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    Restoring Shine to the Rust Belt's Ailing Economies

    Medical schools and teaching hospitals are driving innovations that boost job growth and improve quality of life in areas of economic decline.

    The Robert C. Byrd Bridge
    The Robert C. Byrd Bridge is a landmark Huntington, W.Va., which has faced tough economic times in recent years. The Marshall University Joan C. Edwards School of Medicine is enhancing the city’s revitalization efforts.
    City of Huntington

    It’s not hard to see how medical schools and teaching hospitals serve their communities through free health clinics and prevention efforts or programs that encourage minority or underserved teens to enter the health professions. But increasingly institutions are responding to communities’ needs by focusing on economic revitalization.

    As economic anchors, medical schools and teaching hospitals are often among the largest employers in their regions, offering not only the obvious positions for physicians and nurses but also a wide variety of other jobs, from technicians to maintenance and construction workers to receptionists. And through targeted efforts to hire locally, these institutions can have a significant impact on reviving their communities.

    In 2014, the local leadership of Huntington, W.Va., launched a comprehensive revitalization project. A major player is the Joan C. Edwards School of Medicine at Huntington’s Marshall University, along with its affiliated teaching hospitals. Like many cities across the Rust Belt, Huntington was once a thriving coal town with healthy manufacturing and steel industries. As coal mines and factories closed, the population dropped and poverty and unemployment increased. About one-third of the city’s residents live below the federal poverty level, according to the U.S. Census Bureau.

    As Huntington declined, there was an increase in unsafe neighborhoods, inadequate housing, and issues such as food insecurity—social determinants that are well established to have negative effects on health. The Centers for Disease Control and Prevention (CDC) identified Huntington as one of the unhealthiest metro areas nationwide in 2007. And the city is grappling with high opioid addiction rates. According to a July 2017 CDC report, counties in the top 25% nationwide for opioid prescribing were in areas with lower incomes and higher unemployment.

    Altogether, the situation created a “perfect storm,” said Joseph I. Shapiro, MD, dean of Marshall’s medical school. “It’s almost beyond belief how this part of the country has been hit by the opioid problem, and you throw on top of that the economic challenges related to energy being a decreasing area for workers, and it’s created quite a problem. As citizens of this community, we feel an obligation to try to create some alternatives.”

    Hiring close to home

    As part of the citywide revitalization, a new health innovation corridor is planned that will transform a distressed neighborhood by connecting Marshall’s health, medical, academic, and research centers with other health resources, walking paths, and healthy food options. One Marshall project includes a new facility for its pharmacy school and residence halls for medical and pharmacy students, representing what Shapiro estimated will be one of Huntington’s largest construction projects in about a decade. Marshall has also expanded its faculty practice plan and clinical services, leading to an increase in the physician workforce. “Almost by definition, [the increase in physicians] is paralleled by a growth in nursing and a growth in other health care disciplines,” Shapiro added. “These things all run hand in hand,” he said of job expansion at academic medical centers and the effect on local economies.

    Indeed, a 2017 report from the Robert Wood Johnson Foundation found that hospital programs focused on community investment and job growth have the potential to stimulate local economies. And through job creation and other investments, such programs can lead to healthier neighborhoods as people have more opportunities and resources.

    “It’s almost beyond belief how this part of the country has been hit by this opioid problem, and you throw on top of that the economic challenges related to energy being a decreasing area for workers, and it’s created quite a problem. As citizens of this community, we feel an obligation to try to create some alternatives.”

    Joseph I. Shapiro, MD
    Marshall University Joan C. Edwards School of Medicine

    Smaller cities like Huntington haven’t been alone in facing difficult times. Detroit, Mich., is rebuilding after the decline in the auto industry. In early 2017, city leadership approached three local health systems to create jobs for Detroit residents. Henry Ford Health System, Detroit Medical Center, and St. John Providence Health System responded with a program that trains residents as patient sitters and patient care associates. People in these roles help monitor patients; patient care associates also check blood pressure and other vital signs. The positions require training but not extensive education.

    “Both are very highly needed in any patient care system,” said Jan Harrington-Davis, director of employee, labor relations, diversity and compliance at Henry Ford. “These positions are hard to fill from the perspective of getting people who are dedicated, who are reliable, and also clinically competent.”

    The three health systems partnered with Oakland University School of Nursing to provide training. Focus: HOPE, a local nonprofit group, will help identify job seekers and address barriers such as childcare or transportation. The $2,000 cost per student will be covered by a combination of federal and city funding.

    Huntington, W.Va., skyline
    In Huntington, W.Va., a comprehensive revitalization plan is getting major contributions from the medical school at Marshall University and its affiliated teaching hospitals.
    City of Huntington

    After training—three to four weeks for patient sitters and seven to eight weeks for patient care associates—job seekers will be able to apply for positions in the three health systems. Each system will have its own interview process; those who apply to Henry Ford will not compete with other applicants. The first class of 24 students graduated in July 2017.

    Although this is a newer program, Henry Ford has been looking to local residents for open positions in recent years. “We have a direct focus on hiring from the community for a number of reasons—to reduce the unemployment rate and to get people working,” Harrington-Davis said. In the past two years, the number of Detroit residents who were hired has gone up from 600 to more than 1,000, she added. Other Henry Ford programs have helped local applicants prepare resumes and practice interview skills.

    According to the Robert Wood Johnson Foundation report, local hiring practices can provide life-changing opportunities on the individual level. Creating that career pathway was key when Advocate Health Care in Chicago, Ill., launched a local hiring initiative in 2015, said Clayton Pryor, director of workforce development at Advocate. “Our idea was to focus on underrepresented, underserved communities and ensure that they had access to these jobs by providing job training and skill development,” he said.

    Advocate started the program, called the Healthcare Workforce Collaborative, by looking at the positions that would be in demand throughout the 12-hospital system over the next five years—including certified nurse assistants, phlebotomists, and pharmacy technicians. Then Advocate partnered with community-based organizations to target local residents and understand their existing skills and barriers to employment. “It’s about being connected to the workforce system within the region, understanding the demands as far as roles, the trajectory, and different career pathways. And then [we had to] connect that tangibly to the demands in the hospital system,” Pryor added.

    Funded by a $3 million, five-year grant from JPMorgan Chase to Advocate Charitable Foundation, the collaborative will lead to about 1,000 jobs by 2020. So far, the program has about 200 graduates, about 100 of whom are working at Advocate and other hospitals in the Chicago area.

    A focus on sustainability

    For both Advocate and Henry Ford, the goal is not only to employ locally but also to help people advance once they have a job. “Our hope is to get them in the system and help them gain skills and to increase their aptitude. Then they can transfer within the system of the five hospitals that we have,” Harrington-Davis said.

    As part of the collaborative, Advocate created an incumbent worker strategy to provide career development resources and help employees “build a pipeline forward” as they gain experience, Pryor said.

    In Huntington, health care–related positions at Marshall’s School of Medicine, Cabell Huntington Hospital, and St. Mary’s Medical Center, as well as at other providers, already represent more than 30% of the region’s jobs. As these institutions expand, new projects will bring jobs in construction and support surrounding businesses. And each new employed person, regardless of his or her role, is contributing to the community. “They’re going to lunch; they’re going to dinner; they’re buying homes. All of these help refresh the local economy,” Shapiro said.

    In addition to bringing jobs, medical schools and teaching hospitals bring a pipeline of young learners who can continue to build on local investments, Shapiro added. “They become the next generation of providers, and I think your chance for a sustained economic revival is just that much better.”