Scaling What Works: System Solutions for Workforce Retention and Staff Development at Essential Hospitals

Solving the Retention Paradox

Gabby Assis, EdD, a principal consultant at Performance Without Boundaries, opened the meeting by challenging attendees to consider why nearly one in three new hires voluntarily leave their roles within one year. She continued with an in-depth presentation on tools for addressing employee retention, pointing out the significant ripple effects of staff turnover on teams and ultimately on patient care.

In small groups, attendees explored the importance of addressing retention from an integrated, system-level approach rather than relying on fragmented best practices. Assis explained that successful stability and retention hinge on:

1. Ownership and accountability at the leadership level
2. Consistent practices applied across employee journeys (i.e., onboarding, mentoring, career ladders) within the organization
3. Meaningful integration of data and employee voices (i.e., feedback from employee engagement surveys, 90-day reviews)

System Integration Maturity

While most hospitals and health systems have tried to implement retention strategies, turnover persists. The issue isn’t the absence of best practices; it’s the lack of integration and system maturity. Assis presented a model to assess workforce retention systems’ maturity, including how well retention initiatives are structured, connected, and sustained to deliver steady results. Attendees examined how they can integrate proven strategies across several systems (or departments) consistently to reinforce retention throughout their organization. Discussion focused on leadership accountability strategies, employee support practices, and retention data tools.

Employing and Empowering the Community

James Williams Jr., MA, vice president of diversity, equity, and inclusion, and Keisha Mullings-Smith, HCMBA, vice president and chief consumer experience officer at UChicago Medicine, shared how the health system is partnering with the community to engage, recruit, and retain employees. For example, UChicago Medicine’s Urban Health Initiative partners with community organizations and civic leaders to expand access to care and promote open positions to residents in the South Side of Chicago and surrounding neighborhoods. In fiscal year 2025, the initiative hosted 12 hiring events that resulted in 215 hires.

The organization also partners with city colleges and local high schools to create career pathways for students and provide early exposure to health care careers. Williams and Mullings-Smith challenged attendees to think about potential reasons for persistent high unemployment and vacancy rates at their organizations. They encouraged attendees to explore how local hiring leads to lasting opportunities, career mobility, and increased organizational retention.

Nursing Retention: Historical Trends and Future Strategies

Ashley Graham-Perel, EdD, RN, nurse educator and director of the Office of Engagement and Community Affairs at Columbia University, led attendees through “Nursing Retention Through the Ages.” This presentation gave a historical overview of nursing workforce challenges and highlighted their implications on hospital costs, health care teams, and patient care. Graham-Perel shared research on the factors that influence nurses’ decisions to stay, including job satisfaction, organizational commitment, leadership style, and workplace safety culture. Attendees then strategized top methods to retain nurses and compiled actionable processes that could be strengthened to sustain a consistent nursing workforce at their organizations.

Key Takeaways from Attendees

Attendees emphasized that employee retention is a shared responsibility, but success requires clearly defined roles for leadership and staff. The first year of employment is vital for engagement, and leadership plays a key role in retention. Attendees highlighted several vital strategies that can lead to long-term retention, including building nontoxic work environments, supporting experienced staff, creating clear pathways to advancement, and fostering mentorship. They also highlighted consistent community outreach, tapping into existing partnerships and resources, and promoting a mindset of evolution and adaptability as key practices to sustainable workforce development.

Overall, the convening provided a valuable opportunity to learn, collaborate, and strengthen attendees’ organizational workforce strategies. Attendees learned how their hospitals can turn proven practices into connected systems that reduce turnover and strengthen retention. Many stated they look forward to learning more about measuring impact, employee wellness, legislation, and grant writing during future gatherings.

The Workforce Action group will continue to meet virtually to discuss other pressing issues related to workforce development and resiliency.

Read some of our related work for a closer look into America’s Essentials Hospitals’ work on workforce development and resilience:

• Building Workforce Equity at Essential Hospitals: A Toolkit for Creating and Maintaining a Resilient, Diverse, Equitable, and Inclusive Workforce
• Leading through Disruption: How Health Care Leaders Can Respond in Challenging Times
• Burnout and Workforce Shortages: Essential Hospitals Face Challenges
• Protect and Strengthen the Health Care Workforce
• Strengthening Resilience of and Developing the Essential Hospital Workforce