Creating a culture where every person’s strengths and assets are celebrated—and each employee understands how important they are to the mission of the institution—is critical to employee retention. Impact workforce strategies can become tangible examples of a culture of belonging and the health system’s shared values.

What is a culture of belonging?

A workplace culture of belonging is one in which all employees receive the support they need to thrive in their jobs, find meaning in the work that they do, and are recognized for the contribution they make towards patient care. Developing specific retention strategies that address these elements will create a culture in which all employees, including those hired through outside-in pathway programs, succeed beyond their initial 90 days. In addition, increased retention can improve the business case for these programs and can buoy further support from executive leadership and hiring managers.

There are several important elements to effective retention strategies with impact workforce programs:

  • appreciate everyone
  • encourage long-term vision
  • provide wraparound services
  • collect feedback
  • maintain realistic expectations
     

Deliver Trainings to Promote Belonging and Inclusion

All individuals deserve a working environment where they feel valued, respected, and heard. However, individual biases can have significant impacts on daily working-life for staff, especially when biases negatively impact peer-to-peer relationships and interactions. As a result, implicit and explicit biases could decrease the effectiveness of any program, reducing success in hiring and retention of those hired or promoted outside of traditional recruitment practices. Creating an inclusive community that is supportive of all staff regardless of race, education level, financial background, sexual orientation, gender identity, and other factors thought of as traditional barriers to entry is essential to ensuring a work environment that enables long-term retention for a diverse workplace.

Workplace trainings that promote belonging and inclusion can increase retention.86 Training on topics such as implicit bias or rethinking “professionalism” can help create a working environment that is cognizant of implicit and explicit biases, and can work towards breaking down attitudes and behaviors that compromise psychological safety, ensuring that all employees, regardless of identity or background, can thrive. Employees who are hired outside of the traditional hiring process may face biases from peers who did not participate in the outside-in pathway program. Providing training, or otherwise working with hiring managers and staff to develop cultural competency, can help mitigate challenges and allow for better integration and retention of new hires from different cultural backgrounds. CommonSpirit Health, for example, educates hiring managers about more inclusive hiring through behavioral-based interview training and training about implicit and unconscious biases.

Role-playing simulations are another tool for promoting individual understanding of biases. Advocate Health has utilized a returning-citizen simulation with HR leaders. The simulation helps participants realize the many challenges and barriers people face upon leaving incarceration and re-entering the workforce—such as establishing a home address, finding reliable transportation, getting a driver's license, and registering with job services. This approach has also helped to build internal support for Advocate Health’s Returning Citizens Initiative. Role-playing simulations can also be used to understand how employees are impacted when wages don’t cover all basic living expenses, including housing, food, healthcare, childcare, and transportation. For example, one health system has conducted poverty simulations, which helped HR leadership understand that the challenges that exist in daily life from low wages may prevent employees from getting to work on time. This new knowledge prompted them to change the health system’s policy around attendance.  

Hiring managers are on the frontline in matters of retention. Working directly with hiring managers to ensure they are properly prepared and engaged when hiring employees of different ethnicities, identities, backgrounds, or cultural norms than the majority of existing employees can help create a successful hiring and retention initiative in both the short and long term. Preparation for outside-in pathway program graduates might include taking extra steps to learn about the culture of incoming new hires if their culture is different from the existing majority workforce. For example, taking the step to learn about a new employee’s culture can create space for understanding of differences in religious or cultural practices. This understanding can also prepare a hiring manager to create a plan on how to integrate the new employees into the team in a way that is respectful and inclusive of the new employee’s culture.

One example of successful collaboration with hiring managers can be found at Trinity Health, the Michigan region, which developed a competency-based approach to hiring, promotion, and development that is being scaled to other organizations through a program called HireReach. This work has led to the reduction of first-year turnover (improving the quality of hire), enabling their external hires to be more reflective of the patients and families served by the healthcare system, among other outcomes. 88b

Encourage Long-term Vision

Building a culture that encourages employees to envision long-term careers with space for advancement is an important strategy for retention. Employees who see themselves as having career pathway opportunities are more likely to stay within an organization than those who see themselves as unable to move from their current position.88 Having a long-term career goal coupled with tangible steps and support for advancement encourages employees to begin to take those steps. In particular, paying for training and education programs upfront—especially when combined with the offer of future employment opportunities—can help improve retention. Career coaches can help both new and existing employees understand and recognize career development opportunities and get a more complete picture of the opportunities available to them in the long-term.

Provide Wraparound Services

Centralized, easy-to-access information and resources for social services and wraparound services can help employees weather personal life challenges that may otherwise lead to an employee leaving the health system. For parents whose childcare is suddenly disrupted, employer supported benefits for childcare can ensure an employee can continue coming to work; for an employee whose car breaks down, transportation benefits may be the difference between being able to afford getting to work or having to quit to find work closer to home. Additionally, providing financial planning services can help employees adjust their spending and saving habits to better prepare themselves for such emergencies. Partnering with community organizations to better understand the barriers employees may face and leveraging their expertise and services may uncover more solutions that would enable people to maintain employment and increase retention.

Collect Feedback

Collecting feedback and intentionally engaging employees to understand their experiences is  a useful strategy to identify items to address that could increase retention. According to Shift Work Forward, worker voice is a core pillar of a quality job, which can contribute to employees’ increased job satisfaction, greater influence, inclusion, and sense of “mattering,” and better opportunities for professional development.89a In one workplace, Paradise Tomato Kitchens found that centering workers’ voices led to a reduced turnover rate of new hires, dropping from 72 percent to 32 percent in the year since the HR team introduced “checkpoint interviews” to actively listen to new employees about what was working well or could be improved.89b

Surveys and informational interviews are two means of collecting feedback that can lead to helpful suggestions for improvements. Additionally, providing space for feedback during annual reviews or other periods of reflection can promote a healthy workplace. Providing incentives and rewards to fill out or return feedback is a commonly used strategy.

When collecting feedback, “reading between the lines” may be necessary, especially in regards to understanding personal life challenges that may be impacting an employee’s work life. Certain topics are challenging to broach for both employees and managers, but the ability to recognize when a staff member may need extra support to accomplish their work can be critical to retention.

Recognize that collecting feedback alone is not effective, however. It is critical that when soliciting feedback, said feedback must be thoroughly considered and solutions should be discussed and implemented. Soliciting feedback without acting on it often leads to a lack of faith in the feedback system, and will result in lower feedback returns in the future. Failure to act on feedback can also be taken as acting in bad faith by employees and can negatively impact retention—the knowledge that an employer actively knows about an issue and is not listening or taking action to create a solution is both frustrating and disheartening.

Maintain Realistic Expectations

Retention strategies help, but turnover will always exist. It is necessary to maintain realistic expectations and understand that retention plans should always prepare for attrition. The purpose of intentional, outside-in programs is to provide opportunities for people who have been left out of your system’s workforce for a variety of reasons; at the same time, there are many reasons you may see attrition and turnover by those who have been hired through the new programs you have designed.  

Additionally, it is ideal to prepare for the fact that some people may need further training beyond the initial educational or training periods. Some may need one-on-one support to help them fully grasp concepts or to learn a new skill. Realistic expectations recognize that people make mistakes, may need second or third chances, may require extra time to process a new idea or perform a challenging task, and may need job coaching. This is normal; to expect otherwise will not lead to success in hiring or retaining employees, especially for those facing barriers to entering the workforce.

Who is in charge of retention?

  • Managers and HR business partners can collaborate on retention strategies. If an employee is not being successful, work together to determine whether a corrective action or a supportive conversation that determines the issue will be more conducive for retention. If an employee is having transportation or childcare issues, is there a way to troubleshoot and resolve the issue without corrective action? Are there outside resources or a job coach that can help the employee navigate to a successful resolution? It has been shown that retention increases when department managers and HR business partners are actively on board and involved as partners working with employees hired through outside-in pathway programs.
  • Designating someone as a job coach who regularly works with new employees and helps them integrate into the system can be very effective in increasing retention.

86.

 Rockwood, Kate. 2022. “How Learning and Development Can Attract and Retain Talent.” SHRM. https://www.shrm.org/topics-tools/news/all-things-work/how-learning-development-can-attract-and-retain-talent.

88.

Andrew Chamberlain, “Why Do Employees Stay? A Clear Career Path and Good Pay, for Starters,” Harvard Business Review, March 06, 2017, accessed May 2, 2022, https://hbr.org/2017/03/why-do-employees-stay-a-clear-career-path-and-good-pay-for-starters.

88b.

Maggie Randolph, email to Hue Phung and Lauren Worth, Trinity Health, April 7th, 2026, Healthcare Anchor Network.

89a.

“What We Mean By ‘Worker Voice,’” National Fund for Workforce Solutions, accessed December 18, 2024, https://nationalfund.org/our-solutions/equip-workers-for-success/what-we-mean-by-worker-voice.

89b.

Ellen Frank-Miller, Molly Wendland, and Madi Ryan, Supporting New Hires, Success (Shift Work Forward, 2024), page #1 and page #3, https://shiftworkforward.org/resource/supporting-new-hires-success/.