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Lower Mortality, Higher Patient Satisfaction Starts with Turnover

Philip Betbeze, for HealthLeaders Media, July 9, 2010

High turnover is something that unquestionably costs money and time, but its tentacles extend into just about everything a hospital does. Quint's firm, the Studer Group, has done several studies that show that when a hospital is able to reduce turnover, other metrics also improve, and those metrics aren't applicable only to the financial side of the house.

Turnover is fundamentally about the culture of the organization, and whether it really demonstrates to its employees that they are essential to making an organization among the best in patient care.

Until the recent economic downturn, many hospital leaders could legitimately blame at least some turnover on external factors, such as shortages in clinical areas particularly, and the hot job market generally. But many of those external pressures have abated.

That means, however, that it's time now to address the internal problems causing turnover, because if employees are leaving at an accelerated rate, it has much more to do with a CEO and his or her policies than with external factors. Attacking turnover is not a panacea, but by doing so, CEOs can better deal with associated problems with morale, waste, patient handoffs, patient satisfaction scores, and medical mistakes.

Many CEOs don't see employee turnover as an area where they can make a substantial impact. Maybe they can't match higher salaries available elsewhere. Maybe they can't offer the challenge and cutting-edge leadership of the academic medical center. As a result, concerns about turnover are often shunted to HR. The CEO has many more important things to worry about, so the thinking goes. But CEOs can make a big difference in turnover, and they really should. In fact, few priorities touch so many other related criteria on which the quality of a hospital or health system ultimately will be judged.

Laurie Eberst, President and CEO of Mercy Gilbert Hospital in Arizona, says a consistent staff offers a "huge advantage from a quality perspective." Mercy Gilbert's parent, Catholic Healthcare West, thinks turnover rates are so important that it tracks controllable versus uncontrollable turnover.

Uncontrollable turnover would be equivalent to a top nurse leaving because her husband is transferred out of town instead of because she hates her boss, which should be controllable, says Eberst. Indeed, Studer's work suggests that people generally don't leave jobs because of the reasons they may give, such as a higher salary.

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