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By Monica E. Oss

The reality is, staff leave an organization for a lot of different reasons—not all of which are directly related to their work at your organization. But some reasons—like poor leadership, bad supervisors, toxic workplace culture, inadequate pay, and high stress—are clearly issues that can be addressed in a concerted effort to improve team member retention. Failure to do this can lead to some very real, and accumulating costs—the cost of recruiting, training, and paying of interim staff can add up to 16-20% of annual compensation for each position that needs replaced (see The High Costs Of Paraprofessional Employee Turnover – Sizing Up The Challenge). These costs include salary and benefits continuation, advertising for position replacements, screening and interviewing, and signing bonuses for new positions. And every time a staff member leaves, the cycle starts all over again. To get an update on how recruiting challenges are impacting health and human service provider organizations, and to get some advice on how to manage this increasing challenge, we reached out to leaders in the field for their perspective.

Kathy Carmody, Chief Executive Officer, Institute on Public Policy for People with Disabilities highlighted the problem as she sees it reflected in her organization, noting:

Kathy Carmody

By far, the direct support workforce crisis impacting organizations that provide community services to people with I/DD is having the most significant negative impact on recruitment and retention of all levels of staff within I/DD organizations. Retaining committed and competent direct support personnel is a constant struggle amidst competing employment opportunities in other less-demanding and better paying industries. With states and municipalities increasingly enacting enhanced minimum wage legislation, the challenge of attracting and retaining direct support workers intensifies and impacts not only consumers who depend on them, but every layer and discipline within I/DD organizations.

The constant need to attend to this issue limits the ability of c-suite executives, clinicians, and back-office personnel to anticipate, assess, and address the broader range of challenges and opportunities that lie before them. As a field, the I/DD community is laser-focused on public policy, technology, and reimbursement initiatives to assure a robust and committed direct support workforce. Accomplishing this imperative will improve retention within that classification, as well as supervisory and executive level personnel within I/DD organizations.

How can provider organization executives address this challenge? To minimize the costly rotation of staff members, provider organizations I see the need to focus on two key operational elements:

  1. Make talent (and retention) part of your strategic plan
  2. Become a retention-focused organization that understands why team members leave your organization and act on those metrics

Make Talent (& Retention) Part Of Your Strategic Plan

To both recruit and retain top talent, provider organizations need to position themselves as “employers of choice” by building an employment value proposition (EVP) directly into your organization’s strategic plan. Another way to look at this is that your EVP, for recruiting and retention purposes, is also organization’s brand. You want “good working environment” and that to be known and accepted in the minds of employees and possible employees. There are four key elements of talent management that your organization should incorporate into your strategic plan:

First, prioritize open communication and clear expectations. In order to retain top talent, the human resource team and management must anticipate specific needs for employees by conducting ongoing analysis of employee engagement and satisfaction, as well as future needs. Start by understanding why employees stay and what their concerns are. Plenty of organizations have had great teams operating at the top of their game, only to have a sudden (and mystifying) turnover event leave the organization at square one. Ensure that your leadership and management are open to employee feedback and that the feedback they receive is addressed in a timely and transparent manner. Part of creating a culture of open communication is establishing clear-cut expectations and policies. It is the responsibility of your leadership team to outline the goals and mission of your organization, what they expect from employees in their role, and deliver clear and consistent feedback when those expectations are not met. Lori Schmidt, OPEN MINDS Senior Associate explained:

Lori Schmidt

Staff engagement, and staff understanding of the organization goals and mission are important. If they understand those things, then they may have a stronger commitment to the organization, so make sure people are familiar with the policies, and they need to feel like everything is fair and equitable in the organization.

Second, offer a benefit package that is truly beneficial. Compensation always has, and always will, play an outsized role in retaining employees. In 2017, the average annual wage for home health aides was $23,210, and $23,100 for personal care aides (see Occupational Outlook Handbook: Home Health Aides and Personal Care Aides). In addition, the lowest 10% of health home aides earned less than $18,450, and the lowest 10% of personal care aides earned less than $18,160 (see Direct Support Personnel Turnover Rate For I/DD Sector Averaged 45.5%). The challenge to keep these positions filled is apparent. Peggy Terhune, Ph.D., Chief Executive Officer, Monarch explained the struggle in her organization, noting:

Peggy Terhune

We provide services to both behavioral health and intellectual and developmental disabilities (I/DD) populations. For us, the number one driver of retention problems is compensation for direct care staff, and lack of those “extra” benefits (tuition reimbursement, developmental training, etc.). As I compare us to other provider organizations, our reimbursement is so different. We don’t have any funds for extras.

And Todd A. Landry, Ph.D., Chief Executive Officer, Lena Pope noted that recruitment challenges at his organization are dependent on the field of their program services. But many of the challenges come down to the ability to compete for staff with organizations that are able to provider higher compensation. He explained:

Todd A. Landry, Ph.D.

The answer depends based on the field of our program services. For example, the biggest issue in retention for our child care programs is losing our certified teachers to traditional school districts which pay significantly more. For our charter school, the retention factor is upward promotions with other school districts or charter schools. For counseling/mental health, we are seeing a significant increase in hospitals/health care systems hiring LMSWs.

But compensation isn’t only about salary. There are many other benefits for employees that you can explore including—professional development, flexibility and time off, social and workplace events, student loan repayment, and health and wellness support.

Third, make investment in employees’ professional development a priority. Staff that feel they has professional growth opportunities is a more engaged and committed workforce, leading to more revenue, productivity, and profitability; and lower absenteeism (see Building Your Connection Culture).

Finally, make it a priority to make employees feel valued in their work. How you treat your employees is reflected throughout your organization and has far reaching consequences when it comes not only to retention, but also overall organizational performance. Provide employees with meaningful work and ensure that they are not constantly overburdend to help avoid the steep costs of burnout (see What Is The Solution For ‘Burnout’? Advice From The Field).

Become A Retention-Focused Organization That Understands Why Team Members Leave Your Organization & Act On Those Metrics

To retain the top talent, retention needs to become a real priority for your organizarion’s leadership team. It should be a constant focus and point of discussion for your team to understand why employees leave—and what makes them stay. Daniel J. Smith, SPHR, Chief Human Resources Officer at Centerstone explained that at his organization, they have made a concerted effort to focus on retention:

In a high-demand and tight-labor market, many non-profit organizations encounter a variety of challenges when maintaining employee retention. There isn’t one main driver of retention, but rather a combination of many different factors including the process to align staff in the best way to provide the highest level of consumer care, maintaining a competitive pay rate, and ensuring we’re working to distinguish ourselves as a premier place to work and serve consumers. Staff retention is among our highest priorities, and we are implementing several strategies to break the cycle, improve the total compensation to be above the common market benchmarks, and to increase opportunities for employee growth within Centerstone.

When staff leave, the reasons why should never come as a complete surprise. Gather baseline data regarding staff turnover rates and employees’ perceptions about the organization’s work environment and do this for each position and department. Do you know the top reasons that staff leaves your organization?  Do you know why they stay? Conducting the necessary interviews and surveys to find out is elemental in understanding the size of the challenge ahead of you.

Employee satisfaction and retention must be an integral part of your management focus. And understand, this process isn’t about keeping everyone, or making your retention efforts 100% successful. Nothing is impossible but keeping everyone is highly unlikely. A retention program is about minimizing the “brain drain” that high turnover rates cause, not to mention the high cost of recruiting and replacement. Key elements here include the following:

  1. Staff development training focused on employee retention, team building, communication, and effective supervision skills
  2. Incorporation of retention measures (such as turnover rates, critical position vacancies, etc.) into your organization’s performance measurement system
  3. Recognizing and rewarding employee performance (both overall and for employee retention)
  4. Building “role enhancement” opportunity tracks for high-performing staff members
  5. Encouraging and soliciting employee feedback (with formal feedback mechanisms for new hires and exiting employees)

The next step is to review and evaluate the information compiled in step one and share this information with your management team and other staff. The management team and staff should be educated on the basics of employee retention. What are their perspectives on the information? What changes do they think will improve employee retention? Develop a tactical plan to improve employee job satisfaction and retention particularly for high-performing or high- demand staff.

“Implement and forget” is the bane of just about every operational and business process, from service lines, to tech implantation, to recruitment and retention. As soon as executives and management forget about the plan, that plan will lose its effectiveness and won’t deliver on your original strategic vision. Once you’ve built and implemented the basic components of your organization’s employee retention plan, make certain that you use the related key performance measures as a tool for continued evaluation and improvement of the program.

Ultimately, retention is the responsibility of the leadership within your organization. It is your job to create an organization where employees want to be, and if you can’t, the consequences will be felt throughout your organization. As Ted Dallas, President & Chief Operating Officer, Merakey summed up:

You can’t provide high-quality services without high-quality staff. With the economy near full employment, qualified candidates are harder for all of us to find. Ultimately, it falls to all provider organizations to create an attractive workplace that not only finds great candidates but also keeps them with us for the long haul.

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