Reasons to stay v’s reasons to leave two sides of the same coin? Framing effects in determining weightings push and pull influences on staff retention. A study of UK National Health Service health personnel, using the method of paired comparisons.

Staff turnover represents a significant cost for all employers. Understanding why staff leave and what might need to change to motivate or support them to stay is key to human resources intervention aimed enhancing retention rates. This issue is of particular salience for State sector healthcare due to international labour shortage and falling rates of health professional graduates in the UK and a number of other European States. In common with other risk management domains trail data, in this instance quit rates, provides limited insight into root causes and incubating issues. Intention to quit data is also problematic due to its routinely weak relationship to behaviour. Moreover, both afford limited insight into the key intervention issue of why staff leave, the relative weighting of different push (leave) variables and critically, what might need to change to motivate / enable (pull) them to remain.
To date, the academic evidence-base on retention is dominated by findings based on discrete topics, e.g. job-stress, working hours and single professions, the most widely studied being nurses working in acute care settings. This raises questions over the generalisability of findings and affords limited insight over priority issues or demographics for intervention. Perspectives on root causes have tended to focus on reasons why staff leave, with the implicit assumption that this mirrors what might need to change to motivate / enable them to stay,
Based on a case study of the UK National Health Service, this paper reports on findings from paired-comparisons study that set out to demine and compare the relative weighting of widely identified push and pull influences across the principal health profession employed in secondary care. Participants (doctors, nurses, applied health professionals and emergency ambulance paramedics, working in acute, community, mental health and ambulance services) N = 3952, were randomly assigned to rank the relative salience of (recognition of effort, working hours, time pressure, work-home life balance, pay, workload intensity, staffing levels, and mental health/stress) with reference to “Why do staff who do your type of job leave NHS employment?” or ‘What needs to change to make staff who do your type of job stay in NHS employment?’
Beyond notable consensus and alignment with respect to the primacy of mental health/stress, staffing levels, and a positive relationship between the push and pull frames (Tau 0.714, p. 0.02) for the all-profession samples, results revealed a number of differences in rank order and weighting between the professions. Work-life balance was notably more salient for paramedics than other professions and the salience ascribed to pay was notably higher, ranked 1st or 2nd in the pull frame compared with 4 across the different professions in the push frame, and first or second within the pull frame.
Findings identify priorities issues for intervention, potential gains from a segmented approach tailored to the different profession families and discuss the methodological implications of push verses pull question framing in staff retention research.