Some hospitals aim to improve community health by hiring ex-offenders

Leaders of Sinai Health System in Chicago realized that to boost population health in the poor inner-city communities Sinai serves, they needed to step up hiring of local residents, a significant percentage of whom have criminal records.

“One of the best ways to improve people’s health is to hire them,” said John Figiel, Sinai’s director of talent management. “When you have a job and health insurance, you and your family can access healthcare.”

So about a year ago, Sinai partnered with the Safer Foundation, which works with ex-offenders, to establish an employment referral pipeline with a wraparound support system to better prepare returning citizens for workplace success. It’s called the Sinai Pathway Program.

Last year, Sinai hired 224 local residents through the program—both ex-offenders and other disadvantaged people including those with disabilities—and retained 71% of them. Most were hired for janitorial, food-service, or other entry-level positions, though the foundation said it also has placed nurses and other professionals.

“These folks never had that support at home or on the job,” Figiel said. “That’s what makes this so inspiring, to help them succeed, and they are so grateful. I get excited about this.”

Sinai is one of several hospital systems around the country that have launched programs to hire ex-offenders for both licensed and non-professional positions. Others include Johns Hopkins Health System in Baltimore and Henry Ford Health System in Detroit. MetroHealth and University Hospitals in Cleveland also work with community groups to place people with conviction records.

They report that these hires—whose backgrounds are known only to human resources—generally perform as well or better than people without records.

“I love that our hiring managers aren’t aware that some of their best employees are folks with criminal histories,” said AJ Evans, a talent acquisition consultant at Henry Ford.

It’s part of a growing effort by health system leaders around the country to address the socio-economic factors that largely determine people’s health and well-being. As economic anchors in their communities, health systems increasingly have made investments and built partnerships around economic development, employment and other social determinants of health.

Healthcare jobs generally include insurance, and studies show that people’s health and economic well-being are enhanced by having good coverage.

Advocates hope that the progress made in hiring ex-offenders will continue after the coronavirus pandemic eases and the economy begins to recover.

Unlike Sinai, however, most urban health systems have not made a targeted effort to hire ex-offenders, even though they serve similar low-income, minority communities where a substantial percentage of residents have conviction records.

Health systems are hesitant at least partly because state rules have shifted as policymakers oscillate between punitive and rehabilitative attitudes toward returning citizens. And their top executives may not have made hiring ex-offenders a priority.

There are an estimated 70 million adults in the U.S. who have an arrest and conviction record, with nearly 700,000 people re-entering society from incarceration every year, according to the National Employment Law Project and the Safer Foundation.

African-American adults are 5.9 times as likely to be incarcerated as whites, while Hispanics are 3.1 times as likely, according to 2017 federal statistics.

Healthcare is one of the nation’s largest employment sectors, and until the current economic downturn, the industry faced a shortage of qualified workers for many types of positions.

“It would be difficult to staff up if we weren’t open to hiring ex-offenders,” said Evans at Henry Ford, which five years ago stopped asking about criminal records on its job application forms. “It would be a disadvantage to us to not consider folks with a criminal history.”

But ex-offenders face multiple barriers to finding employment in healthcare, including discriminatory employer attitudes, liability fears, state and federal licensing and regulatory restrictions, and employers’ lack of skill and experience in conducting individualized assessments of job candidates.

Certain types of convictions pose especially difficult challenges, including sex offenses, violent felonies and crimes against children. But it’s possible to place people in jobs where their record isn’t relevant to their core responsibilities, such as keeping former drug offenders away from pharmacy-related duties, said Yariela Kerr-Donovan, senior director of strategic workforce development at Johns Hopkins.

Sinai works with the Safer Foundation to overcome some of these barriers. Under the Sinai Pathway Program, Safer offers employment seekers job search and readiness training, sets them up with educational programs, helps them with child care and transportation issues, and assists them if they need a waiver from state licensing restrictions on hiring people with criminal convictions. After a person is hired by Sinai, Safer’s assistance continues for the first year.

Sinai’s retention record with these employees improved sharply after the Pathway program was introduced last year. Compared with its 71% retention rate in 2019, it kept just 48% of its local hires in 2018 and 36% in 2017.

“In the past, where an employee had an attendance or performance problem, the manager would move toward discipline and termination,” Figiel said. “Now the Pathway program person can step in and help the employee with the issue, which might involve child care or a spouse, and resolve it.”

But for many other hospital systems, restrictive state rules have held them back, said David Zuckerman, director of the Democracy Collaborative’s Healthcare Anchor Network, whose 50 system members are focusing on population health initiatives.

In Illinois, for instance, the Safer Foundation enjoyed success in helping its participants get state licensing waivers to work as direct care workers, said Sodiqa Williams, the group’s general counsel. Then state officials tightened their interpretation of the law, which greatly slowed hospital hiring. So Safer successfully lobbied for a new law last year to ease the waiver process.

Some healthcare organizations also may fear liability for negligent hiring if an employee with a criminal record commits a crime on the job. But experts say the legal risk is minimal if employers thoroughly assess each candidate’s history and their qualifications for the job and keep records supporting their hiring decisions.

Research shows that individuals’ risk of re-offending declines sharply after a few years of good behavior, and that those with criminal records perform as well or better on the job as those without records, said Megan Kurlychek, a criminology professor at Penn State University who has studied this issue.

“Health systems really need to think about creating viable career pathways for the criminal justice population if they’re going to support them in their health and wellbeing,” Zuckerman said. Guidance from state officials on how to hire ex-offenders within the framework of state laws “would be really helpful.”

Still, because of these concerns, some health systems have chosen to encourage vendors to hire local residents with criminal records rather than hiring them directly, as Cleveland Clinic has done through its partnership with Evergreen Cooperative Laundry, Zuckerman said.

They also may be leery about negative public perception of their employing ex-convicts, though that concern could be outdated. “I’m optimistic that attitudes toward returning citizens may be shifting,” Henry Ford’s Evans said.

Strong CEO support is key to hospitals hiring returning citizens, advocates say.

“Without a directive from the top, it doesn’t get done,” said Terrell Williams, co-director of Turnaround Tuesday, an ex-offender support group in Baltimore that has worked closely with the top leaders of Johns Hopkins and the University of Maryland Medical System on hiring people with criminal records. “People go back to their fears about giving people a second chance.”

Johns Hopkins launched a focused effort to hire ex-offenders, disabled people and other previously excluded groups starting in the late 1990s as a response to challenges in filling some jobs. Leaders identified unnecessary organizational barriers that were closing off access, such as the staff’s lack of skill in reviewing criminal records.

The system hired a former Baltimore police officer who could expertly conduct such background checks. It developed guidelines to determine the relevance of an applicant’s criminal background, examining factors including age at time of conviction, length of time between the conviction and the decision to hire, and the salience of the conviction to the security of patients and staff.

Like Henry Ford, Johns Hopkins delays the background check until after applicants have gone through the hiring process and received a conditional job offer. That ensures that qualified candidates receive full and fair consideration before their criminal records are examined.

Some cities and states prohibit employers from asking about criminal records until after they make a conditional job offer. The new federal Fair Chance to Compete for Jobs Act will bar that practice starting in 2022 for federal agencies and private employers that receive federal contracts. That, however, doesn’t cover healthcare employers solely on the basis of participating in Medicare or Medicaid.

“We found we had been missing some very talented people,” said Kerr-Donovan at Johns Hopkins.

For over a decade, 5% of her system’s hires have had a criminal record, including 20% of entry-level hires. A five-year study that Kerr-Donovan conducted in 2009 of almost 500 ex-offenders who were hired showed a lower turnover rate for the first 40 months than for non-offenders. Of 79 people with serious records who were followed for three to six years, 73 were still employed at Johns Hopkins, with only one termination.

Contributing to that successful track record is a recruiting and support program run by Turnaround Tuesday, which offers training sessions every Tuesday to help ex-offenders overcome external and psychological barriers to success. It is continuing virtual sessions on Zoom during the current pandemic.

Over five years, Williams said his organization has placed 830 ex-offenders in jobs with Johns Hopkins, the University of Maryland Medical System and other employers, with an 84% retention rate. The average hourly salary is about $15.

“When the other health systems saw what happened at Hopkins, everyone got interested,” he said. “The most difficult positions to keep people in are entry-level positions, and if you solve that problem for them, that’s a big deal.”

But Williams’ group isn’t content to put people in entry-level jobs. His staff pushes participants to take advantage of opportunities for additional training and advancement within the health systems. “These institutions have career ladders, and you can go from $13 an hour to $67,000 a year. That’s where life becomes more sustainable. Our people have bought homes and sent their kids to college.”

One successful participant is Collie Thomas, now 54, who served 10 years in prison for second-degree murder. Her adult daughter told her about Turnaround Tuesday soon after her work-release in 2013, but she put off contacting the program because she was afraid her record would prevent her from getting a good job.

After finally attending Turnaround Tuesday training, she got a housekeeping job at Johns Hopkins. Eight months later, she spotted an opening in the cardiac care unit and applied. But she scored a little too low on the aptitude test.

Then she happened to run into Ronald Peterson, then-president of the Johns Hopkins Health System, who recognized her from his work with Turnaround Tuesday. She asked him if he could arrange for her to retake the test, which he did. She passed.

After two years in the CCU job, she heard about a position as a peer recovery counselor for patients with substance use disorder. A recovering addict herself, she was interested, and attended a Turnaround Tuesday training session for people in that field. She got that job.

Then last year, she jumped to a higher-paying job at Hopkins working with patients brought to the hospital with assault, gunshot and stabbing injuries. As with the peer recovery specialist job, she knew the territory personally. Her son was murdered in 2002.

“I feel I can change the minds of these kids, when they’re still young, to go to school or get a job,” she said. “When I tried to get this type of help for my son, it wasn’t there.”

Without Turnaround Tuesday, Thomas said she’d probably still be working as a truck stop waitress and living with her niece, like she was when she got out of prison, rather than doing satisfying work for good pay at Hopkins and living in her own home.

“My past is my past; it’s not who I am today,” she said. “I don’t worry about being judged. Those who judge me don’t know me or my story.”