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Employee Retention

As the economy begins to recover, some employees, who sat tight during the recession, are now starting to think about moving on to greener pastures. What can you do today to keep your best employees happy, reduce employee turnover and maintain high service levels – in good times and bad?


In this Pulse article, we explore employee retention, knowing that one size does not fit all:

  • Understanding the impact of employee turnover on the bottom line
  • Learn why it's important to have a personalized approach to employee retention
  • Identify ten steps to hold onto top performers

View related pearls


Employee turnover hits the bottom line hard: Human resources experts estimate that the average "hard costs" of replacing an employee (severance, recruitment, hiring, training, etc.) can range from 50 percent to several times the departing employee's annual compensation, depending on his or her level within the organization . Add in so-called "soft costs" resulting from lost expertise, reduced productivity among remaining employees and degraded customer service quality, and it's easy to see how important it is to retain your top performers.

What's the "secret sauce" that keeps employees happy? That depends on the employee. A physician in a large, multispecialty practice recently told me that a staff member asked to be transferred specifically to his site. "Even if it means getting paid less," she told him, "I want to work for someone who respects me." Feeling respected for one's skills and talents is an important reason employees stay with a practice; for some employees it's the most important reason. Other employees, however, may feel that compensation – or another job benefit – is even more important than respect.

Ultimately, each of your employees makes the decision to stay or go based on a complex mix of tangible and intangible factors that's unique to what that person values. Here are 10 steps you can take to implement an employee retention strategy that meets your employees' individual needs and strengthens your practice.

  1. Hire Right. According to many estimates, at least 50 percent of employee turnover can be attributed to poor hiring decisions. Reduce the odds of having to "undo" a bad choice later by hiring staff who not only have the requisite skills and experience, but also a personality and mindset that fits with your practice's culture and values.
  2. Listen up. The hiring process presents a valuable opportunity to learn what motivates (and de-motivates) candidates. Once you've made your hiring decision, note the successful candidate's reward "hot buttons" and use that information to help tailor retention activities. The same holds true for existing employees: listen and observe each one carefully – or even ask them directly – if you're not sure what floats their boat.
  3. Offer competitive compensation. Know the market values of each staff position and target new hires to the norm for the position and your community. Should you need assistance establishing compensation benchmarks, professional associations, including many Medical Group Management Association local and state chapters, as well as the law firm The Health Care Group, produce annual staff salary surveys. Scan through local job advertisements to identify salary norms for free; try also Internet-based compensation tracker such as Salary.com.
  4. Take a close look at the work environment. Do your employees have work spaces appropriate to their activities? Do they have the tools and resources they need? Are systems, policies and procedures a help or a hindrance? Streamline and simplify wherever possible to make it easy for your staff to do their jobs well and reduce employee stress.
  5. Set and communicate realistic expectations. Top performers often assume heavy workloads, which is great – until it leads to burnout. These employees may be reluctant to turn down requests to add "just one more thing" to their already-overflowing plates, so you need to take the initiative. Periodically review staff assignments with your employees and determine what, if anything, can come off their plates; sometimes tasks remain on job descriptions long after they've lost their utility. Update the descriptions and review them with each employee to ensure you have a common understanding of baseline performance expectations.
  6. Provide opportunities for growth. In addition to streamlining assignments, work with each employee to set quarterly and annual objectives that are specific, measurable, achievable, realistic and time-bound; remember the components via the acronym "SMART". These objectives should go beyond the basic activities of the employee's job description to move the practice forward and provide opportunities for professional development, cited by many employees to reduce their propensity to leave.
  7. Foster relationships of trust. Practices with low turnover rates have good physician-staff (not just physician-nurse) relationships. They socialize, have potlucks at lunch, hold BBQs behind the office, etc. In short, they have fun together – and in the process, develop camaraderie and interdependence that strengthen the practice.
  8. Proactively manage performance. Meet individually with each employee on an annual basis (and quarterly for new ones) – job description and objectives in hand – to review progress, praise good performance and discuss any lingering performance issues (critical performance issues should of course be dealt with as soon as they arise). If you've built relationships of trust, the payoff will come in these conversations, which ideally should be a candid sharing of information, rather than managerial monologues. Acting promptly to correct performance issues is particularly important, as top performers pay attention to how you deal with those they perceive as not "pulling their weight" and may leave a practice in which underperformance is tolerated.
  9. Reward good work. Rewards may be tangible – like cash bonuses or other financial rewards – or intangible, like public recognition for individual or team achievements. As not all employees value the same type of recognition, personalize rewards based on what you know about each employee in order for them to be effective motivators. Surprise rewards are particularly powerful, because employees never know when to expect them: Try a movie ticket as a reward for a long day of work, a gift certificate for a bed and breakfast after months of overtime or a flower on everyone's desk after a computer conversion.
  10. Balance it out. Offering flexibility in scheduling or providing services that meet employees' personal needs can reduce stress and support work/life balance. You might negotiate an employee rate with a local day care provider, make arrangements for a dry cleaner to stop by the office for pick-ups and drop-offs or contract with a car wash service or chair masseuse to visit the office monthly. Caring about your employees means they will care about you.

Take the time to understand what matters most to each employee, tailor their rewards to those preferences and cultivate an environment of respect and trust within your practice. If you do, you'll be rewarded with engaged, long-term employees and reduced turnover costs.

Pearls 07/2012

1. Ask!
Don't just guess of ways that you want to make the work environment better. At least once a year, make sure you ask each employee – "What is the one thing that might help you perform your job even better?" You'll be surprised at the responses – often it's a small request, a dual monitor, for example. It's not uncommon for us to overlook the fact that the employee who is doing the job knows it the best, not you or someone else.

2. Mad Props
Share praise. When you receive a compliment about an employee – or group of employees, "go public" and mention it where others can hear the compliment. Share the patients' comments at the next staff meeting, accompanied by your congratulations. Recognition helps employees understand they work in a culture that supports the delivery of exceptional customer service – and it is much more than something written in the employee manual.

3. What's Up?
Recognize why your employees leave. Although it's important that you do your own due diligence when it comes to determining what matters to your employees, here's a starting point: the top 5 reasons employees gave for leaving their jobs, according to a 2011 nationwide, multi-industry survey by Kenexa1

  1. Lack of opportunities for professional development (cited by 30% of respondents)
  2. Inadequate compensation (28%)
  3. Boredom/lack of challenge (27%)
  4. Poor work/life balance (20%)
  5. Job stress and unfair treatment (20%)

Perform an exit interview of staff that depart in order to determine why they left – and take steps to improve your work environment to reduce future turnover.

4. The Millennial World
Understand the generations at work; get acquainted with Millennials. Born between 1980 and 2000, the Millennials generation is now 12 to 32 years old. This might comprise most, if not all, of your practice's support staff. These newest members of the workforce were raised in the computer era. They are adept at using cell phones, texting, and social networking online. They don't just have different tastes in music, clothes and hairstyles than previous generations -- Millennials have a completely different outlook on social connections – a worldview formed by being born and raised in the digital era. With the world at their fingertips through the Internet, Millennials have been exposed to a far more diverse array of music, ideas, literature and other influences than previous generations. A survey of workers by the consulting firm Randstad found that "trying new things" was the most popular activity of these younger workers. Their attention spans can be short so they might easily become bored with too many routine tasks. And not just bored, but completely dispirited. Spice up your Millennials' work experiences and tap into their potential by crosstraining them on other tasks, assigning them projects that offer challenge and learning and emphasizing the positive role that they play in your patients' lives.

United States