Employee turnover is always a concern, but in flush economic times like these it often jumps. Indeed, according to the 2018 North America Mercer Turnover Survey, U.S. companies reported an average 22 percent turnover rate in 2018, up from less than 16 percent in 2014. Personal and family reason drove the majority of these moves, but base salary complaints and overall job satisfaction each drove 24 percent as well, indicative of employees’ new power in the workplace.

If they aren’t happy, they’ll leave.

Nowhere is this more apparent than in the medical office, where support staff are often under intense pressure to perform and face a daily onslaught of incoming calls, patient visits, and other tasks. The typical primary care front desk employee fields 30 inbound calls per day, and handles more than 1,500 patients and 4,300 total encounters per year, according to the MGMA DataDive Cost and Operations datasets.

It’s a difficult job, and the turnover numbers reflect that. Annual turnover among front office support staff in primary care offices exceeds 18 percent, and in surgical practices it’s above 20. For clinical support staff, these figures are 16 percent in primary care and 25 percent in surgical.

This constant upheaval can be draining on the staff that does stay, as they are often forced to pick up the slack as well as train new employees year after year. But it’s also a financial drag on the practice overall. Hiring over and over again for the same positions is an expensive proposition, not to mention the fact that, without effective support staff around them, clinicians can’t do their best work.

Faced with these challenges, many employers turn to employee appreciation programs— handing out performance bonuses, awarding extra vacation time, and even providing premium parking options—in hopes of improving the situation.

But it turns out that these programs can often have the opposite of their intended effect.

In primary care offices that offer employee appreciation programs, front desk turnover is actually higher than in those without such programs, exceeding 24 percent annually. Even those categories that see improvements, turnover remains high—with appreciation programs in place, primary care clinical support staff turnover falls to 14 percent, and front office support staff turnover falls to 15 percent. We aren’t getting to zero.

What’s the disconnect?

In my experience, it’s that these appreciation programs are not aligned with what workers truly value. Yes, having an employee appreciation program is important, but it has to go beyond just platitudes and handouts in order to be effective at reducing turnover. It has to offer more than bonuses and instead provide employees with real value.

Effective employee appreciation programs usually offer some combination of the following:

Connection: Everyone needs to feel like they are part of a team, that their contributions to the office are valued. In well-run practices, everyone talks. They meet together on a regular basis and discuss everything that is going on in the practice. This ensures that the front desk staff knows what’s happening in the back and better understands why they do things the way they do, and vice versa. That way, everyone on the team is part of the patients’ care; they aren’t just there to answer phones and greet people.

Trust: Too often, support staff feel like their ideas and input aren’t valued. That they can’t share what they want to share with the rest of the team. Assuming the meetings required to facilitate connection are actually happening, trust means taking the good ideas that come from those meetings and then putting them into practice.

Training: Clinicians need to be willing to spend money on training their staff comprehensively, which includes communication skills, technology tools, and organization and project management. This not only helps workers feel comfortable in their day-to-day work, but it also assures them that they’re providing real value and are contributing to the success of the organization as a whole.

Comfort: No one wants to spend their day crammed into a small cubicle, sitting behind a sliding glass window. Do your support staff have enough space to work comfortably? Do they have space to eat lunch? Is there a staff lounge area? The entire atmosphere of the office is a way to show appreciation.

Room for advancement: Many people start working in healthcare because they want to make a difference and want to help people. Maybe that means moving from the front office to take on more of a clinical role as a medical assistant. Having an interest in healthcare doesn’t have to end at the front desk, especially for those who are interested in progressing in the field.

Working in a private medical practice can be challenging, with heavy workloads, endless patient demands, and near-constant interruptions. A basic employee appreciation plan isn’t going to make the day-to-day any easier for support staff. But, an appreciation plan that does more—that shows employees how much you truly do trust and respect them—can make all the difference in the world, turning employees into real team members who excel and, just as important, stick around.

Pamela Ballou-Nelson, RN, CMPE, MA, MSPH, PhD, is a Principal Consultant with MGMA Consulting and has over 30 years of experience across the continuum of care in healthcare management focusing on practice process transformation, PCMH, workflow analysis, quality measures, care management, population health and patient activation. Email her at pballounelson@mgma.com