- Costly Turnover
- High Nurse Turnover
- Lack of Reliable Data
- Telephonic Exit Interviews
- 36 % Reduction in First-Year Nurse Turnover
- 33 % Increase in Excellent Scores for Onboarding
- 36 % Decrease in Poor Scores for Onboarding
- 65 % Response Rate
Parkview Health system leaders are dedicated to providing excellent care to every person, every day. To achieve their goals, they needed to reduce turnover among staff – and the answer lay in understanding the real reasons why people left. Partnered with the Work Institute, they uncovered some of the root causes of turnover so they could devise strategies to dramatically increase retention.
About Parkview Health
With 11,000 employees and 415 physicians, community-owned Parkview Health serves northeast Indiana and northwest Ohio through 11 hospitals and other affiliated health services. Parkview Health clinical teams provide compassionate care, equipped with state-of-the-art technology and facilities. Parkview is a partner with civic leaders on the frontlines of safety, wellness and prevention. Its work has won awards and recognition including US News’ Best Regional Hospitals Top 5 in Indiana, 2017 Advisory Board Workplace of the Year, 15 Top Health Systems 2017 by Truven Health Analytics and more.
Parkview recognized that turnover is not only costly, but also affects quality care. Leaders set a strategic goal of reducing turnover, particularly among first-year nursing staff.
At the time, Parkview managers completed a formal notice of separation process and recorded a reason for leaving. But the reason for leaving data was not aggregated, tracked nor used to shape retention strategies. Additionally, there was no confidence that internal reason for leaving data was accurate and no ability to deep-dive into specific reasons why people left. Leaders were forced to act upon common assumptions, including that pay was the number one reason that employees were leaving Parkview.
Solution: Telephonic Exit Interviews
In 2013, Parkview turned to Work Institute as one of the strategies to reduce turnover, as the company’s evidence-based exit interview methodology produces accurate, detailed and actionable data to inform strategies to reduce turnover.
Partnered with the Work Institute, Parkview conducted exit interviews with former employees using an outbound telephonic method that achieved a solid 65% response rate. Work Institute’s trained interviewers used a behavioral interview process to ask open-ended questions and probe for specific details following each answer.
- Former employees were asked to provide all the reasons why they left Parkview Health, and then asked to identify the most important reason.
- Next they were asked to rate onboarding, supervision, compliance and the organization on a scale of one to five, where one was poor and five was excellent.
- Interviewers then asked former employees for specific reasons why they provided each rating and asked them to offer suggestions for improvements to each.
Work Institute interviewers captured detailed verbatim responses to each question, coded each verbatim response using a numeric system and then stored each response in an online portal. This allowed Parkview management to review data on demand, analyze data quantitatively at scale and obtain critical details by drilling down to qualitative responses.
The reliability of the data and detailed responses gathered through Work Institute’s telephonic interviews empowered Parkview managers with the real reasons that employees left. And it gave them a detailed roadmap for improvements at the regional, unit and department levels.
A few key findings:
- Interviews revealed that pay was not the number one reason employees left.
- Leaders learned that expectations for the job were the top drivers of turnover.
- Management learned that their onboarding processes could be improved.
- Data analysis uncovered regions and business units that needed additional assistance.
- Leaders were able to focus efforts on accurate and specific areas that achieved results.
Parkview leaders developed strategies and implemented initiatives to address key findings from exit interview data, focusing on the reduction of first-year nursing turnover and the improvement of onboarding for new employees.
Leaders further asked employees for feedback to review and redesign the onboarding process. Through best practice literature reviews, co-worker focus groups and manager focus groups, leaders obtained input and built support for a new onboarding process. The team arrived at a new onboarding process that consisted of three stages: Pre-Arrival, System Orientation and Department or Unit Specific Orientation. One of the main goals of the redesigned onboarding program was to ensure clarity of job expectations.
The System Orientation stage involved the new employee attending new hire orientation and clinical orientation. In the last stage, the new employee was assigned a leader, preceptor and other team members for mentoring and training for job-specific tasks and their role on the team.
New strategies and improvements to onboarding resulted in consistently increased excellent ratings and consistently decreased poor ratings for the onboarding process, measured through exit interview data.
- 33% Increase in "Excellent" Scores for Onboarding
- 36% Decrease in "Poor" Scores for Onboarding
Parkview leaders also used exit interview data to add critical new elements to the hiring process to ensure the best candidates were hired and that potential new employees had a clear understanding of the job.
To develop a more robust candidate pool, Parkview also has included referral bonuses, welcome bonuses and has initiated an international nurse recruitment program.
Elements of the hiring process that were re-built included:
- Adding a pre-hire assessment
- Expanded the peer interview process
- Providing a detailed realistic job preview
First-Year Nursing Turnover
Leaders addressed detailed exit interview feedback and have consistently cut first-year nursing turnover annually. In addition to the onboarding and hiring process improvements, programs put in place to improve retention include an RN competency ladder to provide a career path for nurses, an emeritus nurse program, a nurse residency program, a JumpStart nursing orientation and a tuition assistance program to help nurses earn advanced degrees. Parkview also reduced the RN-to-patient ratio to 1:4 and currently offers co-worker incentives based upon financial and service excellence goals.
The new strategies resulted in a consistent reduction of turnover among first-year nurses at Parkview, totaling an 11 percent reduction from 2013 to 2017 (YTD).
- 36% Decrease in First-Year Nursing Turnover
Parkview leaders asked employees for feedback, using a proven methodology, and then acted upon the data, resulting in improved perceptions of the onboarding process, improved perceptions of the organization and reduced first-year nursing turnover.