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Task Force
On Health
Care Workforce


Public Input Welcomed

Aug. 20, 2002
July 16, 2002
May 30, 2002
April 12, 2002

Competing for
Quality Care -
Findings and Proposals
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Care Worforce
- Final Report

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Governor's Blue Ribbon Task Force On Health Care Workforce Shortage

Wilderness Room, The Colonial Building
Friday, April 12, 2002


To accurately assess the shortage of health care workers, and to develop recommendations and strategies to effectively address the issue.


Loren Soft, Chairperson, Billings
Jim Ahrens, Montana Hospitals Association
Sami Butler, Montana Nurses Association
Rose Hughes, Montana Health Care Association
Joyce Scott, Academic and Student Affairs
Sharon Kott, Area Health Education Center
Wendy Keating, Montana Department of Labor
Brian Zins, Montana Medical Association
Mary McCue, Montana Dental Association
Steve Yeakel, Helena, Montana
Representative Edith Clark, House District, 88
Joe McDonald, Salish Kootenai College
Jim McGarvey, Montana State AFL-CIO, MEA-MFT
Mike Hanshew, Montana DPHHS
Bob Bartholomew, Montana AARP
Jani McCall, Consulting with Communities
Desiree Taggart, Office of Economic Development
Jody Messinger, Office of Public Instruction
Patty Ehrhardt, Montana Clinical Laboratory Managers Association
Rita Harding, Billings Area Indian Health Service


Marc Scow, Facilitator
Linda Ashworth, Secretary


Chairman, Loren Soft, in the Wilderness Room of the Colonial Building, called the meeting to order at 9:35 a.m.


Attendees: Loren Soft, Jim Ahrens, Edith Clark, Jean Branscum, Jody Messinger, Rose Hughes, Bob Bartholomew, Sharon Kott, Sandi Butler, Joyce Scott, Mary McCue, Mike Hanshew, Rita Harding, Patty Ehrhardt, Desiree Taggart, Brian Zins

Guests: Bob Wafstet, College of Technology, Missoula

Dianna Chestnut


It was moved and seconded to approve the minutes of the previous meeting, as corrected.




Chairman Soft presented correspondence from Kristianne Wilson on behalf of the MSU-Billings Health Administration Advisory Board. Loren had asked her to ghostwrite a letter regarding an endorsement from the Governor’s Blue Ribbon Task Force on Health Care Workforce Shortage. Concerns had been raised that the requested $750,000 would only be used to fund research. Ms. Wilson stated in her letter that the money would also, “fund efforts to implement, in collaboration with the larger community, selected programs that address the gaps and shortages identified by the research”.

It was determined later in the meeting there was not a general consensus of the council members to write a letter of endorsement and the committee did not have the time to investigate the matter further.

A letter was presented from Dan Anderson, Administrator of the Department of Public Health and Human Service Addictive and Mental Disorders Division. Mr. Anderson voiced his concerns with “more consideration being given to individuals who have proven their competence through successful practice in other states”. Mr. Anderson encouraged the committee to “consider an increased role for reciprocity in granting professional license to persons moving from other states”.

Task force member, Brian Zins, presented written comment cautioning against lowering standards when granting licensing to individuals. He felt reciprocity would be acceptable if the criteria for licensing were compatible, thus maintaining the current criteria with licensure within the state.

Mike Hanshew presented written comments regarding a call he received from Senator Jerry O’Neil of Kalispell. Senator O’Neil felt a barrier was imposed on people currently involved in healthcare fields wanting to pursue further education in their field. Because of a lack of accessible training and educational opportunities in their communities and the need to work full-time, many people are unable to acquire further education. Senator O’Neil suggested that the task force look into a recommendation of creating and expanding opportunities for workers to receive additional credit for specific competencies and experiences that are gained while working in an existing healthcare job. He also encouraged the committee to endorse legislative change that would meld work related experiences with distance learning, thus shrinking the time it would take to advance up the career ladder.

Loren Soft presented the committee with correspondence from Patti Iversen, RN. Ms. Iversen stated her concerns that distance-learning options are very limited in Montana, presenting significant barriers to residents of rural eastern Montana communities. She listed the challenges that currently exist when attempting to utilize Montana clinical sites.

Ms. Iversen also presented a copy of a work force study that will be used to identify potential interventions in nursing work force maintenance and recruitment in fifteen eastern Montana counties.

After lengthy discussion the task force determined to include in its report to the Governor the following barriers and issues that contribute to the shortages in the healthcare work force within the state:

  • Licensing practices in general
  • Reciprocity
  • Exchange of information is poor
  • The cost of contracted care for facilities with low occupancy
  • Signing bonuses are a problem when competing for nurses
  • Number of health care slots need to be increased
  • Students leaving the state for higher wages and better working conditions
  • Transfer of credits is not working
  • The inability of the family breadwinner to leave job to attain further education
  • Lack of information about health care jobs to high school students
  • Large turnover with administrators in Montana hospitals
  • Competition with business when recruiting health care workers
  • Lack of clinical rotation sights
  • Licensing board turf issues
  • Training for leadership management and administrative training
  • Lack of slots in the WICHE, WWAMI, WUE, Minnesota Dental Program

It was determined by the committee to develop goals and specifics for removing and overcoming barriers. Loren stated that Senator Ed Butcher had shown interest in the problem and had requested information on the subject.


Data Group:

Jim Ahrens reported that he is continuing to work on the data report. He stated that Laurie Ekanger would compile all the information into a consistent format.

Mike Hanshew informed the committee that Laurie would do several drafts. She would appreciate some direction on the format. Mike suggested appointing a subcommittee that would work with Laurie.



The Work environment subcommittee brainstormed on a number of issues involving the work environment that health care employees find themselves in today. Topics discussed involved lack of career development, inherent health risks, the “hassle factor’ of regulatory and payment systems, increasing liability, workers being spread too thin, loss of efficiencies of scale, increased work load, nature and rigidity of work schedules (staffing health care facilities 24-7, holidays, weekends, etc.), lack of infrastructure and expectations in rural settings, difficult patient behaviors and expectations, and more medically complex patients. The committee was asked to “boil down” the problem to several points outlining goals and expectations. Whenever this process occurs many smaller, but no less significant, issues can fall by the wayside. In providing a synopsis of earlier discussions, it is the committee’s hope to shed some light on all the issues discussed, but not necessarily issues making the final list of recommendations.

The overall goal of the task force is to accurately assess the shortage of health care workers, and to develop recommendations and strategies to effectively address the issue. The Work Environment Committee was given the task of identifying factors in the current work environment a health care worker is expected to be productive in, which contribute to the shortage of health care workers, and to make recommendations, which address the problems.

The committee determined that a health care workers’ environment is often one of high stress and long hours where too few people share the work. Both workers and finances are stretched thin. The workers face health risks of their own such as needle sticks, allergic reactions, back and other injuries and workplace violence. Professionals fear liability in this arena where perfection is expected and lawsuits are common. Training and staff development does not occur to the extent required for workers to adapt to their ever-changing environment. And excessive government regulations and paperwork often become the straw that broke the camel’s back. The picture the committee looked at is one of a work force in crisis.

Even the patients are changing. As our population ages and technology advances, we are encountering new and more medically complex patients. Difficult patient behaviors are common. Expectations are also at a high point due, in part, to increased health care options and a more informed consumer. All of this adds to the stress and strain on health care workers.

While all of this is happening, the general public does not realize or understand the extent of the problem. The public is not well informed about careers in health care nor does it place a high value on these very special people who choose to work in health care.

What can we do? The subcommittee developed five issue areas needing action. Those areas of concern are excessive regulations, continuing education and training, financial, education and public awareness of health care work and its value.

Summary of Issues and Recommendations:

Strategic Issue #1: Public Awareness. Lack of public awareness of employment opportunities in the field of health care and of the value of health care workers.


To educate the general public, potential workforce candidates and policy makers as to the need for healthcare workers, the diverse opportunities available in the health care field and the value and importance of health care workers to Montana and its citizens.


There is clearly a need to educate the public about the health care worker shortage, about available careers in health care, and about the importance of working in health care. The general feeling that health care industry jobs are not desirable needs to be countered. These jobs need to be valued and viewed a s a “career” choice that involves upward mobility. Until society places a higher value on the work performed by health care workers at all levels many of the problems in the work place will continue.

Recommended Action:

Develop public service announcements encouraging careers in health care, targeting the most serious shortage areas.

Develop public service announcements targeted at portraying the importance of health care workers.

Seek private grants for marketing and promotion

Seek federal appropriations for promotional activities.

Expected Results:

Increased healthcare work force and raised awareness of the importance of health care workers

Strategic Issue #2: Continuing Education and Training. Lack of career development and continuing education opportunities, which exacerbates healthcare work force vacancies and work force turnover.


Provide continuing education and career development opportunities and incentives for health care professionals.


Lack of sufficient training and career development opportunities in the work place clearly contribute to the negative work environment, including burnout and injuries. However, facilitating training brings on problems of its own as well. Employees need time to train, something they don’t have a lot of.

While some staff is being trained others need to carry an even larger workload. In some parts of the state access to continuing education classes is also a problem. Unfortunately, those who hold the purse strings in these work places often don’t tend to see the benefit of work force investment because of its intangibility and the fact that necessary training is competing with other necessities for limited funds. We need to overcome the fact that employers place insufficient value on career development, therefore making it a lower priority. There is also a need to have enough personnel to fill-in while others are being trained. The training/education needs to be affordable and accessible.

Recommended Action:

Increase state/federal funding for health care services to enable facilities to hire sufficient staff and do adequate training.

Enlist state/public support to seek private grants.

Maximize federal training/education dollars.

Develop retraining opportunities for available potential work force resulting from lay off in other career fields.

Develop refresher/reentry courses for health care workers who have left the field.

Expected Results:

Decreased turnover, decreased vacancies, increased staff competence

leading to better quality patient care and job satisfaction, decreased

workplace injuries, increased staff retention, enhanced recruitment


Strategic Issue #3: Regulations. Excessive, complex and duplicative regulations (state and federal) compel workers and providers to leave health care profession (e.g. excessive paperwork, documentation is very costly and diminishes direct patient contact)


To reduce excessive, complex duplicative regulations


Regulations continue to create a “hassle” factor that tends to be the “straw” that breaks the camel’s back. In its zeal to guard against fraud and abuse and assure quality health care, the state and federal governments (as will as third party payers) have enacted excessive and inappropriate regulations that fail to hit the target. Excessive regulations aimed at health care facilities and organizations mean bureaucratic red tape, excessive paper work and stress at the worker level when unreasonable expectation cannot be met. Regulations have reached a critical point of taking time and energy away form the very people health care workers serve-the patients.

Recommended Action:

Develop specific examples of white paper to be presented at the health care work force summit to be held in Bozeman.

Develop legislation (state and federal) to provide for “deemed status” whenever appropriate, between licensing and accrediting bodies.

*State policy makers should play a strong role in development of federal legislation and regulations dealing with health care.

*Governor appoint a Regulatory Commission to review regulations and identify excessive or unnecessary regulations that add time and cost without adding to the quality of health care and to make recommendations for changes.

Determine better ways to deliver services with integration of public and private health systems.

Expected results:

Reduced regulation, reduced duplication of licensing/accrediting requirements and oversight reviewers will allow health care workers and providers to devote more time to quality patient care and services. Decrease turnover, increase job satisfaction.

Strategic Issue #4: Financial. Historical under funding of entire (physical and mental) health care system in Montana.


To assure adequate funding of health care services to enhance opportunities to attract and retain health care workers and to assure high quality of patient care.


The one thread that runs throughout the discussion is a financial issue. The health care system is rife with issues of appropriate funding. Hiring sufficient staff to avoid burnout means spending more money. Better compensation for health care workers costs money. Providing more training and staff development has a cost. Training and equipment to safeguard against workplace injuries and illnesses adds to cost. Each component of the problem has a financial cost. This doesn’t mean there are not other things that can be done, but there’s a need to recognize how under funding health care contributes to the problem and to the solutions. Any discussion of money also needs to include the realization that the Medicare and Medicaid programs have traditionally under funded provider rates.

Recommended Action:

Maximize federal dollar match

Assure Medicaid provider rates are sufficient to provide care and services in keeping with standards and regulations

Develop loan forgiveness program tied to requirement for worker to remain in the state for determined length of time.

Access private grants with state assistance and support

Private sector funding of internships, regulatory issues and pilots

Seek bigger federal appropriations

Expected Results:

Better staff retention, provider retention and quality patient care.

Strategic Issue #5: Education (Education Subcommittee will handle this)

Education: Another common thread was a need for more emphasis within all levels of the educational community to place more emphasis on health career education. Whether it’s providing more information about health careers to high school counselors, expanding health career training in our technical colleges, or expanding degree programs for health care training in our universities, the educational system must respond to the health worker shortages.

The Education Subcommittee will make recommendations related to education. We recommend they include:

  • Adequate state and federal funding of health care services
  • Better availability of training modules that can be used especially in rural areas
  • Public education focus on health fields (career ladder)
  • Tuition waivers for health professions (loan forgiveness for working in Montana)
  • Retraining/education of available work force (lay-offs, welfare, etc.)
  • Refresher courses for health care workers who have been out of the field


Sharon Kott reported that the education group had met and did some more work. She reported that they had changed the term “Higher Education” to “Professional Development and Educations”. The group presented the following draft:

ISSUE 1: Professional Development and Education

Goal I: Distance Learning for Health Professionals

Action Steps:

  • Bring together educational programs, professional entities & organizations
  • Identify existing deliver systems
  • Identify interested network partners
  • Design existing programs for distance delivery
  • Establish a “single point of contact” for distance learning for health professionals
  • Identify new educational needs


  • Career advancement/training opportunities for rural health professionals (i.e. LPN to RN)
  • Education while at home - go to physical training site/educational institution at specific times during the year
  • Continuing education opportunities for health professionals to maintain credentials
  • Adequate workforce

Goal II: Sustainability of dental hygiene program

Action steps:

  • Educate legislators regarding need for continuation of funding for DH program
  • Educate legislators and general public about the adverse oral effects of spit tobacco and that Montana ranks 1st in the nation in male youth use of spit tobacco
  • Dental hygiene program needs to be a line item in the Governor’s budget


  • Continuation of valuable health career education program
  • Address oral health provider shortage in the State of Montana Improve Montana’s economy with high tech, high wage jobs
  • Better oral health for Montana’s citizens

Goal III: Coordinate and communicate curricula/programs offered in relation to

job replacement needs

Action Steps:

  • Identify existing health career programs (including educational programs, professional entities & organizations)
  • Identify where all program graduates are placed
  • Establish a Health Careers’ Education Coordination Committee with a membership representing all of the health career programs in the state
  • Evaluate efficiency of existing programs available for in-state and out-of-state training at in-state tuition rates
  • Identify and monitor where “needs” exist in workforce through the Economic Development Opportunities Office
  • Make recommendations to institutions of higher learning, Board of Regents and legislature regarding programs offered to address health care workforce needs in Montana
  • Assist communities in developing community scholarships in exchange for service after education is completed (utilizing Tobacco Settlement Funds?)

Identify regulations/policies of education, welfare, social service agencies and professional associations and standards that impede enrollment and completion of education programs

  • Actively recruit students (middle school, high school and undergraduate) to these programs
  • Implement “rural training tracts” for each of Montana’s health professions training programs, providing internships or assistantships at rural facilities


  • Assure training programs are in place to meet the healthcare workforce needs of Montana
  • Better communication and collaboration among existing health career education training programs in Montana
  • Enhance existing successful programs making sure the programs meet the needs of rural population
  • Increase efficiency of existing programs and avoid duplication
  • Montana resident who are educated to be health professionals remain or return to practice in Montana
  • Ability to provide incentives (scholarships) to practice in rural areas for all health professions (such as Montana Rural Physician’s Incentive Program)
  • Increase student’s appreciation for rural practice

ISSUE 2: Retraining of Displaced Workers and Homemakers

Goal I: Develop and implement-retraining programs for displaced workers and homemakers into health careers

Action Steps:

  • Bring together educational programs/professional entities & organizations
  • Identify existing deliver systems
  • Identify interested network partners
  • Develop specific programs and statewide criteria for each program
  • Implement programs


  • Supply “on-the-job” training for displace workers and homemakers to help address specific health care workforce shortages
  • Capable workers retrained to perform needed services also giving them a self-esteem boost and providing them with benefits such as health insurance, retirement benefits, etc.
  • Fewer people on welfare roles and in need of other social services
  • Provide wage opportunities that are higher than minimum wage
  • Reduce the shortage of health care workforce


Funding and compensation issues were discussed in the other subcommittee reports.


A lengthy discussion followed on the format and content of the draft.

The committee suggested the content of the draft include the following:

  • Include charts and data in an appendix or index so the information does not get lost in a narrative format
  • Goals that are specific, measurable, achievable, and relevant
  • Include general recommendations on programs and identify specific programs that are in danger
  • Look into obtaining funding for a Health Occupation Specialist for K-12 programs and possibly drafting a letter of support from the Governor for that position
  • Both long and short-term goals
  • The “rural factor” (Bob Bartholomew distributed Rural Health Statistic as compiled by the Rural Information Center Health Service (RICHS).
  • Identify funding sources and strategies (Jodi will develop narrative around this information)
    • State and Federal Government
    • Private funding
    • Reprioritize existing public funding programs
    • Possibility for incentive funding
    • Endorse grant concept
    • Possible support of concept of discretionary funds to get programs started
    • Look at a group of stakeholders that could continue to move plan forward
  • Look at educating our citizens
  • Since many programs are suffering due to lack of funding, consider a recommendation to increase taxes in the next legislative session

The committee agreed upon the following format:


  1. Executive Summary
    1. Intro and Overview
    2. Define Problems
  2. State of the State (Include the data pertaining to the current healthcare shortage within the state)
  3. Short and Long Term Issues
    1. Education/Strategic Issues



Recommended Strategies

Expected Outcome

  1. Work Environment/Strategic Issues



Recommended Strategies

Expected Outcome

  1. Funding or Resources/ Strategic Issues



Recommended Strategies

Expected Outcome

  1. Data (Information to be compiled by Joyce Scott)



Recommended Strategies

Expected Outcome

  1. Barriers/ Strategic Issue (Identification and explanation to be written by Jim Ahrens)



Recommended Strategies

Expected Outcome

  1. Appendix

One member from each subcommittee was selected to form a core group that would become the contact member for that group and would be responsible for reframing each sub-group. The core group will consist of Loren Soft, Sharon Kott, Rose Hughes, Mike Hanshew and Jean Branscum. The group will meet with Laurie Ekanger. Laurie will circulate the first draft before the May meeting.

Mike Hanshew stated he would contact Laurie. It was also suggested that the core group pass on its information to Loren by April 19th and meet with Laurie shortly after that date. Laurie will also meet with Jim Ahrens and Roberta Yager concerning the data report.

It was also suggested that anyone having resources or references that would pertain to the issues fax or send them to Roberta or Jim for compilation.


May 17: Health Care Summit in Bozeman. Jean Branscum reported that the morning session would be devoted to health care shortages in Montana. The afternoon will consist of tabletop sessions and breakout sessions. Joyce Scott and Patty Ehrhardt will represent the Governor’s Blue Ribbon Task Force at the meeting. The summit will be limited to 200 participants.

May 30: Review the first draft and comments. The draft will be sent to the committee members by May 23rd so that each member will be prepared to comment by the meeting date. Loren suggested editing the draft for, readability, flow, recommendations and contents. Ms. Ekanger will be present at the next meeting.

Prior to the June meeting: publicize the June 21st meeting on the governor’s website as well as the website of the Department of Public Health and Human Services.

June 21: Review second draft and finalize draft. Take public comment at this meeting.

July 1: Post draft on the State’s website for public comment

Mid-July to August 15: prepare final report.


The next meeting is scheduled for Thursday, May 30, 2002 at 8:30 a.m. - 4:30 p.m. in the Wilderness Room of the Colonial Building.

Chairman, Loren Soft, adjourned the meeting at 2:35. navigation footer
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