Engagement & Retention

What is it?

Gartner defines employee engagement as “the extent to which employees are passionate about their jobs, are committed to the organization, and put discretionary effort into their work.” Retention occurs when employees choose to stay with an organization instead of seeking employment elsewhere.

While organization-wide culture, policies, and practices certainly impact engagement, studies show that an employee’s immediate supervisor has the single strongest influence on their level of engagement. Research shows that when employees are engaged, organizations experience these outcomes:

  • Lower absenteeism

  • Higher retention

  • Positive workplace climate

  • Stronger work relationships

  • Higher quality

  • Higher productivity

  • Higher customer satisfaction

  • Stronger financial performance

One model (Macey, et al., (2009). Employee Engagement Tools For Analysis, Practice, and Competitive Advantage. Wiley-Blackwell) of employee engagement developed by William Macey, Benjamin Schneider, Karen Barbera, and Scott Young outlines four primary factors that contribute to employee engagement: Capacity to Engage, Motivation to Engage, Freedom to Engage, and Strategic Engagement.

Best Practices in Engagement and Retention

Salary and Benefits: The starting point

While satisfaction with salary and benefits does not by itself create engagement, it is considered a “dissatisfier” that can impact recruitment and retention.

Strategies for addressing Salary and Benefits include:

  • Learn about your organization’s practices for benchmarking salaries and benefits against peer organizations.

  • Check in periodically with your HR department to ensure that salaries and benefits are competitive in your market.

Capacity to Engage: Having needed resources

In this context, “resources” cover a broad range, including not only finances, materials, and equipment, but also knowledge, information, time, and social support.

Strategies for strengthening the Capacity to Engage include:

  • Have regular conversations with staff to ensure they have the resources they need to do their job well.

  • Review workloads to ensure that employees have sufficient time to do their job well.

  • Check in and share information on a regular basis.

  • Help employees build relationships with others inside and outside the organization.

  • Provide all staff with opportunities to learn and practice new skills in a supportive environment.

Motivation to Engage: Finding meaning in the work

Factors that contribute to a sense of meaning include challenge, variety, autonomy, and regular feedback, as well as work that is aligned with an employee’s values.

Strategies for strengthening Motivation to Engage include:

  • Learn about what’s important to each individual and help them find ways to tap into their values through their work.

  • Help employees use their skills to the fullest by providing them with appropriate levels of work challenge, variety, and autonomy.

  • Communicate in ways that connect an individual’s work to the impact they have on patients, colleagues, and the community — and seek opportunities for staff to see the impact for themselves.

  • Place a high priority on employee learning and development. Delegate, coach, and provide stretch assignments and formal learning opportunities to help them continually develop in their role and prepare them for the next step in their career. (See the Learning & Development section for more details.)

  • Provide regular feedback to recognize good performance and redirect unproductive behavior.

Freedom to Engage: Feeling that engagement is safe and worthwhile

When employees feel free to engage, they feel safe asking questions and speaking up — and confident that if they do speak up, their perspective is welcomed.

Strategies for strengthening Freedom to Engage include:

  • Encourage employees to ask questions and speak up when they disagree or aren’t sure about something.

  • Treat mistakes as learning opportunities rather than failures.

  • Create a culture of transparency and information sharing.

  • Provide employees with opportunities to give input into program decision making.

  • Manage conflict honestly and constructively.

Strategic Engagement: Aligning energy and effort with the organization’s goals

Strategic engagement occurs when employees understand how their daily work contributes to the mission and long-term goals of the organization.

Strategies for improving Strategic Engagement include:

  • Ensure that all staff understand the long-term goals of your organization and how they contribute to them.

  • Build employees’ awareness of the rural health care environment, the transition to value, and population health goals in your community.

  • Emphasize the connection between daily work and long-term goals during feedback discussions.

Stay interviews: A valuable tool for improving retention and employee engagement

Often when an employee quits their job, the employer conducts an exit interview to learn the reasons for their departure. While this information can help the employer learn why employees leave and what they might do in the future to improve retention, by the time an exit interview occurs, the employee is already on their way out the door.

A stay interview, in contrast, is a tool for preventing turnover from occurring in the first place. It is a proactive process for discovering the aspects of a job that employees currently find rewarding and identifying ways to improve their work experience.

When it comes to employee engagement, insights gained from a stay interview can help employers identify specific ways to support and strengthen the engagement of individual employees. Check with your HR department to find out whether your organization has a process for conducting stay interviews. If not, see the Resource Guide for a planning tool to help you conduct one.

Engagement & Retention Tools

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National Rural Health Resource Center

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National Rural Health Resource Center

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Key Takeaways

  • Work with your HR department to ensure that salaries and benefits remain competitive.

  • Check in regularly with employees to ensure they have the resources they need to do their job well.

  • Find ways to help each individual tap into their own values and priorities through the work they do.

  • Create a culture of information sharing and transparency where questions and suggestions are welcomed.

  • Ensure that all staff understand how their daily work contributes to long-term goals.

  • Consider conducting stay interviews as a tool for strengthening engagement.

Rural Health Care Engagement & Retention in Action

After recognizing the impact that a lack of available housing has had on recruitment and retention, Coteau des Prairies Health System in Sisseton, South Dakota decided to act. The hospital plans to purchase homes near the hospital and is also exploring the possibility of building a new housing complex.


National Rural Health Resource Center

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