Staff turnover is a critical dimension of any business, especially in medical practices where stress tends to run high and it can be challenging to work directly and intimately with the public. Monitoring and fine-tuning staff turnover deserves careful attention.
“Staff turnover” is the percent of your office staff that leave in a given year. The calculation is simple: Divide the number of people you have lost for any reason in the 12 months (due to termination, relocation, redundancy, etc.) by the average number of people you have employed in the last 12 months. For example, a practice with an average of 40 support staff who lost 10 staff (whether they were replaced or not) has a 25% turnover rate, which is a fairly typical figure in ambulatory health care.
Although a very low staff turnover rate sounds better, that’s not always the case. While you may pride yourself on a single-digit turnover rate, this can be a sign that your management team is too lenient and allows weak or under-performing staff to overstay, which can be just as damaging to team performance as excessively high turnover.
Too low a turnover rate may signal a need to set higher standards. Too high a turnover can have many drivers: poor staff selection, weak onboarding and training, uncompetitive wages, unrealistic workloads and insensitive supervision.
Here, we outline the positive and negative impacts of staff turnover and some tips to reduce turnover if necessary.
POSITIVES OF APPROPRIATE STAFF TURNOVER
1. Fresh perspectives
New staff members bring fresh perspectives and ideas to the practice. This influx of new energy can invigorate the workplace environment, fostering innovation and creativity. In an ophthalmology practice, this can lead to improved patient care through the introduction of new techniques or approaches.
2. Skill diversification
As staff members come and go, the practice has the opportunity to diversify its aggregate skill set. New hires may possess specialized skills or training that complement those of existing staff, enhancing the overall competency of the team. For instance, a new technician might be proficient in the latest diagnostic technologies, elevating the practice’s diagnostic capabilities.
3. Enhanced efficiency
Staff turnover provides an opportunity to reevaluate workflows and processes. New team members may introduce more efficient methods of performing tasks, streamlining operations and improving productivity. This can lead to reduced wait times for patients and smoother clinic operations.
4. Reduced complacency
Appropriate levels of staff turnover can prevent complacency within the practice. Knowing that positions are not guaranteed may motivate existing staff to continually strive for excellence and remain competitive in their roles. This can translate to a higher standard of patient care.
NEGATIVES OF EXCESSIVE STAFF TURNOVER
1. Costs of recruitment and training
One of the most significant drawbacks of staff turnover is the associated cost of recruitment and training. Hiring and onboarding new employees require both time and financial resources.
In an ophthalmology practice, where specialized skills are required, the recruitment process can be particularly challenging and expensive. The American Management Association estimates that turnover costs range from 25% to almost 200% of annual compensation depending on the job function. Using the lowest 25% figure and applying this to the typical $50,000 fully burdened cost per practice staffer means a cost of more than $12,000 every time you unduly lose a staff member.
2. Reduced continuity of care
Continuity of care is crucial in health care, especially in ophthalmology where patient relationships extend over years. Our client studies have shown that turnover disrupts recall and continuity of care protocols. Patients may feel less connected to the practice if they are constantly encountering new faces.
3. Loss of institutional knowledge
Long-term staff members often possess valuable institutional knowledge that is not easily replaced. This includes warm connections with individual patients, clinic protocols and operational intricacies. When experienced employees leave, there is a risk of losing this valuable information, which can hinder the smooth functioning of a practice.
4. Impact on team morale
Higher staff turnover can negatively impact team morale and cohesion. Constantly saying goodbye to colleagues and training new hires creates a one-two punch to a worker’s sense of stability and security. This can reduce morale, job satisfaction and productivity.
HOW TO REDUCE STAFF TURNOVER
Businesses such as fast food outlets have very high turnover rates, but this has little impact because it takes only a few hours to learn most jobs. But higher turnover is very problematic in an ophthalmology clinic, where it can take years to learn how to be a competent technician or biller.
Although we most commonly see a turnover rate around 25% in our eye-care consulting work, we also see stressed practices with rates higher than 50% — and a few practices with rates of 10% and lower.
Here are some fast tips for reducing turnover:
1. First, be sure to measure your turnover rate. Be concerned if it is higher than 30%, and be alarmed if it is 50% or higher.
2. Measure staff morale. Confidential surveys can be brief with a few measured questions or you can take a deeper dive with a comprehensive survey. Use the results to address anything that is reducing satisfaction.
3. Boost workplace enjoyment. People work for both “love” and money. So, even if you pay at or above market rates, you have to also provide lots of attentive staff caring. Indeed, some practices, despite paying well below market rates, still have a low turnover rate because administrators and practice owners deeply engage with staff. At the same time, if you boost supervisory engagement, it will strengthen staffer-to-staffer connections; one of the greatest determinants of job satisfaction is the relationship we have with our co-workers.
4. Have a buddy system for new hires. Every new worker joining your team should be bonded formally for an initial 90-day period to a colleague. This buddy is in addition to the direct supervisor and is usually a peer in the same department. After 90 days, the new staffer will have made connections and found their way in the practice.
5. Think of every job as a career. If you don’t treat every job in your practice as important, you won’t convey a vital message to every worker: “What you do here counts.” One of the lowest turnover rates we have seen was in a client practice where the solo doctor made it a part of his routine to stop by each department at some point every day to say hello and give thanks. It costs nothing and keeps people bonded to you and your practice.
6. Foster career mastery. From surgeons to scrub techs, everyone tends to enjoy work at which they have become a master. Don’t let this mastery be an accident in your practice. Foster skills development with a written syllabus of skills to learn for each position, and back this up with formal training time and periodic skills assessments.
7. Provide abundant feedback and accentuate the positive. This is much more than the traditional annual review. Many surgeons, and by extension their managers, provide negative feedback when an error is detected but no feedback when work is performed at or above expectations. This is a recipe for low morale. When you find your people doing things right, point it out often and publicly. Make sure this positive feedback is widely distributed, so that every staffer gets your message, “I admire and appreciate the work you do here.”
8. Scan for burnout. Very few disaffected staff leave their practices without advance signs of their unhappiness. The administrator, managing partner and department heads should be on the hunt for these signs: higher absenteeism, late arrival, spending lunchtime alone and a generally dejected affect. If you want such staffers to leave, by all means accelerate them toward the door. But if you sense that a good worker is a flight risk, address your concerns directly. “It seems you’re not as happy in your work here as you once were, which really upsets me because you’re such a valuable part of our practice. Can we talk about it?”
CONCLUSION
Staff turnover in an ophthalmology practice brings both advantages and challenges. While it can inject fresh perspectives, diversify skills and enhance efficiency, it also increases costs, disrupts continuity of care, erodes institutional knowledge and affects team morale. To mitigate the negative effects of excess turnover and keep the right balance for your practice, keep the focus on effective recruitment, effective onboarding routines, never-ending skills training programs for all staff and fostering a pleasant and supportive work environment. OM
