How we are helping the NHS find out how to improve retention of new starters

This post is a case study of how we are helping one NHS ICS (Integrated Care System) find out how to improve retention of new starters across the system through a bespoke New Starter Experience Survey.

The NHS is facing a retention crisis

All NHS organisations are facing a retention crisis at the moment.

The cost of employee turnover in the NHS is huge, both in terms or monetary cost, but also the costs of added stress for employees who remain and the risk of decreasing levels of patient care.

There is also strong evidence to suggest that many leavers are doing so within the first year of their service.

As such, there is an extremely clear, and strong, business case for NHS organisations to adopt a more consistent approach to understanding how they can reduce staff turnover, especially within the first few months of employment.

We were approached by one NHS ICS (we have kept it anonymous for obvious reasons) to help them evaluate the experience of all new starters in all NHS organisations across the region.  

Why is it important to measure the experience of new starters?

As we outline below, our onboarding data shows that engagement levels for new starters drops off significantly within the first three months.

If we assume that all new employees start their journey engaged and motivated, then something must be going wrong to disengage new starters to such an extent that they choose to leave.

Whilst we can speculate on the reasons people are leaving the NHS it would be dangerous to make too many assumptions without hard evidence.

One obvious assumption would be that the increase in turnover is due to pay. Whilst the current strikes suggest that pay is undoubtedly having a big impact, especially during the current cost of living crisis, our data shows that pay is not the sole driver of turnover, especially in new starters.

Logically, we have to assume that all new starters are aware of their pay and benefits when they join the NHS in their new role, so there must be other things causing them to leave.  

And this is the point. Without any hard evidence of how new starters feel about their early experiences of working for the NHS, any action that is taken is likely to be unfocussed and not particularly cost-effective.

The challenges many NHS organisations face when trying to improve retention of new starters

Our experience shows that NHS organisations tend to adopt a fragmented approach to addressing the challenge. We typically find that:

  • Some Trusts don’t formally measure the onboarding experience.
  • Where Trusts do measure the onboarding experience they tend to have a fragmented approach:
    • the recruitment team might send out a survey to measure the recruitment process, the L&D team might send out a survey to evaluate the induction process.
    • each survey is likely to be deployed using different tools. One team might use SurveyMonkey, another might use Google docs etc.
    • there is often cross-over or duplication between surveys.

All in all there is no consistent approach to measuring the experience of new starters which means:

  • new starters are likely to suffer from survey fatigue as they are bombarded with several surveys.
  • it is difficult to collate the data.
  • there is no holistic view around where the issues.
  • it then becomes difficult to take targetted action.

The danger is that NHS organisations may be spending lots of time, resources and money on initiatives that might not always be having the impact that is hoped for.

Our solution to helping NHS organisations understand how to improve retention of new starters

The objectives we helped this particular ICS achieve were to:

  1. understand how people feel at various stages of their first year of service with the organisations.
  2. to identify specific actions that can be taken to improve the onboarding process for new starters in their first year of service.
  3. to share best practices across the system.
  4. to monitor the impact of actions on overall levels of engagement for new starters.
  5. to monitor the impact on employee turnover within the first year of service.

Implementing a survey has limited value so it is useful to think in terms of this model.

  1. Gathering data through a well-designed survey is the first step.
  2. Data is meaningless though unless it enables you to identify the main issues.
  3. Only when you have a good understanding of the main issues can you implement focussed actions.
  4. You are then in a better position to evaluate the impact of those actions and either adjust course or move on to the next challenge to be addressed.

Step1 : Make gathering feedback from new employees easy and consistent

The first step was to increase the level of ownership for gathering feedback from new starters. It is quite common for many NHS organisations to have different people looking after different surveys, which inhibits the amount of ownership for the surveys, particularly at a senior level.  

Once there is clearer ownership for taking on the challenge of how to identify how to gather feedback from new starters, the next step was to define a standardised process for gathering feedback from leavers.

This required an understanding of what the existing processes, if any, looked like and how they were administered.

Our experience shows that there is often lots of crossover in what is being captured, but it is often being captured in different ways.

Our recommended solution for gathering feedback from new employees was to utilise an online employee onboarding or new starter survey to gather feedback from all new employees:

  • Online employee onboarding surveys take up significantly less time to administer than paper-based surveys or face to face/telephone interviews.
  • New starters are much more likely to be open and honest when completing an anonymous survey. We find that new starters are reluctant to provide negative feedback in person for the obvious fear of it being held against them and threatening their career prospects.
  • Having a consistent survey generates much more consistent quantitative data. This also allows each NHS organisation to benchmark itself against the other organisations in the region.

We worked with stakeholders from each NHS organisation to design an employee onboarding survey that was bespoke to their needs.

We started by reviewing any existing new starter questionnaires and capturing feedback from the organisation on the main information they felt they needed to capture from new joiners.

We then created a draft survey designed to capture key demographic data (to enable the data to be sliced and diced based on demographics such as staff group, ethnicity, Directorate/Care Group etc) and how new joiners feel about specific aspects of their role and the organisation’s culture.

We also included free text questions where relevant to allow leavers the opportunity to contribute any unstructured feedback.

improve retention of new starters in the NHS

The survey is sent to all new employees after their first week, first month, three months, six months and finally after their first year. The idea is to build a picture of how new employees feel throughout their first year.

Once the survey was built, all each organisation needed to do was implement an internal process for sending out survey links to each new starter at the appropriate time.

Our surveys are fully GDPR compliant and mobile friendly so new starters can complete the survey with any web-enabled device.

Step 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 employee onboarding surveys, but it has an inbuilt web-based reporting dashboard that it makes it extremely easy for each NHS organisation to access their survey.

Users can view their new starter survey data at any time and in real time through our reporting dashboard allowing them to quickly identify key insights and share those with their stakeholders. 

Our dashboard makes playing around with survey data highly intuitive and makes slicing and dicing data significantly quicker and easier than using Excel or other business intelligence software.

The dashboard has inbuilt reporting functionality so users can create as many ad-hoc reports as they wish, but we also regularly meet with each organisation’s stakeholders to review their survey data.

realworld survey dashboard

Step 3 : Identify the key insights to improve retention of new starters

Running a survey is pointless unless you spend time understanding the survey results.

Luckily, our reporting dashboard makes accessing and understanding your survey data really easy and intuitive.

These are just some of the insights from the new starter survey. This data is aggregated data from across the system so there are variations by organisation.

Insight 1 – Overall satisfaction of new employees gradually drops off within the first three months of employment

The proportion of new starters who rate their initial employee experience drops from 89% after the first week of employment to 81.5% after one month and 73.3% after three months.

Whilst more than 70% of people being positive about their employee experience is positive in isolation, this chart shows that there is opportunity to take action to improve overall satisfaction.

improve retention of new starters in the NHS

Insight 2 – Overall engagement of new employees reduces within the first three months of employment

New starters also rate their average level of engagement with the organisation as decreasing in the first three months of employment.

improve retention of new starters in the NHS

Insight 3 – The biggest area of frustration with the recruitment process is the length of time it takes to go through the process

On average, the length of time it takes to go through the recruitment process is the area that could be most improved from the perspective of new starters.

Obviously, the reason for the recruitment process taking some time is for the necessary employment checks to be carried, but benchmarking between the organisations in this region shows that some organisations are rated better than others. This suggests that it is possible to make improvements.

Indeed, this is one of the benefits of our approach – individual organisations can identify how they stack up against other organisations and then share learning to implement improvements and changes.

improve retention of new starters in the NHS

Insight 4 – New starters’ satisfaction with their wellbeing reduces within the first three months of employment

New employees across this particular system report decreasing levels of satisfaction with their wellbeing in the first three months of service.

improve retention of new starters in the NHS

Insight 5 – New starters’ satisfaction with their job reduces within the first three months of employment

New employees across this system also report decreasing levels of satisfaction with their job in the first three months of service.

improve retention of new starters in the NHS

What actions have been taken so far to improve retention of new starters?

A Task and Finish group meets every two weeks to review the survey data and share experience with each other.

Some of the actions that the group members have identified so far include:

  1. The need to remind new starters of the wellbeing support available to them throughout their first three months in addition to telling them during their initial induction.
  2. The need for a toolkit for managers to support them.
  3. The need to review how some of the basics are handled in each Trust. Things such as ensuring security passes etc., are ready for when people start.
  4. The need to review how to speed up the recruitment process.

An additional action that has been taken is to harmonise other surveys into the new onboarding survey. We found that some Trusts were continuing to run recruitment and induction surveys alongside the New Starter Survey. We found that it was relatively easy to harmonise them enabling the Trusts to save time and resource whilst also now being able to take a more holistic view of the new starter experience.

In conclusion

These are just some of the many insights that the NHS organisations in this system have been able to identify from our new starter experience survey.

The increased speed and ease with which each organisation can identify trends is enabling them to implement specific actions that will help improve retention and reduce employee turnover of all new starters.