With severe staffing shortages creating real dilemmas in private healthcare, recruitment specialist Keith Hague explains why he believes great leadership is the cornerstone of staff retention.
In healthcare, the recruitment and retention of staff has become a serious challenge creating huge business dilemmas.
Suddenly we are faced with a European employment market that has greatly diminished since Brexit. Covid caused the lack of travel and isolation of staff who were once willing to become foot free.
The cheap supply of European healthcare staff is now a thing of the past and we have to get used to it. The tactics we tried in the past to retain staff cannot be relied upon because everyone is doing it.
Healthcare recruitment is not an isolated problem. Timpson, the well-known key-cutter and cobbler who have successfully hired reformed prisoners for 20 years, now faces stiff competition from the likes of Greggs, Greene King, and even Pret a Manger.
Competition for staff
Their chief executive James Timpson said that for years they took all the best people from prison and they were the only one doing this, now things are much harder as they fight the competition for scarce staff.
Jim Collins in his iconic leadership book Good to Great, selling over 3m copies since 2001, states that ‘people are not your most important asset, but the right people are.’
He is right, of course, but in today’s market do we really have the option of just appointing the right people or will anyone with the right qualification or experience suffice? The latter seems to be the case presently.
Both public and private sectors, of course, face the same challenging problems in healthcare, but here I want to concentrate on the private sector employment issues, and specifically on staff retention, because if you don’t have a retention problem you hardly need to recruit new people. So keeping staff has to be the first key challenge.
High turnover is the killer
In my early days as a healthcare chief executive both inside and outside the capital, turnover was manageable: around 3% to 4% outside and 9% to 10% inside.
However, a number of London chief executives have told me recently that turnover can climb to 20% and when one fifth of your staff leave every year, that’s almost impossible to manage and it carries hefty recruitment costs that might in the event lead to nought.
In today’s tense staffing market the recruitment of good staff now relies more than ever upon the ability of one hospital to poach or steal good staff from its nearby competitor, offering huge uplifts in salary to do so.
But it doesn’t stop there. Hospitals are taking the view that stealing staff from the same hospital group is now an acceptable practice. One chief executive told me: ‘Who cares anyway, so long as we have the staff to service the next day’s shift.’
Yet this only saves the day, but does not sort out the problem in the longer term. This ‘I’m all right, Jack’ mentality is now common place as well as being a very expensive option.
One private hospital offered a £9,000 salary uplift to poach a top-quality theatre nurse into their business.
Others faced with losing staff will suddenly offer that long-promised training course requested years ago plus a small top-up in salary for good measure. Again, it’s all about firefighting with no underpinning strategy.
The well tried ‘golden hello’, where staff are appointed on the promise of a lump sum of money on signing an employment contract, certainly gets people through the door.
And if you stay for three years, then along comes another lump sum just before Christmas, should you be asked to stay for another three years.
But how do the rest of the loyal staff, who have had no such offers, feel about that? From my experience, they become alienated and look to leave for a ‘golden hello’ themselves somewhere else – and why not? So we are back to where we started on that long circuitous journey that never ends.
It is not all about pay
Clearly, there are some good retention tactics that can work and your excellent HR director will tell you that staff development and training is a key to good retention, and this is true.
Yet it has to be well directed, with a long-term commitment given, and who gets the best development must not be down to who fills out the best form and who speaks the loudest.
Development programmes can, of course, be costly and they must be carefully managed and well directed. But they can work very effectively.
Numerous management papers have been written over the years which show that pay, while very important to staff, can be trumped by committing to a person’s long-term development prospects.
An opportunity to study for qualifications that allow a person to move to the next level in seniority can have very positive effects on retention.
Great leadership assists staff retention
Various tactics of retention have been tried over the many years I have been managing healthcare businesses, some good some not so, but one thing that has not really been explored is the link between staff retention and leadership.
When I speak to chief executives and other healthcare senior leaders, I am always astounded by how they want to sit in their offices all day, isolating themselves from the business on the grounds that they are so busy.
They believe that being a chief executive entitles them to acquire God-like status and have extreme importance. Most students of management will know that people don’t leave organisations, they leave the boss.
So the boss needs to be visible to walk the floors to listen to individuals’ concerns and always offer respect to the lower-paid echelons who can offer so much to any organisation.
Being genuine with people, being supportive and visible counts for a lot when it comes to retention.
Over the years, managers have persistently requested me to build bigger better new offices for them. But if you build offices for managers, they will sit in them all day. People want to see the boss and listen to their view.
HR directors believe it is a very modern concept to call themselves ‘people managers’, but when was the last time anyone saw a HR director walking the floors? I suggest that this is a rare event.
As head of the Wellington Hospital for many years, we had some incredible people. But probably the most important person was the guy from Brazil who delivered the laundry every day without fail. No fresh laundry, no business. It’s as simple as that.
Start listening to people; understand their problems. You may not be able to solve them, but just not talking for once and simply listening works enormously.
I have been mentoring a physician who is now a chief executive in the Gulf. He has learned the art of getting out of the office so much so that when his doctors want to see him, they don’t come to his office.
He goes to see them – after their clinic list or between patients in the theatre rest room or in the local coffee shop. Same for staff. His door is never open because you don’t need to go to his office anymore; he goes into the nursing floors and departments to meet the people in their work setting.
He is admired by the organisation because he cares, and his new business into its second year is surpassing all targets. People want to work there.
I would maintain that the art of good caring management – being visible, taking time to listen to people and walking the floors to feel the temperature of the business – is the best antidote for poor staff retention. Staff rarely leave great bosses.
Keith Hague (right) is a director of Goddard and Hague, bespoke healthcare recruitment specialists