When people think about workforce planning, they generally run the concepts of  ‘recruitment-and-retention’ into a single phrase. However, as we’ve shown in our AHP Workforce Employee Lifecycle series, recruitment is not even the beginning of the employment process (which needs to start well before you’ve  got a vacancy with attraction). Similarly, retention is often a concept that people think about when they start to have high turnover, lose valued staff, or realise the challenges of recruiting and appreciate that hanging onto existing staff is far preferable to competing for new staff in a highly competitive employment market.

Why is staff retention important?

The PwC Global Workforce Hopes and Fears Survey 2022 surveyed 52,000 workers across 44 countries to understand what was important to employees. The report emphasised that workforce is the greatest risk for an organisation – without sufficient, high quality workers your organisation cannot deliver an effective service, meet client needs of grow. The key theme from the 2022 survey was “power”. While not specific to health, employees with scarce skills know their value and want to have that value recognised. Specifically, more than one third of workers plan to ask for a pay rise over the next year and one fifth said they were likely to change employers. However, retention was more complex than simply a pay rise. Employees want fulfilling work and the ability to be their ‘authentic self’.

Supporting and grow your own staff builds organisational capacity and culture

Supporting and growing your own staff reinforces the valuing of your workers by your organisation. Recruiting and promoting staff from within shows that you value and respect your own staff development processes. It also shows that you have internal career pathways. Losing staff is disruptive and costly and onboarding new staff will inevitably shift the organisation dynamics. Mr Pat Grier, former CEO of Ramsay Health Care describes how he focused on an investment in his staff through promoting a positive organisational culture to turn Ramsay from a small and nearly insolvent organisation to a global health care provider.  The key to Ramsay’s success was a strong investment in staff development to ensure that the Ramsay workforce  was a leader in the market, and this was supported by promoting from within.

Staff turnover is expensive

Staff turn-over is expensive. There is little, high quality, published evidence on allied health workforce benchmarks for turnover, retention or costs. A 2011 Australian study found that the direct and indirect replacement costs for an allied health professional were $45 781 for a remote health service and $23 010 in a regional health service (which, depending on the level of the employee at the time was at least 30% of the employment costs of those staff at that time).

Human resource consultants estimate that the cost of replacing staff ranges from 30 –  200%, depending on the role and level of seniority of the staff member. Replacements costs include:

• Loss of productivity
• Cost of backfill
• Time to upskill the new employee
• Training costs
• Hiring and replacement costs
• Separation costs and the costs of starting the new employee

Clearly, the financial benefits of retaining and the high costs of turnover justify the investment in strategies to ensure that you sustain and grow your workforce.

How do you define and measure workforce retention

Based on the limited workforce literature available for the allied health professions, allied health are not good at capturing metrics on workforce turnover. Unfortunately, this limits the ability of AHPs in general to plan appropriately, to benchmark, and to lobby for systemic changes.

A seminal paper on allied health workforce turnover by Chisolm et al outlines a range of metrics, and provides data on allied health retention from rural Australia. These are the key metrics.

Retention = [Total no. employees – total no. employees departed] / total number of employees

Workforce stability = proportion of the workforce who remain in their role for 1,2,3,4 or more years

Median length of employment = the measure of the time your employees remain employed

Survival probability = the likelihood of employees remaining in their job after a specified time (1,2,3,4 or more years)

The same study found the following sobering statistics from Western Victoria (Australia) from an analysis of data between 2004 – 2009, including 11 health services and 901 staff:

• Annual workforce turnover was 26%, (18.7% regional, 25.4% rural and 30.2% in remote health services).
• The median length of stay in the current position was 3.1 years (4.1 regional, 3.1 rural, and 2.7 remote).
• One year survival probability was 92.5% (85.3% regional, 94.9% rural and 93.2% remote)
• Four year survival probability 56.3% (60.4% regional, 66.9% rural, 46.2% remote)

The same study found that workforce outcomes varied across different professions. For example, podiatrists and dietitians median survival time of 18 months; physiotherapists and occupational therapists 3 years; speech pathologists and psychologists had a median survival time of 2.6 and 2.5 years respectively. Profession based differences in survival time were attributed to the age or grade structures within the professions and lack of career development

Approaches to retaining allied health staff

Provide competitive financial rewards

In a competitive employment market and at a time of high inflation, financial rewards are clearly important to staff. While pay is not the primary driver for allied health profession roles, uncompetitive pay or employment conditions will make it very difficult to both recruit good staff and to keep them.

Create an environment where your staff feel safe discussing sensitive topics

The importance and value of a positive workplace culture is highlighted in most allied health workforce surveys, however the PWC report takes this a step further and suggests that during this period of increasingly diverse (and sometimes polarising) views, employees need to be able to have discussions about sensitive topics, to feel safe to share their views, and to have an open and inclusive workplace environment.

Similarly, employees across all sectors report high levels of mental illness and see their employer as the main source of mental health support.

Create opportunities to build and develop your staff

Allied health work is skilled, specialised work which requires regular practice and updating for your staff to remain current in practice. Conversely, if your employees have limited opportunities to work across a wide range of practice or to use their skills to their full scope of practice, they will lose those skills, or at least their confidence to use those skills safely. At the very least, ensure your employees have active opportunities to use their full scope of practice – at least in a way that is appropriate to your environment. You might consider using a competency checker that helps employees to check that they have currency and competence in a range of practice areas that are relevant to their level of seniority and area of practice. Provide support to achieve and maintain those competencies through support, supervision or additional training, and recognition when a staff member has achieved a specific level of competence or skill. These do not need to be clinical competencies – and could include skills in leadership, quality improvement, research, knowledge translation, marketing – or any other area that is important to your practice.

There is a range of resources to support aspects of professional development for allied health staff. Several are provided by professional associations, and a number by large employers, including public and private sector organisations. For example,  Leadership in Allied Health by the Victorian Department of Health (Australia), several professional development programs are listed on the Allied Health Professions Australia website. If you are interested in research, the NHS England Allied Health Professions’ Research and Innovation Strategy for England outlines the strategy for building allied health research careers in England.

Support flexibility where appropriate

COVID-19 shifted the way that nearly everyone works and has created new expectations around home based working. Allied health professionals value workplace flexibility – particularly to allow them to have work-life balance and support family needs. Not all allied health work lends itself to home based work, but where it is possible to structure work more flexibly,  such as allowing staff to work from home, take time-off-in-lieu, or to restructure their work hours to meet other commitments, your staff satisfaction will improve.

Benchmark against your peers (and others)

Every sector and organisation uses different strategies to develop and retain their staff. For many allied health employers, this is a relatively new area. Look for examples of good practice from others in your industry, or outside. For example, take a look at the winners of employers of choice – they normally have some great examples of how to be a great employer. One example is Australian technology leader Canva, who have won several employer of choice awards internationally.

Give back

Increasingly, employer organisations are taking a social or political stance on a range of topics from volunteering to environmental sustainability and governance (ESG). Disney provided a high profile example of what not to do in their approach to LGBTQIA+ people. From creating a safe environment to volunteering, supporting local community groups or taking a clear stance on larger social issues – there are a range of ways you can make a difference to your community and create a reason for your staff to stay with your organisation.

Push factors – what drives staff away?

The PwC study identified five areas that were more strongly associated with the likelihood of employees looking for another job, specifically: lower job fulfillment, less able to be their true self at work, pay, team culture, management support.

Allied health professionals identified the following issues contributing to their desire to seek alternative employment (for example, see  Strategies for increasing allied health recruitment and retention in rural Australia A Rapid Review)

• Overwhelming waiting lists, slow processes, lack of available services
• Resources are unevenly distributed or limited
• Lack of access to professional supervision
• Lack of career development pathways
• Lack of professional autonomy
• Overly bureaucratic work
• Career growth limited to management positions (creating vacancies in front line roles)
• Travel burden
• Inflexible and inequitable work arrangements
• Inability to support / adapt to diverse needs
• Punitive management structures

Conclusion

Workforce shortages are not unique to allied health, and are being experienced globally. Competitive pay is necessary, but not sufficient to ensure that you retain your workforce. Supporting, upskilling and nurturing your workforce in an ethical and safe environment will provide some of the ingredients for your staff to stay with you.  These initiatives take investment – some will take some financial investment – all will require a substantial investment of time to develop and implement fully. However, the savings you can make by lowering your rates of staff turnover will provide a substantial return on investment.