Healthcare Worker Retention

1
Healthcare Worker Retention

• Marc Luoma Pamela Foster
• TRG Inc., PRIME II

2
Agenda

• The need to focus on healthcare worker retention
• Causes of retention and turnover
• Practical work in the field
• QA

3
What about you?

• For specific jobs youve quit, write down the 1
  or 2 biggest reasons you quit.

4
The Need

• Demand on the system is increasing
• HIV/AIDs
• Diseases that previously were controlled
• Large cohorts entering reproductive age

5
The Need

• Ability of the system to respond is decreasing
• Supply issue fewer applicants to schools
• Lower recruitment
• Retention

6
Retention Issues

• Reductions in force due to budgets
• Sickness and death of healthcare workers
• Competition with the private sector
• Competition with more-developed countries

7
Need Evidence-Based Approaches for Retention

• WHO exploring policy options
• Some developing-country research
• Lots of research from developed countries
• Presents a good starting point

8
Retention Quiz

• Individual task
• Select answers to the 6 retention questions
• Record your answers on the quiz
• Plenary
• Review each question
• Discuss answers
• Prizes!
• Grand prize-highest scorers

9
1. Happy, satisfied workers are more likely to

• Work hard
• Perform well
• Remain on the job
• All of the above

10
1. Happy, satisfied workers are more likely to

• Work hard
• Perform well
• Remain on the job
• All of the above

11
Retention/Turnover Model
Job Satisfaction
Intentions
Retention
12
Retention/Turnover Model
?
Job Satisfaction
Intentions
Retention
13
2. Job satisfaction is related to

• Salary
• Supervision
• Work stress
• All of the above

14
2. Job satisfaction is related to

• Salary
• Supervision
• Work stress
• All of the above

15
3. Rank in importance

• Absolute level of salary
• Perceived equity of salary
• Subsistence level of salary
• Frequency of increase of salary

16
3. Rank in importance

• Absolute level of salary (4)
• Perceived equity of salary (2)
• Subsistence level of salary (1)
• Frequency of increase of salary (3)

17
4. Which is most important for retention?

• Supervision frequency
• Perceived caring of supervisor
• Perceived fairness of supervision
• Quality of performance feedback

18
4. 4. Which is most important for retention

• Supervision frequency
• Perceived caring of supervisor
• Perceived fairness of supervision
• Quality of performance feedback

19
Supervision and retention

• People dont quit jobs, they quit bosses.
• Its the managers, stupid.

20
5. Biggest cause of stress for nurses?

• Inflexible schedules
• Lack of training
• Relationships with patients
• Relationships with doctors

21
5. Biggest cause of stress for nurses?

• Inflexible schedules
• Lack of training
• Relationships with patients
• Relationships with doctors

22
6. Which is more important in developing
countries?

• Connection with community
• Administrative policies
• Location of work site
• Personal growth opportunities

23
6. Which is more important in developing
countries?

• Connection with community
• Administrative policies
• Location of work site
• Personal growth opportunities

24
Community Connection

• Physical environment (building, water, etc)
• Demand for services
• Willingness to pay
• Personal safety

25
Job satisfaction influences

• Salary
• Level
• Process
• Raise amount
• Indirect benefits
• Work content (importance)
• Career enhancement
• Organizational support
• Feedback from supervisor

• Clear goals
• Amount of responsibility
• Degree of autonomy
• Caring supervisor
• Job security
• Job title
• Opportunities for development
• Physical environment
• Committed co-workers
• Affiliation

26
Emerging Better Practices

• Recruit and place provider in home villages
• Compulsory rural service
• Financial incentives
• Hardship allowances for rural work
• Tuition payback by rural work
• Community connections

27
Lessons Learned

• Context of Intervention
• Ministries of Health
• Tanzania
• Government
• Department of State
• Private Sector
• CTAM

28
Actionable Issues

• Leadership Accountability
• Issues arent confronted directly
• Negative/corrosive organizational culture
• Vibrant rumor mill
• Little recognition or positive feedback
• Complaining with no offering of solutions
• Organizational structure problems
• Unclear roles
• Fixation on hierarchy
• Unsatisfactory conditions of service

29
Suggested Actions for Improving Retention

• There is no silver bullet no one thing that
  will improve retention. It is a series of
  things, in need of persistent renewal (e.g.,
  periodically taking the pulse of the
  organization).

30
Suggested Actions for Improving Retention

• Leadership
• Envision and describe together elements of a
  positive organizational culture develop
  indicators of such a culture
• Distinguish between good turnover (disgruntled
  employees or poor performers who leave) and bad
  turnover (good performers who leave because of
  organizational performance issues)
• Distinguish between individual, small group and
  organization-wide problematic behavior and
  respond appropriately

31
Suggested Actions for Improving Retention

• Leadership
• Act as role models, develop mentoring/supportive
  relationships with your staff
• Address conditions of service where possible not
  all remedies are costly

32
Suggested Actions for Improving Retention

• Negative/Corrosive Organizational Culture
• Conduct an assessment- talk to people to hear
  their thinking about the organization identify
  key issues
• Clarify roles, remove hierarchical barriers
• Provide accurate and timely information (to cut
  down on the rumor mill)

33
Suggested Actions for Improving Retention

• Negative/Corrosive Organizational Culture
• Provide coaching around specific in-unit issues
  that create work blockages and unsupportive
  environments.
• Offer specific training in giving and receiving
  work assignments, feedback, managing disagreement

34
Suggested Actions for Improving Retention

• Working with New Employees
• Re-examine hiring criteria and enhance
  interviewing skills. Look to hire for retention
  purposes (not only technical, team skills,
  experience managing challenges effectively,
  positive outlook)
• Develop and implement an orientation for new
  employees.
• Provide coaching and mentoring as
  needed/requested

35

• Remind yourselves and others that this
• is an on-going effort. Search for and
• celebrate examples where positive
• changes have occurred.

36
(No Transcript)
37
Q A?