., qualified workers) and have a deep understanding of the current health care market. 
• Assess the relative advantages of different partners: While employers believe their role in developing middle-skill job pipelines is vital, many recognize that certain activities are better suited for other partners. Considering the relative advantages of partner roles should be part of developing a new initiative.   
• Take the time needed to build employer partnerships: Employers recognized that it takes time to make sure partners’ goals are aligned. The up-front time needed for planning and building trust should be built into expectations for partnership development.
• Plan to measure outcomes: Measuring project success helps staff and employers make the case for and gain leadership buy-in, which can be an asset in garnering additional internal and external funding and sustaining the project in the long run.
• Leverage funding: Small amounts of external funds can engage employers in pilot efforts to build employer trust and get initial results, leading to employer investments to sustain ongoing work. Funding an initiative developed by a current industry partnership or other intermediary with well-developed health care employer partnerships is a way to leverage funds for results. Funders should explore ways to encourage employers to include middle-skill workforce investment as part of their efforts to restructure health care delivery.

Finally, not all in-demand jobs in health care are middle-skill jobs. Although employer involvement in initiatives around entry-level jobs is important, potential partners and funders concerned with improving opportunities for the next step on a career pathway need to focus on projects targeting middle-skill job development or advancement from entry-level to middle-skill work. One strategy is to focus on employer initiatives that enhance skills among current entry-level workers.