Finding the will and the way: Applying the framework of commitment and capacity to the implementation of career ladders in the long-term care sector.

摘要

This study applies a conceptual framework of commitment and capacity to a demonstration program for promoting career ladders for direct care workers. The framework builds on the literature of policy implementation, workforce development, and the sociology of organizations. It is used to test the proposition that different types of workforce intermediaries, based in community organizations, unions, and community colleges, will vary in particular capacities for implementing career ladders. These capacities include knowledge of low skilled workers and their employers, depth of resources, and capacity to adapt to change. It also predicts that these intermediaries will vary in their effect on employer commitment to training and advancement of low wage workers.;The study builds comparative cases of long-term care employers paired with community-based organizations, union-based training entities, or community colleges. An additional case is included of employers relying primarily on staff resources rather than external organizations to implement career ladders. The implementation of career ladders is analyzed in each case to determine what supports and barriers to implementation arose, whether these supports and barriers varied for different partners and approaches, and what capacities and commitment factors were salient in each case.;The study found relatively little difference in implementation across cases, though the partnership of employers and community colleges exceeded others in performance measures. The chief exception was the union-based case, which underperformed, due to low employer commitment and poor labor/management relations. All cases experienced similar barriers: low organizational capacities of employers, low performance capacities of intermediaries, educational and personal barriers of workers, and above all, uneven commitment by employers to implementing career ladders. The intermediaries also were similar in supporting capacities, with variation in a few specific areas: community based organizations for linking nursing homes to diverse networks of services; union educators for their accessibility to low-wage workers, and community colleges for their depth of resources and program capacity. Further research could test these findings over a longer period of implementation, with greater uniformity of interventions.