Improving staff retention case studies Promoting flexible working and staff development to improve retention Yeovil District Hospital NHS Foundation Trust What was the problem? The trust had the highest staff turnover in the south of England, with an average for registered nursing and midwifery staff of 22.8% in March 2017, according to Model Hospital data. The three most common reasons for leaving were unknown, relocation and work-life balance. Exit questionnaires did not show accurate reasons for leaving, so were of limited value. What was the solution? The trust focused on a range of interventions after attending NHS Improvement s retention masterclasses. A key turning point was recognising there was no agreed target to reduce turnover, although the outlier position was known. It was acknowledged that turnover needed to be measured and monitored alongside a focus on recruitment activities and patient outcomes. The trust drafted a driver diagram (see Appendix 1) to establish the overall aim and identify key drivers that would deliver improvement. It set up a working group, chaired by the deputy director of nursing, with members from clinical teams, training and education staff, as well as human resources. The working group agreed to: rely less heavily on exit questionnaires, as staff had already decided to leave when they completed them, and improve data capture; increase focus to early identification of staff with itchy feet and signposting them to senior leaders and the head of education for advice and careers guidance undertake a local pulse check survey of staff in two areas (general medical ward and maternity) to better understand why staff might look to leave
promote training opportunities including non-medical prescribing, advance practice and postgraduate courses, using the apprenticeship levy digitally promote vacancies, career development opportunities, courses and study days using a screen outside the staff canteen develop and publish health and wellbeing activities, in and out of the hospital, in addition to promoting local staff benefits and discounts launch a staff transfer window to support staff moving to other departments in a planned and co-ordinated way (see Appendix 2) host a careers development day featuring clinical specialties, education and training opportunities, the transfer window and other local NHS organisations to promote careers in Somerset create portfolio contracts with primary care so staff can work in more than one setting; this approach is under development as part of the sustainability and transformation partnership s (STP) local workforce action board. What were the challenges? In some instances, ward and department managers lacked up-to-date knowledge of postgraduate training opportunities and failed to recognise the value of keeping staff in the organisation, if not in their ward or department. Encouraging the trust board and workforce committee to recognise the value of a reduction target, as opposed to benchmarking against national performance, with a dedicated plan of action. Encouraging staff to take the initiative and follow up opportunities presented to them. Empowerment was key. What were the results? Nursing and midwifery turnover fell from 22.8% in March 2017 to 16.8% in March 2018. Turnover among healthcare assistants fell from 28.2% to 19.0% in the same period (see Figure below). 2
Figure: Yeovil District Hospital staff turnover 29.00% 27.00% 25.00% 23.00% 21.00% 19.00% 17.00% 15.00% Nursing & Midwifery Reg Unregistered Nursing (HCAs) What were the learning points? Time and effort were required to encourage senior staff and department leads to recognise that retention required specific actions. Managers are key to staff retention and need to recognise their responsibilities for what might otherwise be deemed a corporate issue. Recruitment and retention are co-dependent. The success of Yeovil District Hospital s recruitment campaign has positively influenced staff retention but cannot work in isolation. Retention now takes equal priority across the organisation. Next steps and sustainability Continued investment in staff development, transfer of skills and career development within the organisation and across Somerset. Progress portfolio career options with primary care with a view to developing new roles and service developments: eg clinical nurse specialist clinics in GP practices. 3
Closer working relationships with the trust recruitment team and sharing successes across the medical and allied health professions workforce. Development of a clinical workforce strategy, in line with trust and STP ambitions, which sets out plans for the next two, five and 10 years. Want to know more? Jo Howarth, Deputy Director of Nursing and Quality jo.howarth@ydh.nhs.uk To see the other case studies in this series: visit the NHS Improvement website at: https://improvement.nhs.uk/resources/improving-staff-retention/ 4
Appendix 1: Driver diagram
Appendix 2: Transfer window policy Transfer window poster sent to staff The trust is happy to share its standard operating procedure: see contact details above. Contact us: 0300 123 2257 enquiries@improvement.nhs.uk improvement.nhs.uk @NHSImprovement NHS Improvement November 2018 Publication code: SL 20/18