In the past, when the Healthcare Commission conducted its annual health check, the focus was on the importance of policies and procedures in ensuring quality in healthcare. This was evident during my time on the mental health clinical governance team, where we spent hours aligning practice with policy. I also came to appreciate the value of staff involvement in policy and its impact on staff retention.
Recently, I came across an evidence synthesis about staff retention in mental health services, conducted as part of the Health Foundation funded Efficiency Research programme by researchers from the University of Sheffield (Long, et al, 2023). This was intriguing, particularly in light of the release of the NHS Long Term Workforce Plan (NHSE, 2023) around the same time. As I read the synthesis, I wondered whether the authors of the Workforce Plan had taken into account the findings of the review. It appeared to me that they had not.
The researchers adopted a realist synthesis methodology to understand what interventions work, how they work, and in what contexts. They conducted the review in three ‘hybrid’ phases, which combined traditional review methods with valuable input from diverse stakeholders, including staff and service users. The result was an empirical framework that emphasized the interconnectedness of factors affecting staff retention in mental health services, and the significant impact of organizational culture.
The review identified three key drivers of effective staff retention: workload and quality of care, investment in staff, and staff involvement in shaping policies and practice. It was made clear that these drivers impact staff wellbeing, sense of connectedness to the organization, and ultimately, job satisfaction. The researchers created an overarching logic model to demonstrate the relationships between these drivers and their impact on retention.
Despite the relevance of the review’s findings to staff retention in mental health services, the NHS Long Term Workforce Plan seems to have overlooked several crucial aspects highlighted by the review. The Plan appears more focused on increasing the numbers of staff, but fails to address the deeper roots of staff retention issues as outlined in the review.
One of the strengths of the review is its potential to serve as a case study for other health settings in the UK, providing valuable insights for policy makers, service providers, and research funders. However, the limitation of the review lies in the interpretation of information rather than comprehensive identification of sources, and the lack of clarity on how study quality was evaluated.
In conclusion, the review underscores the need for a whole systems perspective that goes beyond simply recruiting more staff, and emphasizes the importance of investing in people and creating an organizational culture that supports staff retention. The implications of the review extend to policy makers, service providers, and research funders, and offer invaluable insights for improving healthcare practices. Full access to the primary paper is available for further reading (Long, et al, 2023).
