Whenever you place a new hire in a role, you hope they’ll go the distance. But ‘hopefully’ isn’t enough in this challenging recruitment climate.
The first 90 days of employment is an opportunity to set firm foundations and begin the first chapter of a productive, long-lasting relationship. And yet, within the caregiver and healthcare sector, those first 90 days are also where the majority (57%) of turnover occurs.
A small portion of this turnover will come from poor-fit hires and people who are asked not to continue after their probationary period. 95.5% of all hospital staff turnover is voluntary though, so there’s clearly something to analyze here.
To put it plainly, employees who are supported and nurtured through their first 90 days in post become engaged, loyal workers — likely to stay for a year or longer. Those who aren’t, resign.
Let’s look at how you can harness the 90-day retention opportunity for your healthcare organization.
Retention efforts begin before recruitment ends
When we think about retention, we typically think of the employees we’ve already onboarded. And this appears entirely sensible: you can’t retain the staff you haven’t hired yet.
At the same time, we know that the employee experience journey starts way before an official job offer. The ‘moments that matter’ start as early in the lifecycle as first seeing your job advert and visiting your website.
Candidates are forming an opinion about your organization throughout the application and recruitment process. They’re deciding whether or not they can see themselves staying with you long-term.
At this stage, candidates are looking at factors such as:
- What you ask of them during the assessment process
- How well and often you communicate
- Your employer branding
- What current employees say about your business on social media
- How well your organization is reviewed and how it’s represented in the press
- What your annual reports say about the employee experience, your commercials, vision and values, and position in the marketplace
Not all candidates will deep dive into your organization’s public profile, but some will. And at the very least they’ll be on the receiving end of how you manage the application process. So to start as you mean to go on: to help employees get past the first 90-day threshold, your recruitment efforts need to serve as retention efforts, too.
This can be a challenge for organizations using staffing agencies, who may have significantly less control over their relationship-building efforts. Similarly, US companies deploying CDPAP may find care workers appearing on the payroll without any previous facetime and with limited understanding of the provider that’s hiring them.
The need to deliver retention is pressing even in these scenarios. Attrition is a phenomenal cost burden for healthcare organizations placing employees from any recruitment source.
Understanding attrition factors
Healthcare workers brought into your organization through traditional means — that is, not CDPAP or staffing agencies — must have been excited about the opportunity enough to accept your offer. What can happen to make them want to leave only a few months later?
Experience versus expectations
Employees come to a new role with a series of expectations. These come from their previous work experiences, your employer branding, and the job description. If their experience is significantly worse than — or even just different to — their expectations, they may decide to move on.
There’s a ‘two-factor theory’ at play here. On one hand, you have hygiene factors, otherwise thought of as ‘causes of dissatisfaction’. These can include issues such as problems with managers, poor working relationships, or a feeling of inadequate health and safety.
Motivating factors are the opposite: they make a worker want to stay. These include opportunities for growth, having a sense of purpose, and feeling recognized for good work.
If there’s a significant mismatch between hygiene factor expectations and experience, don’t be surprised if your staff start to churn quickly. An absence of motivating factors may take longer to push staff into leaving, but eventually, this will too.
Lack of access to training, resources, and tools
Staff who lack the necessary training, resources, and tools to perform their duties effectively quickly become frustrated and demotivated. They’re unable to enjoy their work or do it well.
This isn’t just an attrition risk. A lack of access like this also creates compliance and patient safety concerns — it leaves your organization open to risk, reputationally and financially.
‘Access’ is the right word to interrogate here. Training might be on offer for healthcare workers, you may have paper copies of necessary resources, and specific tools might have been rolled out to the frontline to support their day-to-day. But if employees can’t access them easily — without disrupting their working day — then they simply aren’t fit for purpose.
Frontline healthcare workers need tools designed to meet their needs. Tools and software solutions originally aimed at office-based workers are unlikely to fulfill this requirement.
It’s also important to recognize the additional administrative burden your employees face during their first 90 days. There’s rarely enough time for thorough onboarding and training before workers are asked to care for patients.
This leaves workers trying to juggle patient care and paperwork throughout their first 90 days. This overload and lack of intuitive tools can mean that aspects of onboarding and training get missed.
Scope of the role
Unsurprisingly, some healthcare roles have higher turnover than others. For example, larger hospitals with more than 500 beds have the highest rates of staff turnover.
Similarly, few new hires are comfortable joining a team that remains understaffed. If the situation isn’t resolved promptly then turnover is likely to be high.
Some frontline healthcare workers spend the majority of their day surrounded by other people — on a busy Accident and Emergency ward, for example, or riding in the ambulance with the rest of their EMS crew. Others work solo. Home health carers can go weeks without seeing another co-worker or connecting with HQ.
Every frontline worker needs contact time with their manager. They need support, development, and feedback on their performance. They also want to share their difficulties and suggestions, and this contact time is all the more important during their first 90 days when so much of the role is new.
Contact time with co-workers is essential too. Teams need to spend time together to create a sense of belonging. They can share ideas and experiences and provide peer-to-peer support.
Healthcare and home health organizations relying on staffing agencies and CDPAP need to put in considerable extra effort to encourage this kind of culture.
Seizing the opportunity: what makes those first 90 days engaging
Flipping the above on its head, we can now start to assess what a great first 90 days looks like for healthcare employees.
An immediate and thorough welcoming
Employee onboarding plans set the tone across four important Cs: compliance, clarification, culture, and connection.
- Compliance is vital in healthcare. You need to know that new hires understand what’s expected of them to satisfy the necessary criteria and continue with best practice. You should also use the onboarding process to ensure employees go through any required training or certifications before they treat patients.
- Clarification is broader than compliance. It helps employees understand what their job role is in detail and by being crystal clear from the off-set you can set them up for success. You might also choose to clarify who they will work with, who they can turn to for questions and support as they learn the ropes, what your organizational goals are, and how much their individual contribution matters.
- Culture we’ve mentioned already and it’s where many healthcare organizations start to fall down where retention is concerned. Harvard Business Review data concluded that “Competitive pay and other support options are essential to recruiting caregivers, of course, but organizational culture, including a commitment to excellence, is what makes them stay.”
- Connection is rarely ever achieved without the right cultural environment. If culture can be thought of as how you work as an organization, then the way you connect your teams together naturally falls into this category. Remember: just because a healthcare worker is put on a busy ward with many busy co-workers doesn’t make them connected. Connection requires considered effort, from them and from you. And you have the opportunity to lead by example from as early as day one.
Welcoming staff shouldn’t be a one-way process, though. Yes, you will have lots of information you need to pass their way, but the earlier you get them actively engaging the better.
Run regular onboarding surveys at the end of weeks 1, 4, 8, and so on. And if you have employee groups and communities available to join, make sure your new hires know they are there. These could be around internal initiatives, like digital inclusion, or shared values and characteristics like LGBTQ+. Look for every opportunity to create community, belonging, and psychological safety. The impact on retention and employee wellbeing can be transformational.
An effective onboarding can, according to BambooHR:
- Make employees feel 18x more committed to their employer
- Increase a sense of connection in 91% of employees
- And lead 89% of employees to feel ‘very engaged’ in their work
What could your healthcare organization do with stats like that?
Having the tools needed to succeed
Frontline healthcare workers often have tools extended to them as an afterthought. Whatever their desk-based peers in head office are using is what they are asked to use too.
But these tools are not fit for purpose for the frontline. Either as a result of bad mobile user experience, requiring multiple log-ins, complicated filing systems and navigation, or all of the above.
Some crucial workflows are still paper-based by default, causing a digital divide to form between healthcare teams. This impacts efficiency and productivity, employee engagement and satisfaction, and the quality of patient care.
By empowering frontline staff with the right tools for the job from their very first day you can greatly reduce attrition risks, solving for the ‘hygiene’ and ‘motivating’ factors we covered earlier on.
- Be mobile optimized and easy to use on the go
- Facilitate single sign-on and bring all mission-critical apps together in one place
- Allow teams to stay connected to each other and the wider organization
Transitioning from desk-based tools to a frontline employee app will make frontline hires feel valued and invested in. It’ll also keep them with your organization way beyond the first 90 days.
Checking in regularly
It’s no shock to anyone that great relationships rely on effective communication. What’s important is how you make this kind of communication normal for your new employees.
- Encourage new hires to ask questions, build connections, and proactively seek out the training they need. Home Health Pulse explains it perfectly when they say, “Because inexperience breeds vulnerability, caregivers who feel unsure or underprepared in their position for too long will choose to save their dignity and quit to go where they feel competent.”
- Focus on their relationships with co-workers and the first-line managers who lead them. These should be your employee’s first point of contact when they need help, so make it easy for them to ask
- Ask for their feedback often. When staff find it easy to talk about the challenges they’re facing, you hear about problems early. This lets you tackle emerging issues around burnout or frustration before it’s too late. 91% of nurses blame burnout, poor working conditions, and pay for the staffing shortage — hear them out on these issues to minimize attrition. Annual healthcare employee surveys are only the beginning.
Offer your new hires a variety of paths to communicate their needs. Blink Pulse surveys let you track feedback from your new hires, opening up the opportunity to optimize and improve your retention rates.
Connecting new hires with your overall purpose and mission
“I’m yet to meet a clinician or caregiver who got into this line of work to be on a computer all day” explains Ian Gordan, former President of Administrative Operations for Elara Caring.
And it’s true. At the risk of over-generalizing, frontline healthcare workers typically want a sense of purpose in their work — and it pays to provide this sense of purpose as soon as you possibly can.
Unfortunately, it can be difficult to remember this purpose when workers are constantly rushed, focusing on the immediate needs of their patients. Limited contact with co-workers can make this problem worse.
It’s here that tooling becomes essential again:
- A shared news ‘Feed’ allows you to send regular reminders of the company's purpose and internalize those values in new hires
- Building connections and ‘Chats’ between team members provides a collective sense of excellence and dedication to the cause
- Mandatory reads shared in the Feed and then saved in a centralized ‘Hub’ give all staff members a place to refer back to if they ever need a reminder
Rewarding and recognizing key behaviors
Lastly, but equally as importantly, there’s reward and recognition.
Keep your new hires motivated and enthused during and after their first 90 days by demonstrating a culture of recognition. Reward staff who are doing well early in their time with you. Give them a shout-out on your news Feed or gift them some company goodies.
It’s a basic tenant of psychology that we should reward the behavior we want to see repeated, but the benefits of recognition programs in the workplace extend far beyond productive behavior. Culture, customer service, and commercial outcomes are all improved when your healthcare workers feel appreciated.
Reaching the 90-day milestone — and beyond
Don’t let the 90-day milestone pass by without at least some form of recognition and check-in. If your employee stays with you past the first 90 days, celebrate that — and them.
If your employee voluntarily leaves before they pass the 90-day milestone then you have an opportunity to learn. Ask your employee why they’re leaving and what could have enabled them to stay.
Consider going further, too. Consider holding regular ‘stay interviews’, offering employees an opportunity to discuss concerns they have with their role and their aspirations for their career.
Blink. And deliver the best employee experience from recruitment to retirement
Blink helps you keep top talent from recruitment to retirement. Our frontline employee app enables and empowers healthcare staff with the tools, resources, and support they need to thrive at work and offer outstanding patient care.
Learn more about Blink for healthcare here.