Reducing Support Staff Turnover
- A group of specialty clinics includes allergy, endocrinology, and rheumatology clinics. In March 2016, the clerical and clinical support staff turnover for these clinics was 43.8%.
- Turnover is expensive; the Center for American progress cites that replacing an employee costs one-fifth of the employee’s annual salary*
- The leadership team implemented various measures across the clinics aimed at reducing total turnover.
- By March 2017, the turnover rate dropped by 10.5%.
- From March 2016, by the end of fiscal year 2017 (June 30, 2017), the specialty clinics will reduce clerical and clinical support staff turnover by 10% or greater, from a baseline of 43.8% as of March 2016.
- This aim will be achieved through improving staff communication, building morale and teamwork, developing standard work, and improving staffing levels.
- At the health care system the midpoint salary for a Patient Service Specialist I (PSS I) is $28,777, a Certified Medical Assistant is $31,672, and a Licensed Vocational Nurse (LVN) is $47,860
- If the estimated cost to replace an employee is 20% of their salary, it costs approximately $5,755 to replace a PSS I, $6,334 to replace a CMA, and $9,572 to replace an LVN*
- Endocrinology and Rheumatology did increase salary expenses some as a result of advancing a Registered Nurse position to a Charge Nurse position in each division. The approximate annual increase was $3,950 for Endocrinology and $3,470 for Rheumatology. This initiative is described further in improvement cycle #3.
Patient and Family Centeredness Implications
- Generally, engaged and experienced employees are better positioned to deliver high-quality care and service than new and inexperienced employees
- Tenured staff are able to build relationships and rapport with patients, thus fostering a more personalized patient experience
- When patient/staff relationships exist, patients may be less likely to late cancel or no show because they have a personal connection to the clinic, thus improving clinic operations
- Observed upward trend in patient satisfaction survey questions “Staff worked together,” “Clerks treat with courtesy/respect,” and “Friendliness/courtesy of nurse/assistant” from March 2016 to March 2017
- Reduce clerical and clinical support staff turnover in the specialty clinics
- Conduct 30-60-90 day pulse check meetings
- Improve certain patient satisfaction measures
Rapid Cycle Improvement: Cycle 1
- Plan: Reviewed employee engagement survey results to identify opportunities to improve employee engagement and retention.
- Do: Discussed survey results during May 2016 leadership meetings/huddles. Identified reward/recognition, collaborating with purpose, and communicating with impact as the areas with the greatest improvement opportunity.
- Check: Solicited suggestions from staff on these areas and discussed feedback during leadership team meetings. Turnover decreased from 42.4% in May 2016 to 38.6% in June 2016.
- Act: Proceeded to Plan-Do-Check-Act cycle 2 for implementation of initial action items.
Rapid Cycle Improvement: Cycle 2
- Plan: Implement at least one of the staff suggestions for addressing reward/recognition, collaborating with purpose, and communicating with impact, which in turn would foster improved retention.
- Do: In July 2016, the leadership team launched a monthly electronic inter-divisional newsletter entitled “The Buzz” (which was named by the staff) to improve information sharing and staff recognition.
- Check: Division leadership solicited feedback from staff on the newsletter format/content, and continued to revise as appropriate. Turnover dropped from 38.6% in June 2016 to 35.64% in July 2016.
- Act: Continue to produce monthly newsletter, identify, and implement additional staff retention tactics, and monitor turnover.
Rapid Cycle Improvement: Cycle 3
- Plan: Expand clinical leadership hierarchy to better define roles & responsibilities within the divisions.
- Do: Advanced a Clinic Registered Nurse for Endocrinology and a Clinic Registered Nurse for Rheumatology to Clinic Charge Nurse Roles within their respective division. A Clinic Charge Nurse position already existed for Allergy.
- Check: Turnover was 41.1% in August 2016. Though turnover increased to 41.5% in September 2016, it fell to 38.3% in October 2016.
- Act: Continue to support the hierarchal structure and provide the charge nurses with the tools and support they need to be effective leaders within their divisions.
Rapid Cycle Improvement: Cycle 4
- Plan: Implement standing meetings as a tool for ongoing information sharing and staff recognition.
- Do: In August 2016, clinical staff meeting format was modified to include team building, ice breakers, raffles, snacks/refreshments, and standing agenda items requested by the staff (1. Patient Satisfaction/Goals, 2. Safety, 3. Staffing, 4. EHR updates). Also in August 2016, monthly clerical staff development meetings were implemented. Each meeting focused on a unique professional enrichment topic (team building, ice breakers, customer service, role play, etc.).
- Check: Staff were surveyed both formally and informally on effectiveness of meeting format and topics. Turnover was 41.1% in August 2016. Though turnover increased to 41.5% in September 2016, it fell to 38.3% in October 2016.
- Act: Continue to conduct regular meetings with content that is meaningful to staff, give opportunities for staff to suggest changes, and monitor turnover.
Rapid Cycle Improvement: Cycle 5
- Plan: Implement Shared Governance Committee to give staff an increased voice in clinic operations.
- Do: Clinical and clerical staff were nominated by their peers to represent their clinic areas. The first meeting was held in September 2016 and addressed topics including committee charter, reward/recognition, and future meeting topics.
- Check: Committee members and their peers have reported positive feedback on the committee’s activities and operational influence. Turnover fell from 41.5% in September 2016 to 33.3% in December 2016.
- Act: Continue to encourage and support Shared Governance meetings, requests, and opportunities, as well as ongoing monitoring of turnover.
In March 2016, the clerical and clinical support staff turnover for these specialty clinics was 43.8%. By March 2017, the turnover rate dropped by 10.5%.
Continuous improvement will include the following:
- Turnover reduction will continue to be a focus of management meetings, huddles, and performance tracking
- Every member of the leadership team has a performance goal related to turnover reduction
- The management team will work to further increase team building activities to foster an engaged workforce
- There will be continued emphasis on improving staffing ratios, completely utilizing staff within their full scope of practice, and implementing additional career advancement opportunities
- The management team will review, assess, and respond to the 2017 employee engagement survey results, once they are available
Strive to achieve the system turnover goal of 17.3% or less.
- Success depends heavily on giving staff a voice in improvements to create an effective work environment
- Despite best efforts, some turnover is unavoidable, particularly that which is related to family or personal reasons (i.e. spouse relocation, military, etc.)