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Retention and Selection of Health Care Staff: (Team-based Turnover Reduction)

Clint Maun, CSP

In today’s healthcare organizations nothing is more critical than providing consistent service delivery on a daily basis. This can be accomplished through the work of dedicated individuals on a continuing basis. The relationship of staff turnover to consistent service delivery is well documented and consistent with research by our firm.

To retain an entry-level healthcare worker it costs a minimum of $2,250. This cost merely includes the basics of certification, orientation, advertising, unemployment compensation, administrative costs and other direct costs found on a financial statement. Costs actually run much higher when morale issues, marketing concerns, survey compliance and overall accomplishments of the organization are included.

Healthcare organizations must develop a specific and dedicated breakthrough strategy for retention. It is not enough to place this responsibility in the hands of a few people, such as the administrator, director of nursing or human resource professional. There must be a targeted team effort to make training and retention a top facility priority. For many organizations the ability to provide consistent service delivery on a daily basis sets them apart in the marketplace.


The organization must develop a targeted team effort with a “super team” of 10-12 individuals chaired by the administrator or executive of the organization. The administrator or executive must also have on board a human resource professional and director of nursing services. These three will recruit the remaining team members to include several nursing assistants, along with specific nursing leadership (unit managers, shift supervisors, etc.) and other department management/staff. The team should be cross functional, not just a management team but extend deep into the organization with individuals dedicated to fixing this problem.


The team will develop a written 12-week plan to be signed off by them, making them responsible to report weekly progress to a higher level individual for accountability purposes. That individual could be the administrator’s supervisor or board director. The written 12-week plan must encompass critical issues that affect the ability to train and retain. The 12-week team will focus on three major areas: how to recruit, select and retain quality employees.


The organization should address the particulars of implementing a passionate orientation. Facilities spend time recruiting but rarely take time to train new employees appropriately. Passionate orientation must include a customized checklist for each job, sequenced to provide information as needed. New employees should be required to demonstrate learning from the checklist so you have an assurance they received the information in an appropriate manner and can demonstrate utilization of the information. As a third component of the passionate orientation, a mentor is designated with a parallel schedule to the new employee. The mentor should be rewarded or recognized for helping that new employee complete the orientation process and acclimation to the organization.

By developing a passionate orientation process and assuring it is meaningful and enjoyable for the new worker, you will re-engineer the methodology that is a significant component of whether an individual is going to stay. People make retention judgments in the first 3-4 days they’re working in a location. It is the facility’s job to ensure this orientation and acclimation process is “passionate”.


The team should focus on what it takes to deal with the current workforce in the new millennium. This must include how to make the workplace enjoyable and meaningful at the same time. It is not enough anymore to say you’ve got a good job and can enjoy your life later. Today’s workers want to be involved in a process that allows them to experience meaning and enjoyment at work, at the same time.

The team should work on issues associated with scheduling - including how to involve units in team-based scheduling rather than using a centralized scheduling process. Workers joining the profession are now younger, and they want to be involved in determining their time off. If your centralized schedule model isn’t working and you’re spending most of your time trying to beg, borrow or steal help, it would be worthwhile to consider alternatives with employee involvement in the process.

Prepare a data assessment of why retention is a problem. This would include the development of specific exit interviewing processes upon the transfer or loss of an employee. There should also be an Employee Opinion Survey initiative for an objective view of what’s occurring. You should have Customer Satisfaction Surveys in place to help retain workers by providing them specific feedback about service delivery. It is a positive motivator for staff to be involved in direct feedback from customers. In addition, it would be helpful for periodic salary and benefit studies to determine competitiveness in the marketplace.

It is not enough to say we have a certain percentage of turnovers in the organization. We must look at the specific units, departments and shifts where turnover is occurring at a higher pace.


Upon the development of retention efforts, focus on the selection process. Teams should be involved in the process; i.e.staff should assist in making hiring recommendations. When the staff helps pick their co-workers they develop a sense of ownership toward the decision. The organization should develop behavioral interviewing processes where the questions asked allows the applicant to tell a story about how they have conducted themselves in the past which often determines how they will react in the future. By setting up questions in advance, we move away from a gut feeling approach to interviewing. (Click to see Sample Behavioral Interviewing Questions.)


Do not put ads in the paper that say, “wanted", "hundreds", "we’re desperate", "we need many”. Instead place targeted ads that focus upon the talent in the building with stories about great individuals that have performed acts of courage and extra effort. We’re looking for people like this type of individual. Matching talent to talent puts us in a position of using team-based recruitment. Employees should be responsible for coordinating the ad campaign, flyer distribution and word of mouth referral sources, to help set up a recruitment campaign that is targeted, focused and talent based. Select people who find it an honor to work with us and we’ll show them it is an honor to have them.


The 12-week team selects topic areas to work on with specific goals and targets for weekly accomplishment. They assign action and accountability to team individuals with sub-teams on specific areas. There should be a weekly meeting of the “super team” with sub-team meetings as necessary. This should take priority in the organization. It should be broad-based, targeted and team-oriented if we are to move ourselves to a consistent service delivery position that our customers, clients and residents deserve.

You can reduce turnover and Agency usage in your facility! If you’d like more information on how to take steps to experience successful outcomes in your facility, click here.