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Uncovering a stealth summit on the health workforce crisis

Why were reporters – and worker bees – not invited to the conversation?

Photo by Richard Asinof, taken as a screen shot from Facebook Live recording

Gov. Dan McKee promoted his proposed FY 2023 budget proposal at the health care workforce summit held on April 1, in an appearance that was not posted on his daily public schedule.

By Richard Asinof
Posted 4/11/22
A stealth health care workforce summit was held on Friday, April 1, with no news media invited, to discuss potential strategies to resolve the current workforce crisis in health care. In PART One, ConvergenceRI sets the stage for connecting the underlying economic barriers around racial and cultural equity, the unsustainable nature of the current health care service delivery business model, and the failure by the R.I. General Assembly and the Governor to raise low Medicaid reimbursement rates. Translated, in an election year, it is all about politics.
If a new Governor is elected in the November elections, how will that reshape the current leadership of economic and health and human services agencies in Rhode Island? How big a problem is the fact that much of the data currently being used by the R.I. Department of Labor and Training is apparently based on pre-pandemic projections? With some 352,000 Rhode Island residents enrolled as Medicaid members, more than one-third of the state, what does that say about the great divided between the haves and the have nots? How many of the people who were invited to attend the health care workforce summit make an annual salary at or below the median salary of $40,000 for someone entering the health care workforce? How many of those attending the health care workforce summit were enrolled in health insurance plans paid for by their employer?
All too often, a reporter is placed in the position of dutifully recounting what happens and what is said at staged news events – gatherings, press conferences, briefings, walking tours – and asked to rewrite what government officials put out in news releases as gospel. What is presented on Facebook and Twitter and other social media platforms – and on podcasts – has become the grist for the way that our news feed is fed to us. So much ends up being misinformation or disinformation or distractions from the real stories.
The choices we have – about what trough to feed at – and, as a reporter, what events to attend, are often not great choices.
Being honest, it is frustrating as a journalist with great knowledge of the health care industry not to be able to be invited as a participant in a health care workforce summit. We are expected to be willing accomplices to dutiful report what others want us to report – and not bite the hand that feeds us. The “mother and father know best” that stakeholders assume presents the biggest threat to what appears to be a political tsunami that promises to upend the status quo in this fall’s election.

PART One

“The biggest blind spot [in higher education] is the belief that our problems can be solved by technical experts.”

– Ed Wingenbach, Hampshire College president

PROVIDENCE – For much of the past week, ConvergenceRI has been trying to slog his way through watching four and a half hours of a taped Facebook Live event, the “Healthcare Workforce Summit,” held on Friday morning, April 1, at the Nursing Education Center at South Street Landing.

The gathering was sponsored by the R.I. Office of the Postsecondary Commissioner, in partnership with the R.I. Executive Office of Health and Human Services and the R.I. Department of Labor and Training, with financial support provided by the Rhode Island Foundation.

[Editor’s Note: These days, the Rhode Island Foundation appears to be everywhere at the intersection of health care, private industry, and government, The community foundation with approximately $1 billion in assets underwrote the work of the R.I. Health Care Cost Trends Steering Committee analysis that was presented by the R.I. Office of the Health Insurance Commissioner on Tuesday, March 29. See link below to the ConvergenceRI story, “The bigger disconnect.” The foundation is supporting the Steering Committee’s efforts to have the R.I. General Assembly fund its future work.

A week later, on Tuesday, April 5, Neil Steinberg, the president and CEO of the Rhode Island Foundation, appeared together with Gov. Dan McKee and Lt. Gov. Sabina Matos, serving lunch at Amos House, to promote the $10 million line item in the Governor’s proposed FY 2023 budget to support nonprofits in the wake of the coronavirus pandemic.]

Attendance at the summit was by invitation only – but exactly who got invited to attend has not yet been made public. The goal of the gathering, as explained at the conclusion of the summit by Ana Novais, assistant director at the R.I. Executive Office of Health and Human Services, was to create the impetus for a new public-private stakeholder group, in the public interest, to develop a collaborative approach to breaking down silos in order to develop an action plan to address the health care workforce crisis.

Call it a stealth summit – at which a group of select, elite stakeholders from the health care industry, higher education, labor unions, and trade associations met to chart strategies for a future health care workforce in Rhode Island. No news media were invited to attend, and, apparently by design, there were few if any participants at the summit could be described as “worker bees” from the front lines of health care.

The roughly 60 or so participants spent the morning-long summit in small groups of five or six people huddled around horseshoe-shaped tables, facing large, high-tech screens, with participants connected to the Slido app.  [Only one participant was observed by ConvergenceRI to be wearing a mask, in watching the video replay.]

R.I. Gov. Dan McKee made an appearance to kick off the summit, but for some reason, the appearance was not listed on his public schedule. In an election year, it had the “appearance” of a campaign event, in ConvergenceRI’s opinion, at which the Governor busily promoted his own agenda.

In his brief talk, Gov. McKee hyped his proposed FY 2023 budget, saying that it contained all the funding necessary to support initiatives around job training and education. “Take a look at our budget,” the Governor urged, saying the money was in the budget to support the creation of learning centers in any community that wanted them. The Governor also urged participants to look at the 2030 plan that his administration had put together to chart a vision for the state's future.

The problem, of course, was what was not in the Governor’s proposed FY 2023 budget – his budget contained no plans to increase the low Medicaid reimbursement rates, which roughly 80 percent of participants attending the summit had identified as a primary root cause of the health care workforce crisis afflicting Rhode Island. Was that a working definition of cognitive dissonance in 2022, ConvergenceRI wondered?

Hush-hush?
It is no big, hush-hush secret that the health care delivery service industry is suffering from a health care workforce crisis. There are simply not enough workers [supply] to fill all the jobs needed [demand] to work on the front lines of nursing homes, hospitals, and community health centers. In response, many hospitals have turned to for-profit traveling nurse businesses to fill out their staffing needs – paying exorbitant rates to keep the inpatient beds staffed.

It is also no big, hush hush secret that the roots of workforce crisis are intimately tied to issues of low pay and equity – the workers who are making the lowest wages in health care are predominately people of color. One of the key presenters at the health workforce summit was Sandra Victorino, director of Workforce Development, Diversity, Inclusion, and Community Relations at Care New England. Victorino shared her own compelling career story as a way to illustrate the difficulties of overcoming racial and cultural equity barriers. The ubiquitous Steinberg provided the introduction to her talk.

Among the other presenters were Hannah Maxey, from Indiana University’s Bowen Health Workforce Research Center, and the founder and principal of Veritas Health Solutions, Inc.

Maxey would remark, later in the workshop, after hearing a presentation from Megan Swindel, director of Data and Performance, at the R.I. Department of Labor and Training, and Dana Brandt, the interim executive director of Data Spark at the University of Rhode Island, who had shared data showing that only about 26 percent of those who attend college in Rhode Island in health-related majors stay to enter the state’s health care workforce, in an apt description of Rhode Island’s higher education system: “You guys are like the farm for a lot of other states,” Maxey said, describing what is known as brain drain. “You are cultivating a workforce that is leaving your state, and that is a big problem.”

Maxey also raised a question about an important gap in the health care workforce summit attendance list. “Is there anyone here from state government that represents K-12 education today?” she asked. “Because I think that is a huge gap, because K-12 is your pipeline. Your public schools should be the place where information about scholarships are shared.”

Maxey continued: “I would challenge you all to ask: who’s not here who absolutely needs to be part of this conversation. Because if K-12 is not here, that is a big gap, and [the responsibility] can’t all be on postsecondary education and community partners.”

Were the right people in the room?
It was somewhat surprising, after listening to the nearly five-hour recording of the health care workforce summit, with Maxey’s comments ringing in ConvergenceRI's  ears, to recall that Neil Steinberg, the Rhode Island Foundation president and CEO, had tweeted out praise for the summit, saying: “The right people are in the room and will plan to do the right things to address these needs for ALL in RI. Thanks Gov Dan McKee for setting a positive tone.” “Really?” to quote WPRO’s Steve Klamkin.

When ConvergenceRI reached out to sources who had attended the summit, to ask them to respond to Steinberg’s tweet, if, in their opinion, were the right people in the room.

“The room was full of representatives of higher education, providers, trade associations, labor, third-party payers, and government departments – EOHHS, DLT, the Governor, etc.,” one source told ConvergenceRI.

“The presentations were thoughtful and focused on the issues,” the source continued. “The final activity was brainstorming issues at each table to develop short and longer term goals to address workforce challenges and action steps to make meaningful progress toward those goals,” adding, in conclusion, “It was a worthwhile event.”

A second source told ConvergenceRI that, for the most part, “the people who were there represented organizations who should be part of a workforce development conversation, and that the governor’s presentation was positive.”

The answers provided by the sources reflected the view that the conversations at the health care workforce summit were worthwhile.

But, there is always a difference between those who are inside the room when the conversations happen, and those who are on the outside, with their noses pressed against the glass, looking in. No one working in state government can be expected to publicly criticize the Governor, and few nonprofit agency executives are going to criticize the work of the Rhode Island Foundation.

The bigger questions that loom, however, have to focus on why no news media was invited to attend the summit, and what was actually said during the summit. No news media source in Rhode Island other than ConvergenceRI is pursuing the story, which is divided into three parts.

In PART One, ConvergenceRI sets the stage telling the story about what happened and why it was an important story – even if the story of the stealth summit was “ignored” by the rest of the news media in Rhode Island.

In PART Two, ConvergenceRI shares the process of what might be called the different stages of good reporting: asking the right question to the right people, being persistent in asking follow-up questions.

In PART Three, ConvergenceRI captures some of the dialogue of what was said during the summit, following an exhausting exercise of listening to nearly five hours of a taped presentation.

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