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How our trust prevented 117 workers from leaving in one year

How our trust prevented 117 workers from leaving in one year
By Valeria Fiore Journalist intern
21 May 2018

Guy’s and St Thomas’ (GSTT) NHS foundation trust employs around 15,900 workers and makes about 2,500 staff appointments every year.

In order to ensure the continuity of care to its patients, the trust started looking at how they could have improved their staff retention.

After introducing a new retention strategy in April 2017, the trust managed to lower staff turnover rates and better retain its employees.

Lynn Demeda, deputy director of workforce at GSTT speaks to Healthcare Leader’s reporter Valeria Fiore on how they have done it.


When we started looking at retention, we noticed that we were losing about 1,800 employees a year. Although our turnover rate of 12.6% was lower when compared to 14% in the rest of London, we started asking ourselves what we could do to retain staff.

I think it is challenging to retain staff as it is easy for people (nurses especially) to move around across NHS hospitals and services. On top of that, another point to consider is living costs and how they could influence employee’s choices.


We started by looking at the data. We noticed that the workforce grew by 30% (around 3,600) over the past five years, as there is a constant demand for our services.

By analysing our data, we realised that we could have prevented around 40% (780) of the workforce from leaving.

Factors for leaving

The reasons leavers commonly put forward included:

  • career progression;
  • specialty change;
  • work-life balance;
  • relationships with line managers.

We then put together a corporate retention group involving a number of stakeholders including nurses, allied health professionals, HR business partners, to look at how we could improve retention.

Focus areas:

  1. Career navigation and coaching. We wanted to help staff to think about their career progression and if that could be within our organisation. We developed a career development toolkit, which goes through some questions that people can start to think through for themselves and helps people to prepare for interviews.
  2. Stay discussion. Rather than waiting until people to leave to understand why they have left, we are now encouraging managers to have informal discussions after the employee’s first three months with us and later after the first nine months.
  3. Transfer process. That is to ensure that staff (nurses at the moment) can easily move from specialty to specialty, as long as the skillset matches. It will be easier for staff to move across the institution without having to go through a recruitment process. They would just have a conversation with the line manager.
  4. Accommodation. We understand that is very expensive in London and we are looking at what we can do to support that. At GSTT we have some accommodation for staff and we give nurses and allied health professionals access to a loan to cover the rental deposit.
  5. Flexible working. Although we are all quite flexible in the NHS, we have encountered some resistance from managers in how to manage and arrange their services. So we are now working on how we can make our organisation attractive and flexible.
  6. Leavers’ discussions. When people do leave, we ask them why they are resigning and what we could have done to prevent them from leaving. We have also introduced a mechanism to keep in touch with leavers to make it easier for them to come back in the future.


Since we first introduced this strategy last year, we have seen the voluntary staff turnover rate falling from 12.6% in 2016-17 to 12.4% (around 1950 workers) in 2017-18.

However, the greatest impact of the strategy was clear when we looked at the number of our preventable leavers. About a year ago, the figure was around 40% but now it has come down to 34%, which equates to 663 so we have retained 117 staff so far who would have left.

That is what we want to focus on and I would like to see that figure to be even lower year on year. This would ensure good patient continuity and save us time spent on recruiting, induction and administration work. In business terms, it makes sense.


The challenge is actually getting people to do it. We made the stay discussion format as simple as possible, but it is about making sure that that discussion actually happens and that staff take responsibility to think about their own development. Managers were slightly concerned that they had to have a ‘stay discussion’, because they thought that would have been additional work for them to do on top of the Personal Development Review (PDR) and appraisals. However, the strategy is actually about simplifying the ‘stay discussion’.

It is about making the process as easy as possible for people to:

  1. Get hold of the tools;
  2. Be able to do it.


We are looking at embedding stay conversations across the organisation.

We are planning to work collaboratively on retention in our STP area. If people are leaving, we could keep them local, which means that they might come back to work with us again in the future.

Another area of focus includes what we call our ‘digital employee journey’. We will improve how we are attracting people to our organisation along with making better use of digital tools to keep staff engaged within the organisation. We are also looking at how we can digitally keep in touch with someone who has left, as they may come back to work with us.

Social media is increasing importance in how we will engage our staff in the future. We already have a Facebook page for our nurses, where we publish several ‘a day in the life of…’ nurses working in different wards and publish jobs adverts.


‘I see this as continuous journey and we need to keep momentum up to ensure we continually listen to staff feedback and tailor our retention focus to respond as ‘one size does not fit all’.’

Lynn Demeda is a deputy director of workforce at Guy’s and St Thomas’ (GSTT) NHS foundation trust in Central London.

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