Improved staff retention is a key objective for the NHS, and is now recognised as such as part of the NHS Long Term Workforce Plan.
There are a range of actions employers can take to persuade more staff to stay and thrive in their jobs. The starting point is to create the conditions for retention by prioritising and improving the experience of our NHS People.
Key conversations to support retention
Understanding why staff may be thinking of leaving is an essential part of developing an effective response. There are three main methods that are used to better understand staff retention: retention discussions, stay conversations and exit conversations. This briefing outlines approaches used for each, and examples of how the feedback gained can be used.
Where there are high leaving rates and increasing numbers of staff thinking of leaving, retention discussions can play a positive role in helping understand the reasons and inform approaches to improving experience.
Seeking feedback from staff on issues that are leading them to think of leaving is an essential element of effective retention action. Trusts have used a range of tools for these conversations. These include:
- Feedback via online tools - where staff can share views on wider organisation retention issues.
- Staff surveys - focused on areas where above average numbers of staff have been identified as thinking of leaving.
- Focus groups - using small groups to explore the issues causing staff to think about leaving. These are usually led by colleagues from outside the team, such as HR or organisational development (OD) specialists, and often use OD tools such as appreciative inquiry.
- Individual discussions - aimed at better understanding the issues leading staff to think about leaving. These can help identify particular issues of negative staff experience, as well as issues around wider organisational culture and staff experience.
Stay conversations are individual retention conversations focused on what factors may affect an individual's decisions to stay or leave employment. The Long Term Workforce Plan recommends trusts should expand the use of stay conversations as part of their retention strategy.
Stay conversations can help you gather feedback about what is working well and any areas which could be improved. They are different from exit interviews which happen after a staff member has decided to leave.
The format is generally a one-to-one conversation between an employee and line manager, although they may be with a manager from another directorate or department, or with a member of the HR team.
By regularly having these conversations, organisations can learn more about staff aspirations, frustrations and whether staff feel they will stay with the organisation. Managers are then well placed to respond to individuals to help encourage them to stay. The data from such conversations can also inform the overall retention approach.
Stay conversations in practice
Discussions should be separate from other topic-based conversations with staff, such as health and wellbeing conversations. They should be proactive and preventative, focused on listening and identifying issues.
Many organisations have these conversation with new joiners at set points, for example, 30 and 60 days in - as early career has been identified as a risk period for staff leaving.
Other organisations focus on staff identified as thinking of leaving or in departments or units where there are indicators of staff thinking about leaving. Another model is offering a drop-in service where any staff member can request such a conversation.
Stay conversations should provide information on the reasons why individuals are thinking of leaving, but by analysing responses you should get a picture of wider trends and issues. It also demonstrates to staff you care about their experience.
Keep processes as informal and simple as possible and highlight the value of the conversation to staff as well as the organisation.
Stay questions are not prescriptive and should be posed flexibly and adapted to the local circumstances. Trusts have used a range of questions to explore issues such as particular job role and demands, team relationships, working conditions and career aspirations.
The first part of the conversation tends to focus on the issues ‘pushing’ staff to leave. For example:
- What gives you the greatest enjoyment in your work?
- What do you find most frustrating in your work?
- What would make your work more satisfying?
- How informed do you feel about developments?
- How involved do you feel about changes at work?
- Is there anything we can change in your working environment?
- How do you see your career developing over the next five years?
- Are there are personal factors or health and wellbeing issues that would affect your decision to stay?
The second part of the conversation should look at what can be done to address the issues raised, with the aim of ‘pulling’ staff back from leaving. For example:
- What could be done to improve working conditions/relationships in your team?
- How can we help you achieve your goals?
- If there was one immediate change that could be made in your working life, what would it be?
It is essential that feedback from stay conversations is collated, analysed and responded to. There will be an expectation of actions following the conversation and there needs to be a process in place.
Actions can be identified as:
- actionable with clear timescales
- possible to address in short/medium/longer term
- not possible to act on (provided with a clear explanation).
Issues that should be possible to address in short to medium term are typically within the control of the trust, such as:
- flexible working options
- health and wellbeing support
- learning and development opportunities.
Other issues such as NHS pay and reward are outside the scope of individual organisations to resolve but important to be aware of. Some issues such as bringing staffing numbers and demand into balance will take time to resolve. Ideally seek to respond to all issues within a short timescale to keep up the feedback.
A ‘stay plan’ may be a useful approach to recording the outcome of discussions. For each individual this could cover:
- the objective for each initiative (no more than three)
- actions the manager will take
- ideally, actions the employee will take
- dates for each action and an overall review point, for example six months, to check on progress.
By creating a stay plan it will demonstrate accountability and provide a template for tracking progress.
There may still be opportunities to have dialogue with staff even if they have given notice of their intention to leave. Some organisations offers staff the opportunity to explore alternative solutions with their notice period put on hold.
If staff do still wish to leave, it's vital to ask for feedback on the reasons for leaving via an exit interview. It’s important that leavers are asked their views and that data is analysed to understand trends in reasons for leaving.
New national questions have been added to the national exit survey to link responses more closely to the NHS People Promise themes. More guidance and advice on exit interviews is available from NHS England, at England.nhs.uk.
Listening into action
By actively seeking views from staff on their reasons for leaving or thinking about leaving, organisations should increase staff engagement and obtain data which helps inform interventions to support staff staying in post.
Analysis of this data can identify the types of staff most at risk, the areas with the highest propensity to leave and the issues which are the greatest drivers. Positive factors which can help keep staff in post can also be identified and reinforced through these discussions and feedback.
Based on a better understanding of the factors underpinning staff retention in your organisation, you will be better placed to develop an effective strategy to address it.
To learn more on this topic you may find the following resources useful:
- NHS Employers retention web hub.
- Conscious retention – creating a more secure workforce – recent blog exploring the role of freedom to speak up guardians in staff retention.
Feedback is welcomed on the ideas in this guide and NHS Employers is keen to share examples of approaches. Please contact us at firstname.lastname@example.org.