#33 - Employee Turnover

Wrestling with High Turnover Among Service Workers

Let me guess: You are constantly trying to fill holes in your staffing schedules. Workers frequently quit or transfer, especially in the first 90 days of employment. You and your managers spend too much time shuffling employees and struggle to find capacity to do the more important work. Feels like it takes forever to find, hire, train, and onboard good replacement employees. You are not alone. Historically low unemployment is aggravating these challenges for most support services leaders.

To help, HSSF recently conducted a Collaborative Study of turnover among hospital service workers. Members from twenty hospitals shared data, experiences, and solutions in managing vacancies in EVS, food and nutrition, patient transport, and materials management. Following is a summary of the study’s results available to all HSSF members. Participants can access the full documentation and recordings of two online discussion sessions.

Turnover Rates Are High (But You Knew That)

The study began with a search for published data specifically about service workers in health care settings, but there’s not much out there. The US Bureau of Labor Statistics has some covering workers across a wide range of positions in health care broadly defined, but does not report for the specific departments managed by HSSF members. So we asked participants to supply their employee turnover data covering voluntary and involuntary separations and breakdowns by time-in-job, for workers in the four departments mentioned above.

Supplying turnover data was a challenge for some participants whose HR departments don’t routinely collect and report it. That does not bode well for leaders trying to manage without the reports they need.  My first recommendation – make sure your collecting good data on turnover, where it’s most severe, and why it’s happening.

But we did get useful numbers. Topline results showed average turnover among workers in the four departments is 25% per year. The highest reported was 58% for one participant’s EVS department. The lowest was 5% for a materials management department. Employees in the job for less than one year accounted for 49% of turnover. Employees in the job for that length of time reportedly turn over at 57% per year, so managing this group is critical to reducing your staffing headaches.

The High Cost of High Turnover

It’s tempting to try to quantify the burden. Start with this: if your turnover rate is 25%, and it takes eight weeks from employee departure to replacement, you have to find ways to back up 4-5% of your overall labor capacity. Probably not what you planned for. And that excludes additional time lost to call-outs, FMLA, transfers and other leave, training hours, and other factors.

“Hard dollar” costs include compensation for overtime; temp labor and agency fees; onboarding; new employee training; HR resources; and advertising. Perhaps more important, though, is turnover’s strain on managers’ time and morale, not to mention the employees frequently called on to back up the absentees. As leaders, you become frustrated you can’t contribute as you’d like to the greater goals of the organization, like raising HCAHPS scores, improving the patient experience, and driving down hospital-acquired infection rates. These “soft” costs may be more damaging than the “hard” costs.

Good Practices

Participants shared with each other their efforts to reduce turnover, from improving the quality of recruits to better engaging current employees so they want to stay. Several hospitals have undertaken a review and redesign of the recruiting process to make it faster and more effective. This involves working more closely and communicating more frequently with recruiters, both internal and external. One hospital has moved to using an outside recruiter for all vacancies in EVS and transport.

Some hospitals have programs to draw on pools of hard-to-employ individuals, such as high school dropouts, immigrants with limited credentials, and the developmentally impaired. Perhaps most importantly, leaders are working on many fronts to better engage service employees by training supervisors and implementing recognition programs. For example, University of Pittsburgh Medical Center instituted a “Gemba Day” when managers work side-by-side with service worker associates to better understand their challenges and foster communication.

Another innovative participant pays its EVS workers $500 bonuses for referrals. She reported that this program has yielded reliable workers with lower tendency to leave their jobs.


Participants received study documentation they received included a long list of good practices.  Of more value, they heard from their peers about many innovative and effective ways to manage service worker turnover. Major themes were redesigning the recruit/retain process; improving engagement; and tapping underemployed labor pools.

There’s room for improvement. We’re typically working with a deficit of management information on where and why we’re experiencing turnover. Perhaps most useful would be a thorough effort to understand the root causes of why our people choose to leave – exit interviews would be a good starting point. It would also benefit leaders to close the gap between employee separation and replacement, perhaps by hiring ahead or working to fill the pipeline with qualified candidates before the vacancy occurs. Two participants in this study have placeholder requisitions that enable HR to recruit even when there is no current vacancy to fill.


About HSSF’s Collaborative Studies
HSSF conducts Collaborative Studies on topics of interest to support services leaders. Participants share their perspectives and experiences. J C Wickham Associates, LLC, an operations improvement consultancy, coordinates the study and moderates an online session to discuss results. Participants receive full access to the study write-up and recording of the session. HSSF notifies potential participants by email of upcoming studies.

For more information contact:
Jeff Wickham
Managing Director, Hospital Support Services Forum
President, J C Wickham Associates, LLC
[email protected]