More on Turnover from the Departing Staff Point of View
Cincinnati Children’s Hospital Medical Center (CCHMC) has published their experience with trying to reduce staff turnover. They cite Price-Waterhouse data on turnover which is considerably lower than the data I have found elsewhere, citing a voluntary turnover rate for nurses of 9.6% and for physicians of 6.3%. Like most organizations, CCHMC human resources professionals used annual performance reviews, had promotions and pay raises, and conducted surveys to “optimize engagement of employees.” However, as they entered into the recession in 2007-2009, they found their turnover rate, particularly of key personnel was higher than the national average, and was recognized by system leaders as a key cost and was increasing stress on the remaining employees and the system itself.
CCHMC decided standard methods were insufficiently granular, so they hired an outside party to conduct surveys and to do exit and staff interviews designed to capture the employee’s experience.
“This program was designed to explore supervisor ratings over time, along with turnover rates and costs; to understand employees' overall rating of the hospital compared to the employees' intent to stay and his or her productivity; and to discern employees' real reasons for leaving. When tested research building blocks are in place, a strategic exit interview program will identify issues such employee satisfaction, patient satisfaction, and hospital profitability to see if there's a correlation.”
Perhaps the key finding they reported was:
“It's important to note that the reasons for leaving in the key departments actually varied greatly and changed over time. To see, understand and interpret this data, the departmental report summaries included coded responses as well as verbatim responses detailed by question. Further queries allowed a view by demographic factors in the departments of the hospital in order to find root causes embedded within the verbatim comments. After defining those issues, the team created an action plan for each issue.
Many organizations that are attempting to improve retention make the critical mistake of trying to implement organization level initiatives. Retention and engagement are typically impacted most effectively when actions are taken at a departmental or business unit level. The varied reasons for leaving within the hospital support the notion that specific interventions in the affected areas will have the most impact.”
As would be expected, they found that the solutions which worked in various business units varied based on the information obtained from the exit interviews, (some 4,000 in a five year period.) Sometimes a poorly performing manager had to be replaced, but sometimes it was a matter of building professional ladders for career enhancement or some other tactic. In the five units selected for critical interventions, turnover has been reduced 34%, and they estimate a direct cost savings of $257,000 in the period from 2009 to 2013. Not easily measured, of course, are the benefits of better team performance on factors such as length of stay and patient satisfaction.
While I am sure most hospitals are aware of the costs of turnover, I wonder if there is not a feeling of hopelessness—after all people leave for all sorts of reasons. The CCHMC experience was that their program changed the majority of decisions to leave from dissatisfaction with the organization to personal reasons. If people are leaving happy, it seems plausible that recruiting qualified replacements is easier, as the word on the street will be “this is a good place to work.”
Perhaps part of the problem is the need to cut costs to meet changing payment schemes. Since personnel are a major part of the organization’s cost structure, the temptation may be to let attrition reduce head count and thus save money. The problem, of course, is that the stress on the remaining staff increases, morale tends to go down, and you may end up driving off the “best” staff, and keep only those who can’t find another alternative. This “race to the bottom” is a real risk, but one difficult to see and measure with current methods. Spending money to understand and address why people are leaving when you are in a cost-constrained environment may seem counter-intuitive, put the experience reported by Cincinnati Children’s Hospital Medical Center suggests it works. It will be interesting to see if this approach becomes more prevalent as the shift from “volume to value” continues.
14 May 2016
 Berterman-Gard J, Nelms D, Bork C. Strategic Exit Interviews Reduce Costs and Turnover. Children’s Hospital Today, Summer 2015. https://www.childrenshospitals.org/newsroom/childrens-hospitals-today/summer-2015/articles/strategic-exit-interviews-reduce-costs-and-turnover. Accessed 10 May 2016.
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