#5] When the Employer is the Trainer: Lessons from Cooperative Home Care Associates — STEVEN L. DAWSON

10 responses:

1. Molly Hemstreet
   Founder and General Manager
   Opportunity Threads

   Another thank you for your insightful storytelling and for connecting the personal success of people to the success and longevity of CHCA. What stands out to me in the CHCA story is how the “softer skills” of accompanyment, listening and solidarity are foundational for skill development in workers and training strategies for institutions.

   While participating in many conversations about “training workers” we jump to skill lists, classes, and technological opportunities and never as industry or individual businesses critique our own ability to see the reality of the frontline worker. In the end you name the “greater challenge: building a genuine cultural of mutual respect and support for their companies’ frontline workers….” CHCA has been able to deeply impact industry and build a culture of respect.

   I would be interested in your reflections on how that culture (starting with the worker) is promoted and maintained in the life of CHCA….so we can remind ourselves (the plethora of well-meaning people and institutions building training programs) that if we never see the life of the frontline worker we will never find programs that meet their needs or the needs of our businesses.

   • Steven Dawson
     Visiting Fellow
     The Pinkerton Foundation

     Hello Molly ~

     Thank you for the kind words. As to building a culture of “mutual respect and support” at CHCA, I’ve a few thoughts.

     Thirty-five years ago, the founders of CHCA, Rick Surpin and Peggy Powell, designed the cooperative to employ primarily homecare aides—instead of creating a company that employed a mix of both nurses and aides. They did so intentionally, because they wanted to ensure that the culture of the firm was built around frontline workers rather than professionals. Today of course, CHCA does employ nurses, but only a few compared to its 2000 home care aides, and all in support of those direct-care workers.

     Also from the very beginning, Rick’s and Peggy’s decision to build CHCA as a worker-owned cooperative created a formal legal and financial structure that reinforced the direct-care culture. A majority of the corporate board of directors continues to this day to be homecare aides, and I had the honor of serving on the CHCA board for more than 25 years. Sitting at the boardroom table with African-American and Latina women who had just come in from assisting their homebound clients in the South Bronx and Harlem was the most profound democratic experience of my life. Their knowledge and experience of what was important to themselves and their co-workers as homecare aides—and what was important to their clients—deeply informed every policy decision made by that CHCA board of directors.

     Doing the research for this fifth Pinkerton Paper brought me back to the cooperative after an absence of almost two years. Walking back into CHCAs offices, I was struck afresh at how strong their frontline culture remained. And the reasons remained obvious: the CHCA’s offices are clean, bright, and well-organized—the physical space expressing a level of professional respect to all who work there. The leaders of the cooperative, many of whom have worked for CHCA for decades, all emphasized the same theme: that their job was to support the direct-care workers, so that those workers could support their homebound clients. This was manifested in the interactions I once again witnessed between aides and managers—all managers trained in PHI’s “coaching approach to supervision” explicitly designed to create a “respectful workplace”—and by the “open door” policy of even the President of CHCA.

     One last thought: I’m still impressed at how CHCA has maintained their respectful culture for so long, and at such a scale. While many in the cooperative world worry about losing their culture as they grow, I believe CHCA’s scale has been beneficial: It has allowed the company to attract strong leadership, and to maintain a consistency of those leaders throughout the cooperative’s history. Big can be beautiful—if thoughtfully designed and managed.

     ~ Steven

2. Christopher Langston
   Vice President HealthCare Services, Aging in New York Fund
   Immediate Past Board Chair, Grantmakers in Aging

   Thanks Steven – Having worked with you and PHI, and by extension CHCA, this paper and the entire series have been great reflections on the lessons from the field. I particularly liked this one as I am a big fan of these kinds of human “story” cases as communication tools. I liked Paulina a lot and I’ve always loved all the CHCA leadership.

   Of course, I know enough about the matter to be able to project why the two cases end differently after you stop telling the story – in #1 there will be a problem, maybe the family will accuse her of theft or abuse (or something in her life will go wrong), she won’t know anyone she trusts to help her with the situation and will feel terribly stressed. She may just stop coming to work or have some other non-productive response. In the other version she has the peer mentor, has a supervisor who knows her, she knows she is valued – they can at least try to work it out.

   And from the patient care perspective the differences are also very important. Paulina will certainly someday be faced with a very challenging clinical situation and not be able to get any input about what to do or get anybody on the healthcare “team” to listen. She could just be told to shut up about it, and without support decide to go along and ignore the whatever (incipient pressure ulcer, delirium, unsteadiness, etc.). In this version the patient/client will get hurt. But when a home care worker has a mentor, supportive supervisor, and communications skills, she has a much better chance to get through to the rest of the team and a tragedy may be averted.

   I hope that your readers can see the consequences of how your story ends for both patients and workers.

   However, like other commenters, it is harder for me is to see how these principles (I really liked your call to think about the essential principles in adopting the approach and not be confused by the surface structure) can be extended to other jobs. Oddly, part of what makes the CHCA approach work is that there is turnover – if there wasn’t still 20% annual turnover, you couldn’t have multiple classes of 20 or be able/willing to invest in the training and on-boarding infrastructure that works here. Similarly, CHCA’s scale matters a great deal to its ability to guarantee work and cover the enhanced training and orientation infrastructure.

   It makes me wonder what do some of the other large, entry level employers do? McDonalds could do it. Some big retailers in NYC could probably do it (Target, Lowe’s, Home Depot, Bed Bath and Beyond). What does Starbucks do? What about work in real restaurants e.g., dishwasher? Is there an institution (union?) that can come close to virtualizing the functions that you identify as important for people trying to make a go of all those dishwasher jobs advertised at so many restaurants.

   Clearly CHCA has a winning formula. It is really important for workers trying to get into regular paid work in home care (and their patient/clients). But I think the principles reflect things we would all value in our work lives. I was reminded of one of my other favorite work fables – Patrick Lencioni’s “The Three Signs of a Miserable Job” which argues that people want to be known as people, to feel good about the impact of their work, and to have their contributions noticed.

3. Ken Galdston
   Director
   InterValley Project

   I would echo Chris Mackin’s comment that CHCA’s responsibility to trainees, workers, clients and to advancing best practices in the home healthcare industry as a whole is a most important theme of this account.

   Providing skilled care to clients, many of whom may be struggling with daily life, that grows out of a strong sense of responsibility, reinforced by CHCA’s culture, is a most important quality.

   The lessons for training are ones we will share with our leaders and organizers, organizing to create and strengthen jobs in urban and rural New England communities.

   Thanks, Steve, for a poweful story, powerfully told.

4. Richard Schweid
   Author

   Thanks for this clear and cogent paper. While this model may not work for all professions, or even for all home health care aides, CHCA has developed an approach to workforce training that offers some minority women a way to climb out of extreme poverty. Over half the CHCA aides I have interviewed were homeless with their families at some point in their lives. While home care aides receive only minimum wage, it can be enough to make a large difference in their lives. Limited attempts to apply the CHCA model to other fields have been made, but much more needs to be done.

5. Christopher Mackin
   Founder, Ownership Associates
   Partner, American Working Capital

   One component of your story that occurs to me Steve pivots on the idea of responsibility. The employer taking responsibility for hiring means the trainees are more likely to take responsibility for the training. Diffusion or ‘things (and people) falling through the cracks’ seems to me to be the Achilles heel of these kinds of training programs. Your case study approach makes that clear. The final turn about responsibility, of course, takes place through joint ownership of the company. Breaking down the employer-employee barrier is key to making shared ownership and shared responsibility work. And it is pretty clear that is what has been going on in New York City.

6. Peter Pitegoff
   Professor and former Dean
   University of Maine School of Law

   Thank you, Steve, for your thoughtful and insightful Pinkerton Paper, “When the Employer is the Trainer: Lessons from Cooperative Home Care Associates.” With a window into the robust employer-embedded training model at CHCA, you do well at distilling lessons that hold promise for application elsewhere, including third-party workforce training programs. You also capture the central importance of organizational culture and values. Cooperative ownership and governance at CHCA are clearly impressive. But, as you suggest, the cooperative structure does not create but instead reinforces and complements multiple worker-centered attributes of CHCA. A collaborative, caring, fair, and respectful culture, combined with high standards, can be the foundation for success in many an institution – public or private, nonprofit or for-profit, worker-owned or otherwise.

7. Jake Clark
   Communications Director
   National Fund for Workforce Solutions

   Thanks for your thoughtful analysis of the CHCA model and for distilling the replicable elements of success. Very helpful and insightful. I agree that third-party training programs must be more connected to work expectations, and the level of employer ownership you describe is a worthy goal. I’m curious on how this could be achieved for higher-skills positions such as a machinist or medical assistant. An employer may already conduct a fair amount of training during orientation, but expects the candidate to come in with a fairly involved credential/skill-set. Given the longer yield-time and greater cost, how could third party trainers secure similar levels of employer ownership?

8. Adria Powell
   President and CEO
   CHCA

   I am thankful to Steven for taking the time to interview the staff at CHCA and for producing this comprehensive piece. I believe the paper accurately captures the various components of what makes CHCA a unique and successful “Trifecta”: Training Institute, Workforce Development Program and Employer.

9. Katy Gaul-Stigge
   President and CEO
   Goodwill NYNJ

   These papers are helpful as a workforce professional to have the strong examples for sharing within my organization. As a social enterprise the approach to training and advancement has not been through the lens applied at CHCA, but the value for the company and the impact is clear. I wonder how it can apply to retail or other low wage work that does not require certificates to start employment? As always an inspiring example.