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Opinion: 3 ways for higher retention in health care

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The talent war is far from over, and retaining workers in health care has never been more critical. A 2022 NSI Nursing Solutions Inc. report shows that hospital employee turnover stands at 23%, and the average cost of turnover  for a registered nurse, for instance, is $52,350. As a result, the average hospital  lost $8.55 million in 2022, per the report, and using the RN example, each percent change in nurse turnover would cost or save the average hospital $380,600 per year.

Although studies suggest the reason for turnover is due to career advancement opportunities and relocation, the question must be asked: Are we seeing the whole picture?

Most employees who leave will never burn bridges by telling the truth: “I’m leaving because of the culture” or “I’m tired of being bullied by a temperamental surgeon.”

Surveys often don’t reveal a root cause of turnover: Ineffective leadership and toxic cultures. Here are three ways to work toward higher retention in health care.

  1. Create a culture of accountability.

Whether you’re a seasoned leader, new to a department or hired as a change agent, observe the culture. Notice how senior leaders handle conflict. Is there alignment at the top? If you notice signs of in-fighting at the top, there won’t be support at the middle or first layers of leadership. If there’s avoidance at the top, supervisors, managers and even change agents will become the common enemy when trying to promote accountability.

Some indications of cultural avoidance:

  • Constant reorganization.
  • Senior leaders reversing decisions made by their managers.
  • Inconsistent policy implementation.
  • Exceptions made for high-conflict, high performers.
  • Hands-off leadership.

Retention tip: As a leader, make sure your decisions and boundaries are supported at the top. Constant reorganizing because people can’t get along signifies avoidance. Notice how avoidance affects productivity, teamwork and patient safety, and it’s easier to make the case for supporting your change efforts.

  1. Address conflicts quickly.

After I was speaking at a conference, a leader approached me and said, “The reason I haven’t resolved a conflict in my department is that I inherited the problem.” I asked, “How long have you been leading this department?” Twelve years was her reply. Even if the organization offers leadership development, many leaders struggle to initiate conversations about performance or behavior, waiting until the dreaded yearly review, which often makes the employee feel blindsided.

Why leaders avoid conversations:

  • The problem was inherited.
  • Bad behavior has been allowed.
  • Lack of skills.
  • Low conflict capacity.

Retention tip: By not addressing conflicts or unacceptable behavior, you risk losing high performers who can’t tolerate the climate. Whether you inherited a problem or you’ve let a problem go on too long, you can still course correct. With courage, you can address the problem, set a new boundary and follow through with accountability. Once senior leadership agrees with your plan, initiate meetings – either group or one-on-one sessions to set new expectations.

  1. Make behavior part of performance.

According to the Medical Group Management Association, the topic of disruptive physicians is an ongoing concern. Disruption includes incivility, lack of emotional regulation leading to outbursts, denigrating employees and making sexual innuendos passed off as a joke. Tolerating disruptive behavior for any reason affects every area of the business, from retention, productivity, work-life satisfaction and patient safety. A toxic culture is created due to allowing bad behaviors from high performers. The excuse is “They may have bad behavior but their performance is great.” When behavior is considered part of performance, the standards change and retention goes up.

Reasons for tolerating disruption:

  • Lack of leadership courage.
  • Different standards for high producers.
  • Behavior is not considered part of performance.
  • Entitlement mentality is based on expertise or seniority.

Retention tip: Rather than focusing on the value of a star performer, focus on the compounding financial and emotional effects of a disruptive employee. If you see absenteeism or high turnover in a department, look for evidence of disruptive behavior from a high-conflict high performer. Take a strategic and nonthreatening approach to set new standards offering leadership coaching and self-regulation support for the high-value, high conflict performer. Use the company mission and values as your compass.

When long-term employees tell you they’re leaving for higher pay or career advancement, take a 20,000-foot view of the culture, department by department, to see if there is avoidance, disruption and unresolved conflicts contributing to unwanted turnover.

Marlene Chism is a Springfield-based consultant and author of “From Conflict to Courage: How to Stop Avoiding and Start Leading.” She can be reached at


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