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Creating a Successful Workforce Culture

February 1, 2008
by Susan Gilster, PhD, NHA and Jennifer Dalessandro, BS, NHA
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Hiring—and keeping—committed staff

Few would argue that turnover in long-term care has been out of control for a long time, despite repeated research projects and surveys examining the needs and desires of staff. For decades, the industry has asked: “What satisfies staff in long-term care?” So what is the problem and why does finding and retaining good employees continue to plague the field? We know what employees want, but we do not seem to know how to provide for their needs.

The cost of turnover is high, ranging from $2,200 to $5,000 per employee and as much as 150% of employees’ annual compensation. Real numbers speak volumes. Do you have a problem? If you don't look, you won't know. All too often, facilities do not think they have a problem. While consulting in two organizations, we discovered that both had a high number of staff being hired and leaving. The cost of that turnover surprised them. In one facility, the annual projected expense of turnover was approximately $840,000. In the second facility, where the board of directors did not believe there was an issue with staffing, the expenditure was in the neighborhood of $350,000 per year.

This article will explore mechanisms for designing a workplace culture that addresses the concerns and desires of staff while maintaining the organization's vision and mission. A cost-neutral approach to staff recruitment and retention will be presented as a long-lasting and sustainable solution.

An Organizational Approach

Creating a successful workforce and culture takes an organizational approach that is leadership-driven. Leadership is critical in the recruitment and retention of staff. Leadership comes from the person at the top—the administrator, CEO, executive director, or designee. Without his or her input or blessing, any initiative, program, new approach or attempt at “culture change” will fail.

The leader need not be the facilitator of change. However, if this person is not the change agent, he or she needs to get out of the way and support others in their quest. Moreover, the answer to an organizational transformation is not found in a single program, department, or initiative. It is not simply an overarching philosophy. It must be more concrete, with a global, systematic, organization-wide plan involving leadership and all staff, all departments.

Research varies, but what we do know is that you cannot “buy” employees, at least not for the long haul. Money and benefits are often listed third or fourth, or even farther down, on a list of staff desires. When an organization is competitive in its wages, employees do not move based solely on a 25-cent raise. They may indicate wages as the reason for leaving, but all too often that's not the case. It's just that they do not want a hassle by explaining the real issues, or they are unaware of the importance of their input. True employee satisfaction is found in the intangible items they list in their satisfaction surveys. And what staff usually indicate they want in and from their work are respect, meaningful work, to know they are making a difference in the life of another, communication, good job preparation, and to know organizational expectations. They also want input into decisions that are made about their work and the organization, as well as teamwork and support—physically and emotionally.

Leadership is in a position to meet these needs and determine the facility's level of staffing. It starts with the leader's desire to create a work culture that meets the needs and desires of staff. Leaders have the power and authority to initiate programs and support others in their quest to create an exemplary workplace. It starts with the leader or designee's vision and plan, which are then shared and enhanced by the leadership/management team and the entire employee base—all departments, all shifts. It is, in essence, a collective leadership model.


Visioning is the process of creating a dream organization without restraint of money or time. A well-developed vision includes laying out how things will work in all departments, and how it will feel and operate as a whole. The vision must be created and supported by all staff. If only the leader is involved in creating a vision, the vision belongs solely to the leader. It will not unite the entire organization.

Staff retention is enhanced by a reason for being, and vision is the motivator and driver. It is something to work for and toward. If there is no vision, employees simply come to work, do their own individual thing, and go home. There is nothing that binds them, unites them, or excites them. There is no direction, no destination, nothing to work toward. Without a vision, staff do not know what is expected, what they should do, or how they should perform. If the leader has no vision or destination in mind, how does staff follow a leader going nowhere?

Once it's created, the vision should be used as the basis for all decision making. When faced with an issue, one must look to see if choices being considered are consistent with the organization's vision. Decisions should be examined on the potential impact they may have on everyone—all staff, all departments, and all shifts. It should also be reviewed from the perspectives of the residents, families, and community.

Vision should, once established, be a topic of conversation that takes place with all members of the organization at least annually and anytime it appears that the group has lost its way. Heightening ongoing awareness keeps the organization together in heading toward the same positive direction.