At its simplest, workforce shortages at established organisations occur when fewer people want to join than choose to leave.

In healthcare, local availability of appropriately skilled people is just part of the story. Many factors affect the attractiveness of a role at a particular organisation. An uncompetitive salary relative to alternative employment and local costs of living; unsociable hours of work; inflexible terms and conditions of employment; lack of childcare facilities and poor work / life balance are just some.

For professionally regulated groups, such as doctors, nurses and healthcare scientists, additional factors also apply. Professional healthcare workers undergo lengthy periods of advanced education and training to gain scarce skills. They are subject to formal and continuing testing of their competence in order to maintain their professional status and, in return, have an expectation that they will have a ‘job for life’ where they can contribute fully to their chosen vocation. Workforce shortages weigh heavily on them, affecting their ability to achieve the best possible outcomes for their patients, and can lead to an irrecoverable breach of their psychological contract with their employer over time.

Multiple academics note that a breach of the psychological contract, the set of unwritten and reciprocal beliefs describing an implied relationship between an employee and their employer, leads to reduced job satisfaction, professional commitment and a greater intention to quit their organisation. Others note that few workforce planning models take account of such psychological concepts in supply-side inputs, calling into question the predictive efficacy of the model’s outputs. The latest NHS Long Term workforce plan methodology makes no mention of taking account of these factors in its calculations, albeit one of the documents referenced in it – ‘Factors associated with staff retention in the NHS acute sector’ – states in its conclusions:

‘… much of the substantial variation in trust-level leaving rates remains unexplained: the factors included in our model explained between 11% and 20% of the variation in leaving rates at the trust level depending on which staff groups were studied. Continuing to improve knowledge of these factors – including more intangible trust and job characteristics such as culture and overall management quality – will be important in designing and evaluating policies to boost retention through improvements in these channels’ (IFS, 2022, p42)

Board members at NHS organisations have little control over many elements of individual employment contracts. But in their position as representatives of the organisation, they can significantly affect how professionals ‘feel’ about their role and their employment. Taking actions that improve the bond between the individual and the employing organisation has been shown to lead to a reduction in unwanted turnover. Perhaps now is the time to take stock of the psychological aspects of existing relationships to improve staff retention: to undertake professional workforce planning rather than workforce planning for professionals?

We’ve spent the last decade understanding psychological factors associated with the career intentions of professionals working in healthcare. Please do get in touch for an initial discussion if you think we might be able to help.

IFS (2022): Kelly, E., Stoye, G., & Warner, M. (2022). Factors associated with staff retention in the NHS acute sector. Institute for Fiscal Studies.