Please don’t go!

Neil Eastwood gives his perspective on how to address issues of staff turnover, drawing on examples from US care settings. This article first appeared in Care Management Matters December 2014

‘I’m leaving’

It’s a phrase that’s not easy to be told in any situation, but according to recent surveys, such as the National Care Forum’s 2014 Personnel Statistics Report, if you are an employer in the care sector, you have been hearing it more frequently in the past year. The National Care Forum’s survey on members provides a snapshot staff of turnover, vacancy rates, age, qualifications, sickness absence, reasons for leaving, agency spend, zero hour contracts and recruitment from outside the UK. According to the findings, turnover rates continue to average close to 20 per cent although some improvement seems to have occurred. However, worryingly, the ‘churn’ rate is up for the third consecutive year, with 38.8 per cent of staff leaving within one year of appointment and 65.5 per cent within two years. In homecare, the figures are even higher with 47.4 per cent leaving within one year and a staggering 73.5 per cent within two years.

Understanding the situation

If you are like most employers, you will wonder what could have been done differently each time a valued member of staff tells you they are leaving. A similar question will be in your mind when you have to undertake a dismissal. Of course, workforce departures can seem like a series of isolated disappointments, each with its own seemingly unique circumstances. There is rarely time to explore underlying causes before you have to move on to dealing with the consequences – the potential impact on clients, recruiting to replace them and adjusting rotas. No wonder it’s easier to simply accept it and move on. Managing a care workforce is a messy business. It’s not possible to ever get it completely ‘right’. Despite the seeming complexities, ambiguities and unknowns associated with the unexpected ending of an individual’s employment, I have discovered through my research of the US care sector that there are common themes and measurably successful interventions. I want to bring you some fresh retention perspectives based on studies of what US providers are doing. That is not to say that the resources already available to you here through respected organisations such as Skills for Care are not effective, rather that I will assume you will already be familiar with them. I hope to add to the debate.

Why do care staff stay or leave?

As a starting point, it is helpful to understand the range of factors that influence whether a frontline care worker stays or leaves you. If you haven’t done this exercise yourself, let me tell you it leaves you wondering how your turnover can be so low. The lists below show some of the contributing factors that US managers cite. I have adapted certain elements for a UK audience: Personal factors – Outside work Demographics Health Transport Financial Relocation Values Aspirations Motivation Family Education level Job Experience Job stress Physical requirements Personality fit Workplace attitude Relationships with colleagues at all levels Engagement Workplace injury Employment factors Pay and benefits Training Hours, location Communications Culture Recruitment Policy Leadership Ownership Employment Practices External factors Alternative jobs Competitors Government Policy Economy Public perception/Media Societal norms This process of mapping potential causes of staff loss allows you to identify the factors that are fully or partially within your control and those that are not. This enables you to focus on the things you could do to improve staff retention. In addition, you may start to see patterns that apply to your organisation based on considering your recent leavers against these triggers.

US Retention Findings

There are real similarities between the UK and the US care sectors and there are some key retention findings from a number of US sources and studies that can be easily applied to UK care businesses. The starting point for much of my work was to study the recruitment process in the US. Recruitment is so important to care providers and good recruitment can lead to good retention.

• Best practice recruitment is a fundamental driver of retention. If you select mainly suitable and reliable staff, that is, in my view, the single biggest contributor to long job tenure. New sector-specific candidate screening tools can play a role along with values-based interviewing, for example.
• The first 90 days of employment are critically important. Norms are set and impressions are made particularly in the first few weeks of the job. This is when the implied promise made to the candidate needs to be honoured. Exemplar care providers in the US ensure that during this period their management are regularly visible to new starters, that their opinion is actively sought and each new member of staff is assigned a mentor.
• Caring attracts them, a lack of respect pushes them away. The adage ‘people don’t leave their jobs, they leave their bosses’ holds doubly true in social care. The best care staff are relationship-centric people. Pay is not their biggest motivator. In the pressure of a busy care setting it is too easy for supervisors to communicate poorly or show a lack of humility or empathy towards team members. This would be damaging to any workplace relationship but for those who care for a living, it is toxic. A number of studies in the US have demonstrated the positive impact of communication training to instil a culture of respect. The impact on retention levels has been dramatic.
• Factors that drive retention are not always the same as those that drive staff turnover. The reasons that keep care staff in a job can be different to those that push them to leave, so when considering interventions it is important to be clear what you are attempting to address.
• Job satisfaction is not enough. Many care businesses poll their staff to measure job satisfaction but a recent study into the determinants of job tenure in homecare workers in Maine found that this measure was actually very similar between leavers and stayers. Job engagement is a much more valuable metric.
• Age is a predictor of employment tenure. US experience seems to suggest that older workers are more likely to stay longer, particularly if there is uncertainty over a consistent income. Younger staff may be more reliant on a minimum earnings level whilst those without dependent children and perhaps with other sources of income can be more flexible. This is particularly noticeable in homecare settings. There was also evidence of younger staff seeking career progression to a much greater extent than those later in life.
• Some attempts at staff motivation can actually be detrimental. There are distinct differences between recognition and appreciation. For genuinely caring staff, appreciation (a personal communication that they are valued within the organisation) can be a more effective engagement tool than recognition (praising their ‘external’ performance often to other staff) because they are relationship-centric individuals. In many cases, attempts at recognition can actually be damaging. For example, you may operate an ‘Employee of the Month’ scheme but often high quality care is delivered away from direct supervision so awards based solely on acts that were observed by other staff can be seen as arbitrary and unfair. Perhaps your employee recognition effort is actually motivating only one employee whilst demotivating the others.

Some practical interventions Much of what has been covered here will be of relevance and interest but it is one thing to be interesting and quite another to be of actual material value. For that to happen then work practices have to be changed. That is not a trivial thing to do in a busy care setting. I have suggested below a few interventions to consider, from the relatively simple to implement, to the more ambitious.

Quick fixes

1. Ensure you stay in touch with ‘good leavers’. In US tests, three out of ten leavers returned to their employer because there was on-going communication.
2. Be sure to send a personal note of appreciation home to all ‘good’ staff at least once a year. This will not only be motivating to them but will also be seen by a spouse or partner who can often be the one encouraging them to leave.
3. Involve frontline staff in a taskforce or some aspect of your operation outside of their core duties. A great example is to get them to meet prospective new staff and answer questions about the work. This will make them feel valued and empowered and differentiate your company to applicants.

Medium-term actions

1. Put your supervisory staff and schedulers on a communication and active listening course. This will help to reduce disputes, conflict and lower turnover of both frontline care staff and supervisors.
2. Review your incentives and motivation schemes. If you have an Employee of the Month award, get staff feedback on whether it is doing what you intended. Consider introducing more personal appreciation mechanisms.
3. Upgrade your recruitment process. To improve retention, it is important that you minimise the recruitment of unsuitable staff through poor attraction and selection. In many cases, weak attraction leads to a limited choice of candidates and pressure to offer a job to the only applicant.

Longer-term strategies

It may be necessary to consider a fundamental culture change towards one of mutual respect and empowerment. This would include reviewing leadership, workplace practices and communication methods. Whilst this is a big commitment, it may be the right approach for some organisations. High staff turnover is a cycle that can be broken. Consistency of care staff is crucial to the people you support. Although it may feel that there isn’t time to step back and analyse the situation, by doing so and taking steps to recruit the right people, motivate your staff and build on their reasons for working with you in the first place, you can build a good team that you can retain for years to come. Neil Eastwood is Founder of Sticky People Ltd.