“Staff turnover is telling us something!” – Dr. Kevin Ann Huckshorn, in her plenary address at the 2015 OPEN MINDS Executive Leadership Institute.
I couldn’t agree more. Behavior is communication, and in my work I see paraprofessionals voting with their feet. Last week at the 2015 OPEN MINDS Executive Leadership Retreat, I took a detailed look at how big this problem is, and some of the ways that organizations can address the problem, in my session, Talent Management: Getting the Most from Your Human Capital.
Paraprofessionals provide non-medical health care, personal care, and supportive services to millions of people who are aging or disabled, in facilities, and in home-based settings. According to the Paraprofessional Healthcare Institute (PHI) (see Recruitment and Retention of Paraprofessionals), eight out of every ten paid services in long-term care are provided by personal care attendants, certified nursing assistants, home health aides and other individuals. In mental health and treatment addiction centers, mental health assistants, psychiatric technicians, and behavioral health assistants provide support for consumers with activities of daily living, socialization, data collection, collaboration with treatment team members, and assistance during crisis situations.
This group has a very high turnover rate – reported to be more than 70%. Home care agencies report between 40% and 60% annual turnover (see Recruitment and Retention of Paraprofessionals). What is the reason for the high turnover? Obviously compensation is an issue. And, this will be partially addressed by the new minimum wage rules that just went into effect for some of these workers – New Fed Rules Mandate Minimum Wage & Overtime For Home Care Workers Effective January 1, 2015. Also, according to PHI, deficiencies in three key areas lead to turnover: compensation, professional development/growth, and support. These themes are also echoed in a literature review and study published in 2015 by Heather Micke at St. Catherine’s University (see Causes and Solutions for High Direct Care Staff Turnover). Ms. Micke’s research further cites lacks of support/appreciation, insufficient training, and difficult work as reasons for high turnover.
As we move to more home-based and community-based services across all of health and human services – with the incorporation of more paraprofessional staff – this issue takes on even greater strategic implications. According to the PHI, there are three million individuals comprising the paraprofessional health care workforce, plus untold more in a “gray market.” The Bureau of Labor Statistics expects the demand for this workforce to increase by 35%, “growing faster than other health care occupations, and growing three times as fast as all other industries.” For management teams, the issues are both service performance and quality of care, and the costs of this turnover in terms of recruitment, training, and payment of interim staff.
A major issue with paraprofessional turnover is the diminished quality of services and diminished service capacity at provider organizations. When an employee leaves, the workload on remaining staff immediately increases, leading to additional stress and poorer consumer relations. And if staff positions are left unfilled for too long, the situation can trigger the possible loss of the remaining employees (see The Long-Term Influence of Service Employee Attrition on Customer Outcomes and Profits).
In addition to organizational performance, these high turnover rates also have a cost. The estimates of costs of turnover vary – but for health and human service organizations, 16-20% of annual compensation is an estimate of the costs of refilling each open position (see Employee Retention – The Real Cost of Losing an Employee and The High (and Hidden) Costs Of Staff Turnover In Healthcare). These costs include salary and benefits continuation, advertising for position replacements, screening and interviewing, and signing bonuses for new positions.
Other costs associated with turnover are hidden, such as the lost base of experience and training (the “institutional knowledge” that many organizations rely upon, see Managerial DNA), and the negative cultural impact that high turnover can have on staff morale and confidence. For more, check out these resources in the OPEN MINDS Industry Library:
- Staff Recognition: More Important Than Ever
- Do You Have The Right Team?
- Maximizing Staff Recruitment Efforts
- Winning the Human Resource Wars: Tried, True & New Strategies for Behavioral Health & Social Service Organizations
- Strategic Human Resource Management: Tackling the Issues of Employee Recruitment & Retention
While much of the workforce issues have been focused on professional staff – recruitment of psychiatrists, nurses, and social workers – the recruitment of paraprofessionals will be an increasingly strategic issue. The solution is to adopt proven, specific steps to improve staff retention. But more on that next week.