Turnover and Retention Strategies among Mental Health Workers

Background: The purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience? Methods A qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts. The healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels. The results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.


Background
Mental health workers experience high turnover rates of more than 50% [1], a factor that has been linked to inadequate quality of care for patients in community mental health clinics [2]. Aside from contributing towards poor quality patient care, high turnover rates among mental health workers impose significant financial burdens on organizations [3] and increase worker dissatisfaction [4]. Turnover is related to a number of factors such as low salary, poor work-life balance, relationship conflicts, and limited opportunities for career growth [5]. Since high turnover rates among mental health workers can lead to lower quality care, it is essential that health care administrators develop and implement effective retention strategies.

Turnover and Retention in Healthcare
Since mental health workers work closely with patients to develop trust and deliver high-quality care, it is essential that turnover be reduced. A recent report by the Substance Abuse and Mental Health Administration (2017) indicated that factors such as understaffing, increasing workloads, and a lack of training contributed towards turnover among mental health workers. High turnover rates disrupt the workplace cultures of mental health organizations and can have negative consequences at the organizational and individual level. For instance, organizations that experience high turnover might have difficulty with recruiting skilled professionals [6], and incur significant costs associated with recruitment and training of new employees [7]. As a result, clinics with high turnover may find it hard to provide high-quality care in the future. Since many workers leave their jobs out of dissatisfaction, effective retention strategies include those that focus on improving employee motivation, workplace satisfaction, and employee engagement [8].  [4]. Mental health workers also often work in stressful work environments, a factor which can further increase their job dissatisfaction [13].

Recruitment and Retention
Effective retention strategies capitalize on the factors which motivate workers to join and stay at an  [24], and so were not appropriate.

Recruitment Procedure and Participants
The participants in this study were recruited using purposive sampling from community mental health clinics in Fort Worth, Texas. Eligibility criteria were that participants had to be healthcare administrators with more than two years of experience with hiring and retaining mental health workers within their

Data Analysis Procedure
Member checked interview summaries were analyzed with the aid of NVivo 12 software. Data was analyzed using thematic analysis, a technique used in qualitative studies used to generate themes based on careful analysis of interview data [27]. The phases of thematic analysis include familiarization, coding, initial theme development, theme revision, theme finalization, and report generation [27]. During the familiarization phase, interview transcripts were read several times to identify key words and phrases related to the research question. Codes were then used to describe these key words and then grouped together to generate the initial themes. Themes were revised to form more concise thematic groupings before the final list of themes was developed.

Reliability and Validity
In qualitative research, the researcher must ensure that the study's credibility, transferability, dependability, and confirmability are upheld [28]. In this study, an audit was used to increase dependability. The interview guide was tested by Human Resources professionals with more than 10 years of experience with implementing successful retention strategies to ensure that the interview questions were designed to answer the research question. Interviews were also member checked by participants to enhance credibility [26]. Detailed methods procedures help uphold the transferability of this study by making it easier for future researchers to replicate this study or apply its findings in another context [28]. Confirmability was maximized by reducing bias through the use of a validated interview instrument and assessing the potential sources and contributions of researcher bias throughout the study process.

Results and Discussion
Participants discussed a variety of different retention strategies that their organizations used to improve worker satisfaction and retention. These strategies are summarized in Table 1

Implications and Recommendations
The strategies for mental health worker retention identified in this study may be employed by HCAs in other clinics to increase the satisfaction and retention of their employees. Across the country, mental health worker retention rates have been estimated to be as high as 50% [1], highlighting the urgency with which successful retention strategies need to be implemented. An inability to retain mental health workers negatively impacts the facilities that demand

Limitations
There were several limitations to this study.