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A few years ago I received a call from a parent whose son received services from my community behavioral health agency. She called to inform me that she was moving his services to another provider. I was shocked. I had known them for years and felt we had a very good relationship. Upon asking what we had done to make her feel she needed to change service providers, she said there was nothing we had done; it was that they wanted some more consistency in their service delivery. She explained that over the last year her son had five Service Coordinators. There were times when she would call the Service Coordinator only to find out that the person had taken another job or the case was reassigned. This caused her and her son some distress because the Service Coordinator was the primary contact person when they had questions. They were having the same problem with staff providing direct services. Once they became accustomed to a person, it seemed they moved on to a higher-paying job, graduated college, or left the field entirely.

As I have traveled across the country teaching The Mandt System® RCT course, I ask the instructors if they have a problem with turnover. With very few exceptions, the overwhelming answer is yes. Organizations have a difficult time attracting and keeping staff, especially the really good ones. To some extent this is to be expected as people gain experience and seek jobs to advance their career. Many of these moves, however, are horizontal, moving to similar positions elsewhere or to jobs in an entirely different field with about the same pay. The interaction above got me thinking about what it would take to have staff want to stay in these positions.

When we think about turnover there are several consequences that are fairly easy to quantify. Organizations can calculate the cost of recruitment, orientation and training, lost service delivery, and low productivity for new employees. What is not easy to calculate is the cost of turnover on relationships. The Mandt System Relational material identifies relationships as the context in which work gets done. By establishing and maintaining healthy relationships trust is developed. High turnover often causes relationships to end before the trust is even established. Additionally, Maslow’s Hierarchy of Needs as mentioned in The Mandt System material states that consistency and predictability lead to feelings of safety and security. When people (like the mother mentioned above) feel the service-delivery relationship is inconsistent and unpredictable, it should not be surprising when they seek a different relationship to get their needs met. This trust and safety is even more important when a person’s needs include assistance with their behavior, personal care or medical needs. Dr. Peter Breggin, as quoted in The Mandt System, said, “It is easier to de-escalate with someone you know and trust, than with someone you either do not know and do not trust, or someone you know and do not trust.” Obviously it is undesirable to interact with someone you know and don’t trust when you need help, but often not having trust in the care giving relationship is not due to the staff being untrustworthy. It is because the relationship hasn’t had the time to build trust.

So what do we do about high turnover? In my situation we decided to gather some information from staff regarding what they found satisfying and dissatisfying about their jobs. We also asked what efforts could be made to improve their satisfaction. As you would assume money was a large factor, but it wasn’t the only thing. We found several things that were not salary related such as appealing work environment, flexible hours and schedule, better equipment and technology, and recognition for their efforts. Financially we found that offering productivity and tenure incentives cost less than high turnover. In fact, productivity incentives (for those with productivity standards) paid for themselves. The key is to periodically reassess the work force so that your retention plan changes as your work force changes. Attempting to achieve 0% turnover is not a realistic goal, but any decrease is likely to achieve (and maintain) happier consumers and employees.

Mike Bellisario – Mandt System Consulting Faculty

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