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The cost of poor healthcare worker retention

Friday of last week marked the launch of the long-anticipated UK National Health Service (NHS) Workforce Plan. This plan highlighted the healthcare worker vacancy rate of 112,000 full-time staff. This staffing shortfall has impacted the public through cancelled appointments, difficulties seeing the GP and family members being treated in hospital corridors. It has made the working week a struggle for healthcare workers too. The plan states only 26.4% of NHS personnel think there are enough staff to do their job properly. Retention of healthcare workers is one of the biggest problems facing the UK NHS. The NHS workforce Plan promises to reduce the leaver rate over 15 years and retain 55,000 to 128,000 full-time staff. But without mentioning pay in the plan, and with the longest junior doctor strike in history planned next week (July 13-18th), many questions remain about how retention will be improved.

The UK healthcare system is just one of many that is under pressure to do more with less. In this article, we discuss some of the factors that influence retention, and encourage readers to think about retention through a cost-effectiveness lens. The outcomes of the healthcare system are influenced by a multitude of factors. Access to healthcare services, robust infrastructure, and state-of-the-art equipment all play a role in achieving positive results. However, these investments cannot function optimally without dedicated human resources to bring everything together. The presence of high-quality healthcare professionals is not only vital for ensuring positive health outcomes but also for managing the overall cost of the system.

Controlling health expenditures has become a significant challenge for many countries, particularly in recent decades. In this context, the experience and expertise of healthcare employees can significantly contribute to the system's cost-effectiveness. Over time, as employees gain experience, they develop experience curves that enable organisations to operate more efficiently. Therefore, retaining experienced healthcare personnel is crucial in fostering ongoing efficiency and progress within the healthcare system.

Replacing a nurse or a doctor is an expensive endeavor. It involves considerable costs associated with searching for suitable candidates, selecting the best fit, and providing necessary training for the new hires to adapt to the workplace culture, procedures, and colleagues. The admin costs of arranging a new hire can reach up to 60 thousand Euros. Additionally, the adjustment period for both patients and new personnel can have a significant impact on the patient-doctor relationship, which plays a vital role in patient well-being. Building a good relationship takes time but holds huge value for the patients as well as the practitioner. Unnecessary staff turnover can potentially affect both the quality of treatment and overall health outcomes.

It is evident that retaining healthcare workers brings significant benefits. However, achieving this consistently across the healthcare system remains a challenge. In the United States, for instance, the turnover rate has been trending upward and currently stands at 22.5%. In contrast, countries like the Netherlands have managed to maintain a lower turnover rate of around 12%, while the rate in the UK varies between 11% and 14% for general practitioners. The recent NHS workforce plan quoted a retention rate of 9.1% for the whole NHS. These variations suggest that there are strategies that can be employed to control turnover.

Several factors influence why people switch jobs. In high-income countries, aging populations contribute to workforce attrition due to retirement. While some countries are gradually raising the retirement age, the effects of an aging workforce cannot be entirely avoided. In addition, the healthcare industry can’t keep up with the demand for healthcare workers, caused by increasing age and morbidity. A shortage of healthcare personnel is almost normalised in today’s healthcare climate. Attracting healthcare workers into a high-pressure job with long hours is also a thankless task and makes the sector less attractive to new talent. Factors such as improved work hours, reduced stress (likely only mediated by hiring more staff), higher pay, shorter commutes, and better career prospects all play a role in their decision-making process. But health systems today are struggling to afford the rewards. While this may benefit the healthcare worker to some extent, it does impose short-term financial costs on the system.

If a cost-effectiveness analysis were conducted on potential interventions to address healthcare personnel retention, the resulting outcomes could provide valuable insights for policymakers regarding investments in healthcare personnel required to deliver innovation. It is important to recognise that the additional costs associated with salaries or additional benefits should not be perceived solely as burdens on the health system. Instead, these costs need to be compared with the additional benefits that patients would receive. These benefits include improved patient experiences such as friendlier and more timely attention, earlier detection of health problems, and reduced waiting times. Consequently, such improvements would lead to a better quality of life for patients, decreased healthcare demand, and reduced productivity loss which all have a monetary value. For example, investing in additional staff training to implement virtual wards has initial upfront costs, but will result in more appropriate referrals to virtual wards and thus will reduce the use of hospital beds and pressure on A&E. Only by thoroughly analysing resources can we determine cost-effectiveness of possible interventions which could help justify investment decisions.

Retaining healthcare workers requires a comprehensive approach that addresses the complex challenges they face beyond salary. Tailoring incentives to individuals, and focusing on maximising their well-being, are all effective options to create an environment that fosters loyalty and commitment among healthcare professionals. Analysing workforce retention through a cost-effectiveness lens may help policy makers implement retention strategies with confidence. This, in turn, benefits both the workers themselves and the healthcare system.

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