Planning Strategies
The Real Reasons Staff Leave
Asking yourself these questions can help you avoid the costs of turnover.

Ophthalmic practices across the country are facing similar challenges in attracting and retaining qualified talent. Though your turnover figures may be low, even minimal loss of staff can be disruptive to a lean organization.

Many costs are associated with staff turnover:

• dissatisfied employees planning to leave are less productive
• employee defections disrupt the work routines of those who remain
• the separation process has its own inherent costs
• it's a major expense to attract, hire and train replacement workers
• staff productivity suffers while new hires come up to speed.

Practices are often shocked to see that these costs are much greater than they initially anticipated. Reducing your staff turnover even a little can yield significant benefits to your practice.

ALL TURNOVER ISN'T EQUAL

It is important, however, to distinguish between voluntary turnover (separation) and involuntary turnover (termination). Termination can be beneficial as you cull poor performers from the practice. What hurts is when good employees quit.

When long-term employees quit, their loss is the most expensive and the most disruptive to the organization. They take with them training, skills, experience, productivity and the social bonds that help your less experienced employees succeed at their work.

It doesn't help to make excuses, such as: "If only we could hire better people," or "They all leave for better money," or "This level of turnover is normal for ophthalmology; that's just the way things are."

These excuses shift the responsibility for any staffing problems to outside factors and prevent you from making effective changes in your internal processes.

INTERNAL FACTORS TO EXAMINE

What are the conditions inside your practice that influence whether employees stay or quit? My experience indicates that the following five factors hold the key to the level of staff turnover:

Commitment. A sense of employer commitment is the strongest influence on employees' desire to stay. Your practice should have a clear "vision and values" statement that demonstrates real commitment to your employees.

Long-term prospects. How do your employees see their future with your practice? Does the practice have an employee recognition program? Do established career paths exist?

Job satisfaction. Are your employees enthusiastic about coming to work each day? Is their work satisfying?

Stress. While high stress has become a legal issue in the workplace, even low levels of stress can cause people to quit. Do your employees complain about inefficient office procedures, difficulty accessing information, unrealistic deadlines, too many work interruptions, and/or an unreasonable workload?

Fairness. Are employees promoted for the right reasons? Are jobs posted and made available to employees first? Are the criteria for receiving raises and promotions made clear to all staff members?

MONEY ISN'T EVERYTHING

What happened to the money issue? The most common reason staff members give for quitting is money. And if you pay below industry averages, people may indeed leave for that reason. But most quit because of the factors listed above. They usually won't tell you because it's politically delicate.

As a practice leader, you need to know what's important to staff members and which issues are causing problems. By focusing time and resources on the internal factors that affect staff turnover, productivity, teamwork, communication and job satisfaction, you can effectively address problem areas, boost staff morale and enable your practice to be a cohesive, peak-performing organization.

Dr. Gable is chief executive officer of Dynamic Health Connections, Inc., in Lake Forest, Calif., which provides specialized consulting expertise for subspecialty physician groups, managed care organizations and other medical organizations. You can reach him at dhc38@aol.com.