Amanda K. Spagnolo of Endeavor Health: Building New Pathways to Careers in Healthcare

Amanda K. Spagnolo

Director of Education Policies and Procedures, Medical Group

Endeavor Health

Amanda Spagnolo is the Director of Education Policies and Procedures for the Medical Group at Endeavor Health, a nonprofit integrated health system in the Chicago metropolitan area. With over 18 years of nursing experience, she is committed to the training and development of new talent. Read on to learn how an apprenticeship program is allowing Endeavor Health to create new and innovative career pathways into healthcare.

What is your role at Endeavor Health?

I am the Director of Education Policies and Procedures for the Medical Department. I've been a nurse for about 18 years, and I started in pediatric oncology in an inpatient unit in Indianapolis. After roles as a travel nurse, a camp nurse, and eventually, an infusion nurse at Pittsburgh, I decided to go back to nursing school because I realized that I really enjoy training. That interest is what has brought me to the role I’m in today.

 In my career, I've worked at many organizations, but this is the first where I felt I could actually grow, not just fill a position.

What is it like to work at Endeavor Health? What makes it special or unique?

I would say working at Endeavor Health has been a little bit of an adventure because I feel like I've been constantly growing, and every role that I've been in has evolved. In my career, I've worked at many organizations, but this is the first where I felt I could actually grow, not just fill a position. At Endeavor, we are committed to helping our people develop, and this mindset is what birthed the apprenticeship program.

What challenge were you aiming to address when the program was first launched?

We were drowning in staffing shortages. Like many healthcare organizations, we didn't have enough medical assistants, and projections showed it would only get worse. We needed a fast solution that addressed both immediate needs and created a sustainable talent pipeline for the future–this is where the Medical Assistant Apprenticeship Program came in.

Although we first thought that it was probably best to follow the curriculum based on how long traditional school is, we quickly realized we could do things our way, so we tailored the program to our own needs.

How is the Medical Assistant Apprenticeship Program structured?

We divide the learning into two parts, with apprentices spending approximately half of the program in the classroom and the other half working in a clinical setting. During the first three weeks, we say that the apprentices are in boot camp because they are entirely in the classroom. Our goal at this stage is to ensure apprentices learn both the soft and hard skills that come with the job–for example, knowing how to room a patient while being courteous and professional.

Once they’ve made it through boot camp, we send our apprentices out to one of the rotations, where we balance learning by having apprentices spend two days in the classroom and three days on-site; this gives them a chance to put everything they’ve learned into practice and undergo skill checks to determine competence.

How did you design the curriculum to prepare apprentices quickly and effectively?

Initially, we designed the program as a nine-month program. Over time, we’ve evolved it from a nine-month program to a 16-week program, which is much shorter. We realized that 16 weeks was enough time to cover the content and skills we think every medical assistant should have. Although we first thought that it was probably best to follow the curriculum based on how long traditional school is, we quickly realized we could do things our way, so we tailored the program to our own needs. Once hired into their specific positions, apprentices may gain additional skills based on their specialty, but we ensure that all of them have the same baseline skillset.

What qualities are you looking for when recruiting for the apprenticeship program?

One of our key factors is whether they have a long-term goal in healthcare. Sometimes, we'll have candidates come in and mention that they eventually want to become, say, a police officer. While we admire their goals, we want to hire individuals whom we can retain and assist in developing their desired careers within the healthcare field. 

From there, we want to get a sense for their soft skills. For example, can they show up on time? We understand that assessing reliability during an interview can be challenging, but we make an effort to ask relevant questions. We also ask ourselves about the kind of worker they are, whether they have problem-solving skills, if they can de-escalate, and whether they can take feedback well. We strive to get the full picture.

What challenges have you encountered in running the program? How have you overcome such challenges?

There have definitely been challenges, like with any new project. There are a lot of speed bumps. One of those was the length that we talked about. Another has been deciding placements. 

Initially, we brought together our recruitment team, myself, and the educator in the classroom. We began by analyzing our needs and where the best fit for apprentices might be. Then, we attempted to assign the apprentices ourselves based on that information. After a couple of times doing that, we got some feedback from the managers; they felt they were being left out of placement choices. We also noticed our apprentices were not getting good fits either. 

As a result, we decided to implement a round-robin system. The educator in the classroom deserves all the credit for this idea. She arranged for the apprentices to attend an interview day where all of our managers and supervisors were present, and they sat in groups so that each apprentice could move from one group to another and meet everyone. When we were done, we had all parties fill out a survey. After everyone filled out their surveys and the apprentices left, we sat down with our recruiter and managers to collectively decide where the apprentices should be placed. Since we've done that, we've seen a lot less movement between sites.

What support does Endeavor provide apprentices?

The position is a full-time, paid, and benefited position. This is their job: to go to school here within the organization-provided program. Something that's very unique to us is that we are paying them like any other employee. Part of their 40-hour workweek includes coming to the classroom to ensure they are studying and completing their assignments. We only require the apprentice to buy a couple of things: A stethoscope, a blood pressure cuff, and a watch with a second hand, that's it. 

Post-apprenticeship, we ensure that tuition reimbursement and all other benefits for employees are available to our apprentices, as they are full-time, paid and benefited employees.

If we were to compare our apprentices to our own traditional medical assistants, our stay percentages are noticeably higher.

What are the long-term employment outcomes like? Has your organization calculated the program’s ROI?

If we were to compare our apprentices to our own traditional medical assistants, our stay percentages are noticeably higher. In our first year, we observed that our retention rate was ~22% higher than the system average, and overall retention was 12% higher.

We are just getting to the point where we can calculate ROI. In terms of dollars spent and saved, we estimate that the improvement in apprentice retention has saved the organization over $100,000/year.

Do you have any program success stories you'd like to share?

Several years ago, I had a student who was a high schooler, and she was participating in a workforce development class. She knew she wanted to pursue a career in healthcare, so her high school assigned her to me. I had her with me for two years, her junior and senior years, and she had a big vision, which included attending nursing school. 

After she graduated, I was really excited for her and decided to reach out and check in. I assumed she had just started school based on the plans we had discussed in the spring. When she responded, however, she mentioned that she was actually working at a pizzeria, and that school hadn’t worked out because her family couldn't afford it. I was really disappointed to hear that she was unable to pursue her dreams. 

At the time, we were a few cohorts in, and I told her verbatim, "Hey, you should apply, and then this is how you can go to nursing school eventually." She applied and was accepted. Today, she's a medical assistant on our team and is enrolled in nursing school and doing very well for herself. 

I want to see everybody have a chance. We know that everyone has different levels of access to opportunities, so we want to bridge that gap by creating opportunities.

What made you decide to operate this program in-house?

We actually met with a few different organizations to learn about apprenticeship opportunities that were offered, and whether we could make it work with our organization, but ultimately, things kept getting held up in our legal department. Because of this, we began to wonder if we could do it ourselves. From there, we started thinking about the how and decided to go down our own route. As our efforts kept evolving, we arrived at where we are today.

What advice would you give other employers starting their own program?

They should first secure buy-in from their leadership, especially executive leadership, to ensure they can get organizational support. For us, creating a proposal that compared current spending to potential future costs and savings allowed us to convince our leadership that this was a worthwhile investment.Second, make sure your in classroom educator is empathetic, honest, creative, and organized.  Our program would not be where it is today without our classroom educator. 

Why is this work important to you personally?

I want to see everybody have a chance. We know that everyone has different levels of access to opportunities, so we want to bridge that gap by creating opportunities. I’m passionate about seeing people grow into their best selves.