The patient’s comment was a sure indication of a problem at the University Muslim Medical Association (UMMA) Community Clinic in Los Angeles. “I see a different doctor each time I come,” the patient said. "How come they never stick around?"
Leaders at the federally qualified health center decided to take steps to answer that question, setting out to improve provider satisfaction and reduce turnover.
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The clinic’s annual turnover rate for providers was about 25%. While that's on par with other clinics in Los Angeles, continuously replacing providers is a costly problem, writes Yousef Turshani, M.D., UMMA’s chief medical officer, in a case study on NEJM Catalyst.
Half of the providers at the center were temporary or locum primary care clinicians. Leadership turnover was also a problem, with four medical directors in six years.
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So a new leadership team that joined the clinic in late 2015-16 decided to turn the tide. “It sought to create a sustainable culture that would invest in its workforce and infrastructure to reap the rewards of higher quality health care and staff retention,” said Turshani.
The goal for the first year was to fill open positions with providers who fit the clinic’s culture and cut the turnover rate in half.
The plan worked, and the center had a 0% turnover of primary care and behavioral health providers between June 2016 and 2017. The clinic took the following steps:
- Enhanced communication. Leaders held one-on-one meetings with every staff member to learn why people were unhappy and focus on what could be done. An effort was made to involve providers in key decisions with formal and informal meetings and not implement initiatives in a top-down approach.
- Freed up leadership time. The center cut clinical leaders’ direct patient care responsibilities to provide more time for resolving operational issues and communicating with clinical staff.
- Rewarded clinical quality. Bonuses, at least in part, are tied to patient satisfaction and clinical quality measures. The clinic scrapped a proposed productivity bonus plan, which providers said would incentivize quantity over quality.
- Involved providers in the hiring of new employees. People coming in for interviews shadowed a provider or had lunch with him or her. Provider input was incorporated into hiring decisions.
- Set up a staff recognition program. Leaders wanted to create a more supportive culture and established a program to recognize clinical staff with peer-nominated awards and encouraged leaders to thank staff members for their work.