Actionable Tips for Improving the Employee Experience, Turnover & Patient Satisfaction

We recently conducted a study that focused on uncovering the key factors that impact two healthcare metrics – employee turnover and patient satisfaction (HCAHPS). Why? Because these factors are critical to healthcare organizations functioning effectively. Spoiler alert – the approach we outline in this blog works. Two recent examples of clients following this strategy resulted in significant return on investment. In one instance, the client reduced their Registered Nurse (RN) turnover from 19.8% to 11.8%, 8 full percentage points. In another example, the client reduced their turnover rate from 28% to 24% across the organization, resulting in a savings of more than $8 million.

If you still need an impetus to pay attention, take a look at the scary stats below that underscore the importance of healthcare facilities taking strategic aim at reduc­ing employee turnover, as well as providing an employee experience that links to improving the patient experience and HCAHPS scores.

  • Reimbursement Rates: HCAHPS scores are a factor in the reimbursement rates from the Centers for Medicare and Medicaid. Thus, poor performance on a hospital’s HCAHPS is tied directly to the bottom line.
  • Money, Money, & More Money: Turnover for patient-facing employees can have direct impact on the costs to the organization, increases in patient care ratios, increases to workload for remaining clinical staff, as well as negative impacts to patient care outcomes. Specifically, it has been found that RNs have an average turnover rate of 14.2%. Loss of one RN costs a hospital between $44,000 and $64,000, equating to an estimated loss of $4M to $6M a year1. Finally, because of the increased patient load on the remaining staff, it has been found that there is a 7% increased likelihood for failure to rescue or patient death for each additional patient2.

So, you now know why you must act; how do you take action? By the way, get all the details on the study in our recent white paper.

  • Focus on Senior Leadership, Job Fit, & Management: These are the strongest and most consistent drivers of both voluntary turnover and HCAHPS scores, based on the study. Get descriptions on these drivers here. Caveat: while these areas consistently relate to outcomes for SMD’s clients, it is still important to validate drivers of outcomes in your own organization. While these areas may come up as drivers, other nuanced drivers may be found in other organizations depending on the survey focus, organizational culture, and employ­ee makeup.
  • Directly assess the connections between the employee experience and subsequent turnover: You can pull a page from our book and do this – we revisit client survey data a few months after the survey administration. Using a file of employees who have since voluntarily exited the organization, we can flag employees in the survey data as turned over or still employed. This allows for an analysis of the direct drivers from the employee experience that are related to turnover. From here, you would know exactly what to focus on improving to reduce the likelihood that employees will exit. You also can review survey scores of those employees who remain with the organization by supervisor or department and know exactly where in the organization there is the most near-term risk of high turnover, based on the key drivers that are identified. Organizations are then equipped to make targeted, strategic steps to intervene and get in front of turnover.



1. Nursing Solutions, Inc. (2014). 2014 National Healthcare and RN Retention Report.

2. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288(16): 1987–93. doi:10.1001/jama.288.16.1987