When it comes to employee retention, in business generally and healthcare specifically, the first thing to keep in mind is this: It’s not just about the money … though that certainly helps.
Yes, it matters if a hospital or skilled nursing facility offers a competitive compensation package. It goes without saying that if such an organization is not on par with others — in terms of salary, benefits and other perks — it will have a hard time holding onto people. But it is far from the only factor affecting turnover.
Engagement matters. Recognition matters. Making sure workers are able to maintain a healthy work-life balance matters. And leadership really matters.
Nursing Solutions, Inc. issued a report concluding that hospitals’ turnover rate in 2017 was 18.2 percent, its highest of the decade. The report went on to note that the average cost of replacing a bedside registered nurse is $49,500, and that the average hospital loses anywhere from $4.4 million to $7 million as a result.
There is, however, some dispute as to the actual cost of replacing an employee, in any business. One study calculated that it takes between six and nine months of a salaried employee’s pay to fill the breach, while others believe it can be twice the annual salary of such an employee.
Still another study broke it down according to where workers stood in the pecking order, noting that the cost of replacing someone in a low-paying job ran to 16 percent of that person’s salary, and put that total at 20 percent for a mid-range job and a whopping 213 percent for someone at the executive level.
Also to be considered are the outlays for such things as advertising and interviewing, as well as those for onboarding. On top of that is the gap in productivity between an established worker and a newcomer. And finally there are unseen costs, such as those involving training and that which might be due to errors made by new arrivals as they get up to speed. It has also been surmised that there is an impact on a company’s culture when someone comes or goes — that certain employees might disengage at some point during the transition. (Also to be considered are potential disruptions to patients’ routines, who of course grow used to certain staffers.)
Suffice it to say, then, that the costs are considerable, not to mention constant. A 2017 report indicated that 37 percent of healthcare professionals plan to depart their current posts within two years, 68.6 percent within five. The primary reasons cited were time-related — the unpredictability or burdensome nature of their schedules, or a lack of flexibility within the workplace.
Another report put the onus squarely on management, saying that 80 percent of the time employees depart because in their estimation the manager is not up to snuff. Moreover, fully 25 percent of employees say they would take a better boss over a raise.
So managers can set the tone. They can serve as conduits from the C-suite, communicating to the rank and file the organization’s vision and direction. They can establish the culture, make workers feel wanted and yes, hold the fort when it comes to that slow (and costly) leak of talent.
Finding good managers, then, is the first order of business for any employee-retention strategy, which the vast majority of hospitals view as important but less than half actually get around to implementing. Unearthing such people is easier said than done, however; just 39 percent of the employees responding to one study pronounced themselves “very satisfied” with their immediate supervisor.
Too often healthcare facilities promote the top nurse into a management role, without any regard for his or her leadership ability. That is a temptation best avoided in most cases, as there is a raise-all-boats aspect to installing the right person in a managerial role. Capable managers tend in turn to hire the best employees — employees who show such characteristics as optimism and resilience — which does not go unnoticed by existing staff. Sufficiently heartened by the competence of those around them, their level of engagement is that much greater.
And engagement, defined by the HealthStream Engagement Institute as “an individual’s cognitive, emotional, and behavioral connection with an organization’s mission, vision, and values,” is an enormous driver of retention. One report ascertained that engaged employees are 87 percent less likely to depart than those who are not, and placed the gap in operating income between an engaged and disengaged employee at 52 percent.
How does an organization promote engagement? Let us count the ways:
- Senior moments: It is essential that the senior team reach out to staffers — make an honest-to-goodness attempt to engage them on their level, in order to gain a greater understanding of the daily challenges they face. I visit each of The Allure Group’s six facilities every week, as do others on our senior team. We listen to our staff’s concerns (as well as those of our residents), and act on them.
- Cutting-edge culture: Giving staffers the most up-to-date tools is also critical to engagement, and something else that is central to the Allure ethos. In recent years we have implemented all manner of technological innovation, including EarlySense, a contact-free patient monitoring system, ConstantCare e-vitals (which allows for the sharing of patients’ vital signs to their electronic medical records), various robotics to aid in patient rehabilitation and TeleHealth Solution, a telemedicine platform.
- Saluting success: There are various ways to recognize outstanding performances on the part of employees — recognition dinners, awards, extra time off, shoutouts, etc. A prime example came in June 2018, when Allure CEO Joel Landau surprised each of the 250-plus employees of the Harlem Center with a $1,300 bonus. It’s also important to be mindful of staffers’ personal milestones, like birthdays and anniversaries. Anything to make them aware that they are valued, and part or a larger whole.
- Clear a path: The importance of professional development cannot be overstated. Indeed, one of the things with which employees were least satisfied was the opportunity to develop new skills. Knowing they have a chance for advancement — that there is a training program in place that will help them achieve their career goals — is yet another key to promoting engagement.
- The balancing act: Promoting a healthy work-life balance in healthcare is admittedly trickier than in other businesses. It is, for instance, far more difficult to allow those who work in most healthcare fields to work from home. What is possible, for the most part, is to allow some schedule flexibility — to give a nurse three 12-hour shifts and four days off in a given week, as an example. That gives the worker more consistent access to patients, in addition to more downtime.
In sum, retention will always be a challenge. But it is one that can be met by putting the right people in the right positions, supporting them and creating the best culture possible.