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Following the publication of our first white paper, Delivering on our promise to staff – engage, empower and retain, we talk to author Tracey Barr to hear about the retention framework presented within the paper and what her key takeaways are.

Tell me about how the framework was developed

The process can be split into three phases, which took place over around five months. Firstly, we needed to understand the context in terms of the scale and the impact of the retention challenge facing the NHS. This involved analysing data which are publicly available – such as NHS workforce statistics and the most recently published NHS Staff Survey to find trends nationally, regionally and at a team level.

The second phase was a desk-based review of the published evidence on retention with a view to identifying the key drivers – understanding why people leave, and also why people stay. It was surprising how little research has been done on retention and how difficult it was to find what had been done. Bringing this information together led to the creation of the ImproveWell eight-point framework.

The final stage was testing and refining that framework by talking to ImproveWell clients and partners to validate whether, based on their own experiences, the framework made sense and was something that would be both helpful and practical for them to use to help address the retention challenges they are facing in their own organisations.

What surprised you about the evidence that you found for what influences retention in the NHS?

One of the most surprising things for me was the relative lack of attention given to the retention challenge facing the NHS, given how important it is. Much of the national NHS narrative around the workforce challenge focuses on recruitment as the solution. But it’s not a simple numbers game. My personal view is that retention is at least, if not more, as important because you cannot simply replace a highly experienced healthcare professional with someone newly qualified. It’s the ‘experience gap’ not just the ‘workforce gap’ that impacts on patient experience, safety and outcomes.

I was also surprised to learn how complex retention is, the very many factors that influence an individual’s decision to leave as well as the importance that local factors, like being listened to and hearing how feedback is being implemented, play. These are often the first things to be dropped when teams are under pressure.

As a result, there isn’t a single off-the-shelf solution to encourage people to stay in the NHS. Retention strategies need to be tailored locally and to individual teams.

Is there one simple, cost-effective thing all NHS hospitals and trusts could do to improve retention?

As I mentioned, one of the main themes to come out is the need to understand your local context. Another important theme is around flexibility – people want more choice in how, where and when they work. This is common theme across all sectors post-pandemic, but is a challenge to tackle in healthcare given the need to provide a 24/7 service and with the majority of staff in patient-facing roles.

Tell me about a case study from the report that particularly stood out to you

I particularly liked the Chelsea and Westminster Burns Service example because it was championed by the Matron and you could see the measurable impact it had on people feeling listened to, and the benefits that has had on recruitment and retention. It‘s a great example of how piloting and rolling-out in one area (the Burns Service) can be used to test and demonstrate the benefits to other parts of an organisation before expanding to other parts (the ICU), showing how easy this methodology is to replicate.

How do you hope the NHS will use the framework and the white paper?

At a national level, my hope is that the framework is embraced by and embedded into the NHS National Retention Programme. And locally, I hope NHS organisations will be able to take a step back and consider their own local context, what their own position is in terms of retention, and be able to use the framework to think about what other levers that they can pull locally to help them to address their retention challenges.

I also hope this framework will help the NHS to better understand the value digital platforms like ImproveWell and other digital tools – such as those that help with scheduling and support flexible working – and encourage their adoption to improve the day-to-day experience for NHS staff, to increase job satisfaction and improve retention.

Finally, I hope this framework has an impact beyond the NHS. In the UK, all health and care providers, not just NHS organisations, are facing retention challenges, including independent, social care and care home providers. And as retention is a global problem, this framework and these solutions are applicable for health care organisations across the world.

Download the full white paper: Delivering on our promise to staff – engage, empower and retain

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