The financial costs of workforce attrition are high. They include training new students, the costs and administration involved with employing and supporting new starters in an organisation, and the costs of employing temporary agency and bank staff to fill gaps. Further, there is a knock on effect on the workload and stress of remaining staff.
In 2023 the Royal College of Occupational Therapists (RCOT) published findings from a workforce survey report. With data gathered from 2,600 UK respondents, the following concerns were raised:
- Increased demand for OT services
- Clients presenting with more complex needs due to delayed interventions
- Teams not large enough to meet demand
- Clinicians too busy to provide the desired level of care
- High levels of work related stress
- Feeling undervalued
- Lack of fulfilment in role
- Lack of opportunities for career progression.
The impact of these factors on OTs intention to leave were reported as:
- Over a third of respondents said they intend to leave their current role within the next two years.
- Almost a quarter of respondents said that they intend to stop working as an OT within the next five years.
- Less than half expected to be working as an OT for over ten years.
This clearly indicates a problem with future workforce retention, highlighting the need to address staff concerns and wellbeing now.
There is a lack of data on OT retention and turnover figures as a whole, making it difficult to determine specific clinical, personal or geographic factors.
The Health and Care Professions Council (HCPC) analysed the retention of newly qualified Allied Health Professionals in the UK between 2013 and 2017, dividing the results by profession. They found that 1 in 16 OTs left the profession over a 4 year period. Although this could be improved, it indicates that new starters don’t have attrition rates as low as some other AHPs or nurses. This could be influenced by successful preceptorship programmes.
There is limited academic research around OT retention. Much of this is from Australia or USA, with a focus on identifying factors in rural areas and mental health settings. From this research, the following factors have been identified as influencing OT retention:
- Being in a supportive team
- Having challenging and rewarding work
- The opportunity to use OT skills
- Pay
- Flexible working
- Education, supervision and opportunities for career progression
- Manageable workloads
- Having representation and mentors in the workforce for OTs of colour
- Personal factors and work/life balance
- Location
There is a lack of evidence evaluating specific strategies around OT retention.
Leaders interested in improving OT retention can also benefit from looking at research from other healthcare professions, where more literature is available. For example in nursing retention research, these additional factors have been identified:
- Leadership and management
- Workplace culture (including bullying, discrimination and a sense of belonging)
- The physical environment and available resources
- Staffing levels
- Work related stress, burnout, and critical incidents
- Working hours, including shifts and flexible working
- Location
In the UK, the NHS Retention Hub provides online resources for healthcare leaders of all professions. Some of these interventions aren’t evaluated in the academic literature but there are examples of local case studies. A bundle of actions is recommended as being more effective than a single one. Recommendations include:
- Shaping organisational culture
- Collecting and analysing workforce data
- Communicating with your staff
- Supporting new starters (including preceptorship) and those moving roles
- Supporting international staff
- Development and career planning
- Supporting staff in late career (including legacy roles and menopause support)
- Flexible working and flexible retirement options
- Health and wellbeing
- Recognising and rewarding staff
- Making improvement and change
- Evaluating impact
Looking after the wellbeing of the OT workforce’s professional and personal lives is important for the future of the profession and the clients we serve. There is responsibility from leaders and managers to be aware of the above mentioned factors, and to include retention strategies in policies and ways of working. There is also a responsibility from OTs at all levels to show kindness and understanding to each other and to OT students, to create a positive working culture and to lead by example. More research would be beneficial to understand OT retention further, both through improved workplace leaving data and through evaluation of specific strategies. This could be focused to identify specific geographic or clinical areas with the poorest attrition rates, and also to look at the needs of OTs at different career stages.
Click here to watch a five minute video produced for the RCOT annual conference 2024.
References:
Bae et al (2023) Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review
Ball & Ejebu (2021) Retention of NHS nurses: A scoping review
Ford et al (2021) Recruitment and Retention of Occupational Therapy Practitioners and Students of Color: A Qualitative Study
Hayes et al (2008) A survey of recruitment and retention issues for occupational therapists working clinically in mental health
HCPC (2023) retention rates of first time hcpc registrants, 2013-18.
Marufu et al (2021) Factors influencing retention among hospital nurses: systematic review
Millsteed (2001) Factors Affecting the Retention of Occupational Therapists in Rural Services
NHS England (2024) Retention Hub
RCOT (2023) Workforce Survey Report.
Roots and Lee (2013) Recruitment and retention of occupational therapists and physiotherapists in rural regions: a meta-synthesis
Scanlan et al (2010) Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push
Scanlan et al (2013) Enhancing retention of occupational therapists working in mental health: Relationships between wellbeing at work and turnover intention
Scanlan et al (2013) Job satisfaction, burnout and turnover intention in occupational therapists working in mental health
Smith et al (1995) Recruitment and Retention Strategies Used by Occupational Therapy Directors in Acute Care, Rehabilitation, and Long-Term-Care Settings
Vries et al (2023) The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals
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