The use of the exit interview to reduce turnover amongst healthcare professionals (Protocol)

Description of condition \ud
Turnover is defined as "the process whereby staff resign from the organisation or transfer within the hospital environment" (Bland Jones 1990). It is a problem that affects all organisations and has become a focus of healthcare institutions because of expenses related to time and money. Wise defines this phenomenon as an erosion of human resources within an organisation resulting in an increase in the cost of doing business (Wise 1993). Unfortunately, when health care is involved the end result of turnover can impact on patient care and clinical outcomes. Turnover has been a focus of interest for organisations since the early 1900s (Cotton 1986). It can be viewed as beneficial to an organisation to a certain degree, stopping it from becoming stagnant and non-productive (Weisman 1981). Tai et al. suggests that, in any organisation, trying to retain staff and keep turnover rates at an acceptable level is beneficial. In healthcare facilities turnover rates range from 10.1% to 50% (Tai 1998); however, rates of 15% to 20% annually are considered acceptable to prevent an organisation becoming stagnant (Capko 2001). \ud
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Description of intervention \ud
Exit interviews are conducted in many organisations to elicit reasons for employee turnover (Leahey 1991). The practice dates back over half a century (Melcher 1955; Moran 1956) and takes the form of: either a formal or informal verbal interchange, conducted at a point between the time of resignation and the employee's last working day; a written questionnaire, completed either before or after leaving the organisation; or a combination of both approaches. The exit interview can be defined as "a widely used tool for gathering information from separating employees" (Giacalone 2003 p. 398). An excellent summation of the process is "that the scope of inquiry is not simply why employees quit their jobs, but the impact of the total work environment on those who chose to stay" (Drost 1987 p. 104). Although there is argument for and against the exit interview, it remains a recommended component of the exiting process. Well accepted reasons for conducting such interviews include: attempting to change the person's mind about leaving; using the interview as part of an 'image management' exercise (Lefkowitz 1969); documenting specific reasons for the resignation so that managers can use the information to improve the service (Erickson 1996; Leahey 1991; Neidermeyer 1987); and, more recently to 'trend' reasons for turnover (Erickson 1996). An exit interview also provides organisational feedback about unethical or bad behavior and information about current practices, working conditions, management and training programs (Drost 1987; Giacalone 2003; Jackson 2002; Jurkiewicz 2001). In ideal circumstances the employee is interviewed by someone other than the line manager. Information is then gathered and analysed and fed back to managers and executives in a timely manner. \ud
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Although the exit interview is widely used, validity of the approach has been questioned (Jurkiewicz 2001; Lefkowitz 1969). There are often inconsistencies in the way the interview is managed, and it may be conducted by people who are unskilled in interview techniques. The exercise is costly, and information may not be analysed and fed back in a timely manner, or may be disregarded completely. More importantly, the information elicited may not be accurate. For example, departing employees may wish to leave a good impression to improve chances of a positive future reference or re-employment (Hinrichs 1971; Yourman 1965); they may feel intimidated about discussing their true reason for leaving, especially if conflict is involved and the interview is conducted well before the person's departure date; or they may feel that disclosing their real reason is a waste of time, based on previous experience with the service (Yourman 1965). \ud
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How the intervention might work \ud
The intervention under consideration in this review is the exit interview and the primary outcome is staff turnover. In theory, the exit interview reduces turnover by alerting management to organisational deficits or problems that may be amenable to quality improvement activities. Responding to concerns raised during the exit interview provides the organisation with a reputation for caring, which may, in turn, contribute to staff retention. \ud
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Why is it important to do this review? \ud
There is a world wide shortage of healthcare professionals (WHO 2006), so many strategies have been used in an attempt to reduce this phenomenon, the exit interview being just one of them. This review is timely and important because retaining healthcare professionals has become a priority for most countries around the world. To understand the organisational environment, the manager must be aware of the tools available to assist them in trying to reduce turnover and retain staff. The exit interview is one such tool, but whether it is effective in reducing turnover or the number of healthcare professionals who leave their profession is still disputed. \ud
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Objectives\ud
To determine the effectiveness of various exit interview strategies in decreasing turnover rates amongst healthcare professionals working in healthcare organisations. \ud
To address these objectives we are planning to carry out the following comparisons. \ud
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1) Exit interviews compared with no exit interview. \ud
2) The effects of the following characteristics of the intervention on the magnitude of the effect across studies: method of delivery (face to face, telephone, self-complied, electronic or postal). \ud
3) The effects of the following characteristics of the intervention on the magnitude of the effect across studies (depending on the number and quality of studies found): \ud
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the timing of the interview in relation to the healthcare professional's resignation; \ud
the person who carries out the interview in relation to the employee's immediate work environment; \ud
the location of the interview in relation to the employee's work environment