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Physician and Nursing Turnover are Symptoms, Not the Disease

October 25, 2017

physician-nursing-tunover.jpgTreating illness means addressing symptoms, but we all know the symptoms don’t go away until you treat the underlying cause. Turnover is not an underlying disease. It’s a symptom. You need to understand and treat the disease, and there’s rarely a single, simple, treatment. You need a holistic approach. If someone is trying to sell you a single, simple treatment, assume it’s snake oil until you are convinced otherwise.

Healthcare has been facing a growing talent shortage for some time and as the unemployment rate continues to decline, finding qualified candidates becomes harder and harder. Organizations are spending more time and money trying to attract candidates.

Related: When Talent Shortage is Your #1 Concern

At the same time, keeping good employees is a challenge. We get calls almost weekly looking for a solution to an organization’s “turnover problem.” Some have teams or committees focused on the issue. The problem, though, is that turnover is not an isolated, distinct problem. The underlying problem is different for each organization and there is no single, magic bullet treatment for it.

Healthcare turnover is a unique problem. First, it tends to be higher in healthcare than in other industries. According to a recent study, “all industries” turnover is 16.7%. The highest turnover is found in hospitality at 25.9%, followed by banking and finance at 19.1%. Then comes healthcare at 18.9%. Manufacturing and distribution, by comparison is at 14.8%. (CompData’s 2015 BenchmarkPro Survey of 28,000 organizations.)

Some studies show that nursing turnover is particularly problematic with young nurses turning over in the first year at a rate of 22%.

The impact is uniquely problematic:

  • Manufacturing produces a product. Hospitality provides a place that IS the product and their staff supports that product. In healthcare, for the most part, human capital IS the product. Physicians, nurses, and nursing assistants provide the core service in healthcare. There is no product that exists separately from the work they do. A hospital building provides nothing to patients – it’s simply the place where staff provide care.

  • Being understaffed puts patients at risk.

  • Being understaffed or constantly training new staff makes it more challenging to manage the numerous changes underway – new technology, new care delivery models, and improvements to the patient experience and quality of care. Turnover makes it difficult to re-design an entire business model!

  • These are complex organizations. Turnover is a growing problem at the leadership level with physicians, nurses, and technical and front line staff. Each group presents different challenges.

Related: The Shocking Cost of Physician Turnover

Are you attracting the right applicants? Are you selecting the right candidates? If the answer to both is yes, then what’s happening once they are on-board? What are the internal and external variables at play?

  • Pay-scale?

  • Employment market dynamics?

  • Workload?

  • A disconnect between employee and employer expectations?

  • Manager style? (The number one reason for turnover is the relationship with the immediate supervisor).

  • A lack of employee engagement?

  • Is the work rewarding?

  • Do employees feel valued and empowered?

  • Do they see opportunities to grow and develop?

Occasionally, it’s not too complicated. We have a small health system that was seeing high involuntary turnover during the on-boarding process. They found themselves firing new front line employees (patient care techs, transporters, dietary staff, etc.) during their initial training because of simple behavioral issues. We found that hiring managers were doing a poor job during the hiring process. They were in a hurry to fill positions. They were not good interviewers and had little objective data on which to make a hiring decision. By implementing an efficient, structured behavioral interviewing program and using a healthcare-specific pre-employment behavioral assessment, we nearly eliminated the problem.

In other situations, the system is targeting engaged front line staff who want to grow and provide a high level of patient service. The problem is they are still hiring managers who don’t value employee engagement and just want dependable people who do the basics. If you hire great employees but make them work for a poor manager, they aren’t going to stick around. In this case, it’s not too hard to upgrade the manager-level expectations and hire to those expectations. 

Related Whitepaper: Front Line Staff, the Patient Experience and Your Bottom Line - Avoiding the "Cultural Hourglass"

More often, though, it’s more complicated and turnover is driven by several of the factors listed above. One of the most successful and holistic approaches we’ve seen was presented in a recent webinar: Attract and Retain Nurses to Build Your Culture – DaVita’s Story

DaVita hires nurses for inpatient, outpatient, and home health settings. The jobs are demanding but rewarding. It’s hard to find nurses, generally, and even more so for these unique services that fit DaVita’s unique culture. DaVita built a comprehensive, holistic approach to attracting, selecting, and retaining nurses. The branding strategy, applicant experience, interview, on-boarding, and on-going training are all designed to attract, select, and develop nurses who provide outstanding care and feel valued..and who will stay. The result? The selection system attracts and identifies nurses who are better performers on the job and they improved retention by 19%!

A Plan?

A holistic and effective approach to turnover starts with understanding the underlying disease. This takes some work but isn’t too complicated. Then, regardless of what you find, consider a comprehensive, holistic solution that:

  • Ties the message you are sending to applicants through your branding strategy

  • Creates a positive candidate experience

  • Targets those candidates who are most likely to succeed and stay

  • Links directly to the on-boarding process and on-going training and development

  • Is an integral part of a larger initiative to build a culture that values and engages employees

Sorry, like most health issues, there is no simple pill. This disease requires some lifestyle changes.

Want to learn more? Read our whitepaper below:

Turnover in Healthcare


Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.