Four Hospitals Cut Service Worker Turnover

Improve the selection process to ensure better job fit and reduce turnover


Voluntary turnover, particularly in the first year, is a good indicator of an organization’s effectiveness in hiring and assimilating staff. First year turnover in the hospital sector, at 28.3%, is significantly higher than the rest of U.S. industries at 21.5%. After their first year at a hospital, 22.2% of first year nurses leave and for some segments of the hospital workforce, turnover is often over 50% (PricewaterhouseCoopers Saratoga 2012/2013 U.S. Human Capital Effectiveness Report). The report also points out the bottom line impact. It estimates the cost of turnover as 1.5 times the base salary of an exempt employee and .5 times the base salary of a non-exempt employee. These four hospitals, part of the same health system, are located within a 15-mile radius of each other. They had a long history of turnover in service worker positions, particularly dietary, environmental services, and transporters – as high as 63%. The system had done extensive analysis and tried several strategies, with little success. In addition, hiring managers were reviewing up to 50 resumes and interviewing as many as 10 candidates to fill a single position. There had been no coordination of recruiting efforts and the four were actually competing for talent from the same pool of candidates.


Turnover is a complex problem, but the most direct solution is to improve the selection process to ensure a better job “fit” and ensure that candidates’ skills and behavioral competencies are in line with the desired organizational culture. Accordingly, we took a comprehensive approach:

Define the Desired Competencies
Dependability is the first functional competency that comes to mind with these positions. Senior leaders at this health system recognize that front line workers impact the patient and family experience. They want staff who will contribute to the patient-centered culture they are building. Our team used focus groups and surveys to understand not only the variables that have historically contributed to turnover, but also those that will predict long term success. In a few short weeks, we developed a competency model for these positions that would form the basis of an efficient, effective, and legally defensible hiring system.

Hiring Process Centralization
Working with human resources, we designed a centralized process for sourcing and screening candidates for all four hospitals ensuring maximum return on recruiting efforts from a common talent pool. The central team reviews applications and pre-employment assessment results to eliminate candidates with little chance to succeed. A phone screen narrows the pool even further and the final candidates are sent to the hiring manager. A communication process was created so that recruiters and hiring managers are working closely to constantly improve efficiency and selection accuracy.

Assessment Tools
The tools focus on dependability, compassion, patient-focus, adaptability, and collaboration. The central recruiting team uses ServiceFit® for Healthcare, administered seamlessly through the applicant tracking system, to evaluate candidates’ behavioral competencies and eliminate the bottom 25% of candidates. Concise, structured, behavioral interview guides were created based on the defined competencies. All hiring managers are trained in Select Interviewing® with a combination of live training and Select Interviewing® Online ensuring an effective, predictive candidate interview.


Short Term Turnover
In just the first four months of the project, 121 employees were added. When compared to the 119 hires in the same period for the previous year, short term turnover was cut in half. Actual savings: $450,000. Savings over an entire year: $1.3 Million.

Service worker short term turnover graph

The system allows recruiters to narrow the candidate pool to a more qualified group of applicants without increasing recruiter headcount, effort, or energy. Recruiters and hiring managers only spend time and resources on better qualified candidates. Hiring managers are not required to review resumes and when a candidate is sent to the hiring manger by the central team, there is an 85% chance that candidate is suitable for hire. This allows managers to spend more time managing and less time hiring.

The Patient Experience
Nursing staff quickly noticed an improvement in the quality of transporters. Feedback from HR, following a nursing team meeting:

During a discussion about patient centered care, two nurses spoke up and said that “transport gets it” and that the new transporters have been great. Further, a Unit Director mentioned a long-term patient has been depressed. After a transport last week, the patient came back in better spirits and had bonded with the transporter!

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