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Cincinnati Children's Hospital Medical Center Case Study

Employee restocking hospital inventory

Project SEARCH -- An Employment Approach Based on Community Collaboration

Cincinnati Children's Hospital Medical Center is dedicated to providing the highest level of pediatric care to meet the medical needs of infants, children and adolescents. Children's Hospital is recognized nationally for excellence in diagnosing and treating complex pediatric diseases. They are committed to bringing the very best in family-centered medical care to the children they serve from the local community as well as to those who come from around the country and the world. The center employs over 7,000 people in support, clinical care, teaching, and research capacities.

Motivating Forces
Seven years ago, Erin Riehle, clinical director of the Emergency Department at Children's Hospital, had a revelation. She had been struggling to solve a performance problem that plagued the efficient operation of the ER department that involved restocking supplies in a timely and dependable manner. It was no problem to fill these entry-level jobs with students and other part time workers hoping to pursue careers in health care professions, however, their turnover was continuous due to the repetitious nature of this task, though critically important, restocking of ER supplies was not valued nor reliably performed.

Then, Children's adopted a major diversity initiative in their hiring practices. As a supervisor of a large department, this initiative would be an important directive for Erin. At this same time, Erin saw that Children's had adopted a policy statement from the American College of Healthcare Executives which reads, "Healthcare organizations must lead their communities in increasing employment opportunities for qualified persons with disabilities and advocate on behalf of their employment to other organizations." She recognized that virtually every child with a disability is a customer at Children's at some point in their growing years, yet they encountered almost no role models with disabilities among the staff they saw.

Putting these factors together, she realized that the solution to her staffing problem could also help fulfill the diversity mission of her hospital in a more complete way. And so, the idea for Project SEARCH was born--a program that would provide employment for individuals with significant disability barriers to employment.

Hospital staff talking

Developing Collaboration with Community Partners
Erin realized that the hospital would need community partners to achieve her goal of bringing people with significant developmental disabilities such as mental retardation into the Emergency Department to fill these jobs as productive employees. The two collaborating partners are Great Oaks Institute of Technology and Career Development, a public human services agency that serves people with disabilities, and Hamilton County Board of Mental Retardation and Developmental Disabilities. Great Oaks is a very large career and technical school, serving 36 school districts and preparing more than 6,000 youth in full and part-time programs per year. The Hamilton County MR/DD Board provides educational, vocational, coordination and residential services to adults and children with mental retardation and other developmental disabilities. More than 10, 000 participants are currently involved with the MR/DD Board.

These partners recognized Children's Hospital as a highly desirable, large local employer with good jobs in a wide array of vocational areas that would result in a win-win situation for all. The partners committed themselves to providing staff who would be devoted to this employer and become truly knowledgeable about the work site. In addition, there was a commitment to provide training and support services that will enable carefully selected and motivated candidates to perform successfully and reliably the necessary functions of identified jobs.

How Does It Work?
Project SEARCH is located at Children's Hospital. Staff are provided by each organization, with Erin directing the overall program as Director of Disability Services. There are now several pathways for young people with disabilities in this program, including training programs in health care occupations and a transition to work program for high school students. But the payoff for the hospital is the employment program that started it all.

The partner agencies assist in preparing and screening their participants to meet several eligibility requirements (e.g., social and communication skills, independent in self care, able to take direction, desire to work) to enter the program. Program staff identifies open positions and analyze the tasks and demands of these jobs to match with program participants who are qualified to perform them. After coordinating the hiring process, program staff provides support on the job to these new employees.

"The key to our program is having the professionals from the Great Oaks Institute of Technical and Career Development and Hamilton County Board of Mental Retardation and Developmental Disabilities working on site", Riehle explains. "All the managers know them and they know the jobs and what it takes to succeed in them." All of the employed individuals report to their department supervisors, like traditional employees. But in addition, follow-along services assist the worker in resolving problems and adapting to changes that may seem minor or embarrassing for supervisors to address (scheduling special transportation, dealing with co-worker requests, hygiene), yet can lead to termination for these workers if effective and knowledgeable support is not provided.

Each participant receives up to 8 hours of follow-along services per month of employment from program staff dedicated to the program site. Thus, the amount of staff allocated to the site increases with the number of people placed in employment. This keeps the program cost effective for the agencies and adequately staffed to meet the needs of the employer and the workers.

Results Achieved
Currently, more than 70 people with significant developmental disabilities are working as employees of Children's through this program, with two staff providing on-the-job support services to these individuals. On average, these individuals have been employed for five years and earn an average wage of over $8 per hour. Most are working an approximately 32 hours per week and receive full benefits. These employees work in a wide range of positions, often overlooked for people with development disabilities. Many of these require mastering complex functions, yet they are routine in nature, such as sterilization tech, department sticking, lab courier, and clinical support staff.

"We see the program as a valuable recruitment source and retention solution for us", explained Lori Southwood, Director of HR for Children's. "They are extremely proficient in what they do. They have helped us fill positions in different ways; so that work that was not getting done, or done well, has been turned into jobs that can be done by these folks, and is being done much better than before. At first you expect many hurdles. We have learned that perception is the hurdle. Employers need to experience it once and then they will see. When there is a disciplinary or performance problem with an employee in the program, the support structures that are in place and the resources are made immediately available to the supervisor to correct and resolve the rare problems that occur. Some of these jobs are critical to patient safety and these employees are prepared to focus on them with a greater level of attention and precision than was achieved before."

Cindy Jackman, Clinical Director for a large patient care unit, provides another example. Supply carts were purchased to keep at patients' bedsides, so RNs could provide more direct care rather than spending valuable skilled time running back and forth for supplies. As in the ER Department, the people hired to stock these inventories were typically students hired part-time who were not interested in this work or attendants who were already too busy. In both cases, the task took a back seat, and therefore, this effort to have nurses function more efficiently did not work.

With students trained and hired through Project SEARCH, a much higher level of task completion and accuracy has been achieved. Employees obtained through the program have resulted in greater efficiency and far less frustration for the nursing staff. "We value the quality and support of the program staff, the excellent attitude and job performance of these employees, and their capacity to adapt to changes in our work routine. While the program staff is available to support these staff, we attempt to integrate these employees into every aspect of unit life as regular members of our team."

Because of the federal funds Children's receives as a research institution, they have a significant obligation for Affirmative Action. "This program gives us an exciting way to fulfill our plan", says Southwood. "We are really breaking through barriers, extending our commitment to diversity and affirmative action in a way that sends a message to all levels of employees and the young patients we serve. Now, every aspect of our operation uses these staff."

"We are bringing our mission alive", adds Jackman. "We do value what everyone brings to the world and we include them in our work force. It is important for parents of our patients to see what's possible for their own children when they see these staff working in responsible positions, and it is important for our traditional staff to see that we have a role in preparing these children for real roles in the world."

"This experience has also opened our eyes to interesting ways to meet new needs we will have", explains Southwood. "With our partners we are learning how we can provide training in small doses while people are employed to prepare them to advance and fill future needs. Rather than lament shortages in certain occupational areas, we are learning to "grow our own", helping people advance while they are working here, in ways that are compatible with their schedule and builds on their achievements.

Hospital staff preparing medical equipment

From the employer's point of view, the program has been enormously successful by improving performance in high-turnover, entry-level positions such as the ER stocking jobs. The Project SEARCH employees have also had a low rate of absenteeism and been rated highly for their work ethic, accuracy, and enthusiastic attitude. The program has helped the Hospital achieve its diversity objectives and has resulted in extensive local and national acclaim for its efforts. And the collaborative model has benefited its community partners and their participants in achieving their objectives, as well.

"Our program uses a business model", explains Riehle. "We provide a single conduit for organizing and delivering employment services, in collaboration with the community, and deliver them in an effective and accountable way as an integrated part of the work site. It is an appealing model to employers and it works." Large employers like Children's are approached by many agencies representing people with disabilities and other disadvantaged job applicants. Businesses have little understanding of who these agencies are and why so many of them are coming to their workplace. Businesses, especially in the health care environment, are focused on security, access to parking, and other issues that make it desirable to have less people walking in and out of their facility. They want external partners to facilitate the business conduct and professional functioning of the employer organization and its staff with the people it serves.

Other hospitals and employers around the country have begun requesting consultation from Project SEARCH to adopt this win-win model in collaboration with community partners. The program has demonstrated multiple and sustained benefits for the employer and the customers it serves, for the people hired, and for the community.

McMahon, B., Wehman, P., Brooke, V., Habeck, R., Green, H., and Fraser, R. (2004). Business, Disability and Employment: Corporate Models of Success. A Collection of Successful Approaches Reported from 20 Employers. Richmond: Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports and Job Retention.

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