How we are helping identify how to reduce employee turnover in the NHS

We work with several organisations to help them identify how to reduce employee turnover in the NHS. This case study outlines how we have helped one particular Trust identify how to reduce employee turnover and improve employee retention. We have anonymised all the data and not made reference to the name of the Trust itself.

For example, one of the most common assumptions would be that the increase in turnover is due to pay. Whilst pay is undoubtedly having an impact, especially during the current cost of living crisis, our data shows that pay is not actually the sole driver of turnover in the NHS.

The things that drive employees to leave are likely to be due to a combination of factors and they are also likely to vary from one organisation to another so it is equally tricky to assume that the things that impact turnover and retention in one organisation are going to be the same in all other NHS organisations.

Whatever the specific reasons people have for leaving, without any evidence of how people feel about working for the NHS and why they decide to leave, any action that is taken is likely to be unfocussed and not particularly cost-effective.

The danger is that NHS organisations will spend lots of time, resource and money on retention initiatives that might not always be having the impact that is hoped for.

The challenges organisations often face when trying to identify how to improve retention and reduce employee turnover in the NHS

The Trust in this case study was facing some particular challenges that we actually find are quite common to all NHS Trusts when it comes to gathering feedback from leavers:

1. There was no structured approach to gathering feedback from leavers

Even where feedback from leavers was being gathered it was done using multiple methods.

Some exit interviews were being done, but they were not always carried out with all leavers.

The structure behind the exit interviews was not always clearly defined and the interviews were often carried out by different people.

In addition, different parts of the organisation were often doing different things. Some were holding exit interviews, some were sending out paper forms, others were running online surveys using something such as SurveyMonkey or Google forms etc.

As a result, data from leavers was not being captured in a consistent format with a consistent process, the response rate was low, and leaver data was not gathered in a co-ordinated way.

2. Data captured from leavers was not being analysed effectively

As a result of the fragmented processes in place, any data that was captured from leavers was very rarely collated.

Even where leaver data was being reported it was very time consuming to do as the information had to be pulled together from different sources. This meant that a lot of resource had to be dedicated to the analysis – usually involving the BI team!

This situation also meant that there was a significant time lapse from gathering feedback from leavers to presenting the information back to the organisation.

This meant that feedback from leavers was considered to be of poor quality and was often dismissed as being out of date with the end result being that it was difficult to make decisions around where to focus efforts to reduce employee turnover.

Our solution for helping organisations understand how to reduce employee turnover in the NHS

Our recommendation was that exit interviews are not the best way to gather feedback from leavers as they have four fundamental drawbacks:

1. Exit interviews take up a lot of resource to manage. Someone needs to organise them and someone needs to carry out the interview.
2. Exit interviews tend not to generate accurate feedback. As they are carried out in person, they are, by definition, not anonymous, which inhibits leavers from giving the unvarnished truth, if they even choose to take part in the first place.
3. Exit interviews are rarely consistent. Unless you have one person who carries out all exit interviews, there will always be variation in style.
4. Exit interviews are difficult to analyse. Interviews are great for capturing lots of qualitative feedback, but qualitative feedback is time-consuming to analyse and difficult to quantify.

Telephone exit interviews do not overcome these drawbacks either.

Our solution for the NHS Trust in this case study was to implement a bespoke online employee exit survey for the following reasons:

1. Exit surveys take up significantly less time to administer than exit interviews.
2. Leavers are much more likely to be open and honest when completing an anonymous exit survey.
3. Exit surveys generate much more consistent quantitative data.

The objectives of our survey was:

• to gather feedback from as many leavers as possible, as efficiently as possible.
• to gain a more comprehensive understanding of why people were leaving.
• to gain a more comprehensive understanding of how leavers felt about the organisation.
• to be able to identify variations in why people left based on demographic data.
• to identify what could be done to change the employee experience to reduce turnover and improve retention.

To achieve these objectives there were two stages we went through to implement the survey.

Stage 1 – make gathering feedback from leavers easy and consistent

The first step was to identify one person or team who could take ownership of the process going forwards. Many NHS organisation are creating retention teams, which is a great place to start.

The next step was to define a standardised process for gathering feedback from leavers. This required understanding what all of the existing processes looked like, who owned them and how they were administered. We found there was often lots of duplication in what was being captured with different teams doing different things in different ways.

When it comes to designing the exit survey we worked with the Trust to design an exit survey that was bespoke to the needs of the Trust. There is no standard format for exit interviews or surveys, we recommend they always be customised to suit the needs of each organisation.

We started by reviewing the existing leaver questionnaires and capturing feedback from the organisation on the main information they felt they needed to capture from leavers. For example, understanding why international staff were leaving was one of the issues for this Trust.

We also reviewed themes from the NHS National Staff Survey and other engagement data sources to create some consistency between the employee data gathered from different sources and what would be gathered from the online exit survey.

We also referred to our own library of employee experience survey questions to create a draft survey designed to capture:

• demographic data – to enable the data to be sliced and diced based on demographics such as staff group, ethnicity, Directorate/Care Group etc.
• how leavers felt about specific aspects of their role and the organisation’s culture.
• we also include free text questions where relevant to allow leavers the opportunity to contribute any unstructured feedback.

Once the survey was rolled out we carried out all of the exit survey administration for the Trust. All we need is for the Trust to send us leaver details on a regular basis and we do the rest. We send out survey invites and  survey reminders.

Stage 2 – make analysing and reporting on feedback from leavers as easy as possible

Having a consistent survey structure is a good starting point for making data analysis easier, but where we really add value is through our survey platform.

Our survey platform not only allows us to administer exit surveys, but it has an inbuilt web-based reporting dashboard that it makes accessing employee exit survey data extremely easy.

Turning insight into action

Surveys are simply a means to an end. The value is not in running the survey, it is not even gathering the data. The real value is in being able to identify specific actions that can be taken to reduce employee turnover and improve retention.

Our exit survey platform enabled the Trust to quickly identify specific themes that emerge from their leaver data. Below are just some example insights we identified in the data from the Trust.

Survey response rates:

Firstly, we saw an improvement in response rate from leavers.

Actually, there was often no true picture of actual response rates prior to implementing our exit survey as there was very little visibility over how many leavers feedback was being captured from.

However, there is usually a sense that response rates are very low, typically around 10%. We are now seeing a survey response rate of around 45%.

Variations based on leaver demographics:

In this Trust most leavers have a length of service of between 2 and five years. This is consistent with our exit survey data from other sectors and is likely to be caused by people looking for their next career opportunity once they have been with the organisation for around two years. Indeed, most leavers left because of career progression.

However, 22% of leavers leave within the first 12 months indicating that the onboarding experience could be improved.

60% of people reported they were leaving the NHS to work in a different industry sector.

However, 40% of people left to work for another NHS organisation. This group are most dissatisfied with how they feel about their wellbeing, their line manager and their development.

Where should the focus be to improve retention and reduce employee turnover in the NHS?

Quite often with surveys it is difficult to know where to start focussing on to make changes.

Satisfaction scores in isolation are not always the best place to start as people may be dissatisfied with some things, but they may not actually have a big impact on engagement or turnover.

Our survey analysis enabled us to identify how strongly each survey question correlated with questions around advocacy for the Trust in this case study.

When combined with question scores on how people feel about each survey question it pointed towards specific questions that will have a positive impact on overall engagement if work is done to improve satisfaction scores on those questions.

The table below shows how the individual exit survey questions were highlighted from this analysis.

The further towards the top of the table a question is, the greater the relationship it has with how much leavers would recommend the organisation as a place to work. These are the things that are driving dis/engagement.

The colour coding is based on how satisfied leavers are with each question. Questions highlighted in green indicate a good level of satisfaction – the organisation is doing something well so should keep doing what it is doing. The questions highlighted in amber are where satisfaction could be improved.

Combining the two things, actions that are taken to improve satisfaction on questions that are towards the top of the table and colour coded in amber will have a positive impact on overall staff engagement.

This, in turn, will have a positive impact on staff retention.

In conclusion

The retention crisis facing the NHS is a significant challenge. However, if we keep doing what we’ve always done, we will get what we always got.

Implementing multiple initiatives based on intuition around why people are leaving is not the most focussed, efficient or cost-effective way to do things either.

In our experience, many NHS organisations do not have a structured and consistent approach to gathering feedback from leavers. Even those that say they do, often have to invest significant resource into analysing the data.

This case study highlights how our exit survey service will help NHS organisations identify how to start reducing employee turnover and improving retention in a significantly more cost-effective, structured way.