|Year : 2017 | Volume
| Issue : 1 | Page : 6-13
A qualitative and quantitative study of the reasons of attrition in an Indian hospital
Kasturi Shukla, Ruchismita Deb
MBA Department, Symbiosis Institute of Health Sciences (Symbiosis International University), Pune, Maharashtra, India
|Date of Web Publication||19-Dec-2016|
Symbiosis Institute of Health Sciences, Senapati Bapat Road, Pune - 411 004, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The study attempts to evaluate the reasons of attrition in the organization from the perspective of the existing as well as the leaving employees; compare and identify the gaps, if any between the perspectives of these two employees groups. The study also aims to critically analyze the utility of 'exit interviews' for analyzing the reasons of attrition. Methods: This cross-sectional study was conducted in a 150-bedded hospital in Ahmedabad, India, during May-July 2015. Exit interview data of forty leaving employees were collected and reviewed. One hundred existing employees were interviewed through quantitative and qualitative methods to understand their perceptions about attrition in the organization. Results: Attrition rate of 26% was observed in the study and 57% leaving employees were nurses. 70% leaving employees cite "blanket reasons" such as better opportunity and personal reasons during exit interviews. 72.5% leaving employees believed that exit interview is largely for record purpose and 11% were unsure of its utility. However, when existing employees were probed qualitatively, a variety of responses were received. 65% existing employees quoted salary issues, partiality/poor recognition, improper assignment of tasks, and monotonous work as reasons for attrition in the organization. Conclusion: Exit interviews somewhere fail to probe into the real reasons of attrition. To improve retention, organizations must monitor their existing employee's intention to continue working in the organization and any sign indicating a poor intention to continue must be addressed immediately to avoid ripple effects. Moreover, to use exit interview as a tool to improve employee retention, leaving employees must be interviewed in-depth to uncover the actual reasons for quitting the job.
Keywords: Attrition, employee, exit interview, in-depth interviews, qualitative
|How to cite this article:|
Shukla K, Deb R. A qualitative and quantitative study of the reasons of attrition in an Indian hospital. CHRISMED J Health Res 2017;4:6-13
|How to cite this URL:|
Shukla K, Deb R. A qualitative and quantitative study of the reasons of attrition in an Indian hospital. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 21];4:6-13. Available from: http://www.cjhr.org/text.asp?2017/4/1/6/196033
| Introduction|| |
Hospitals are specialized service delivering organizations. As healthcare sector is highly resource and cost-intensive, staff replacement becomes expensive due to poor availability of specialized workforce and high cost of recruitment and training. , One of the ways to control the staff replacement cost is to control attrition and retain existing employees. In organizations with high attrition, it is imperative for management to identify the reasons of attrition. The two possible sources of information for reasons of attrition are existing employees and leaving employees.
Leaving employees are mostly subjected to exit interview to identify the reasons for quitting the job. Hence, exit interview is a very crucial tool for the organizations to reduce attrition. However, in reality, it is mostly considered as a "one more form to be filled" and the extent to which it is actually utilized in reality is uncertain. ,,,, Usually, exit interview comprises a set of closed-ended structured questions, in which hardly any one-to-one conversation or in-depth interviewing is involved. ,, Besides, a leaving employee perceives little or no gain from exit interview and hence may be resistant to share details for quitting the job. 
The existing employees, though cannot be matched to leaving employees, surely have a feel of the reasons due to which their colleagues are leaving the organization. Further, interviewing existing employees for causes of attrition may be more profitable as they are still a part of the organization and can be retained. Hence, the attrition reasons cited by them can be followed up for not losing more employees.  Therefore, another set of information regarding causes of attrition should be gathered from existing employees.
The present study was conducted with following objectives: (a) to gather information on possible reasons of attrition in organization from the perspectives of existing employees (feedforward) and leaving employees (feedback); (b) to compare and identify the gaps, if any between the possible reasons of attrition stated by the two groups of employees; (c) to understand the utility of exit interview in ascertaining accurate reasons for attrition.
| Methods|| |
Study design and setting
This exploratory study was conducted using qualitative and quantitative tools on employees of a 150-bedded superspecialty hospital in Ahmedabad, India, during May-July 2015.
Study subjects included two groups of employees. One group was the existing employees, whereas the second group was the leaving employees who had resigned and were in exit phase. Existing employees were interviewed with the understanding that they, being a part of the organization, have a fair understanding of the reasons of attrition in the organization. Hence, they were included to understand their opinions/reasons for attrition in the organization. All data collection was done after obtaining approval from hospital authorities and written consent from employees.
Completed exit interview forms filled out by the leaving employees were collected from the human resource (HR) department of the organization and analyzed. A 17-item questionnaire, consisting of baselines variables, quantitative and qualitative questions, was developed for existing employees. Employees working at executive/middle management levels across various departments were approached to participate in the study due to high attrition in this cadre. The questions were related to various aspects of work environment in organization. Baseline data pertaining to age, gender, marital status, qualification were also collected. In addition to the quantitative data collection, qualitative interview was also conducted to extract subjective information. The qualitative questions were specifically directed to ascertain the possible reasons for attrition across four broad domains: (i) overall reasons for attrition, (ii) poorly utilized employee's skills leading to attrition, (iii) availability of skill/knowledge development opportunities to reduce attrition, and (iv) initiatives required by the organization to improve retention.
Questionnaires with ≥5% missing data were excluded from analysis. The baseline information as well as quantitative responses to questionnaires was summarized. Qualitative responses from existing employees were transcribed and reported. The reasons for attrition obtained from existing employees and leaving employees were compared and reported. The comparisons of the reasons for attrition obtained through the feedforward and feedback modes are utilized to identify the gaps between the responses obtained from the two groups of employees.
| Results|| |
Exit interview analysis of leaving employees
Exit interview data were obtained for the forty leaving employees. Their baseline details are given in [Table 1].
Majority of the leaving employees were females (57%). Ninety-five percent of those who resigned were in the 1 st year of service and maximum attrition was observed in nurses. Out of total employee strength of 150 employees, 40 had left the job in the last 1 year. Hence, attrition rate of 26% was observed that entails a huge cost of staff replacement including the cost of recruitment, training, and induction. This is so because staff replacement is necessary to ensure smooth functioning of work.
As these were leaving employees, detailed responses could not be sought as exit interview forms were the only source for identifying reasons for attrition. Out of forty leaving employees, 70% had cited "blanket responses" such as better opportunity and personal reasons as the reason for quitting the job. 12.5% were "asked to resign," another 12.5% left the job due to marriage-related relocation, and remaining 5% employees left due to health issues.
All the exit interviews were conducted by the HR executive, usually a middle-level manager without any specific training on interviewing skills. Out of the forty leaving employees, 29 (72.5%) said that they believe that the inputs given by them during exit interview are just for record purpose. Remaining 11 employees were unsure of the utility of exit interview.
The information available through exit interviews was very limited in the sense that besides the structured format, no additional questions were asked to the leaving employees. Hence, existing employees were also interviewed for their opinions/reasons for attrition in the organization with the understanding that existing employees, being a part of the organization, have a fair understanding of the reasons for attrition in the organization.
Interviews of existing employees
One hundred and thirty existing employees were requested to participate in the study out of which 100 agreed to participate and provided consent. Their baseline details and responses are given in [Table 2].
Around 70% of the employees were aged <30 years. Forty-one percent had excellent relationship with their reporting manager and 75% received rewards for their achievement. Ninety-one percent felt that appreciation is important for them. These quantitative data provide one side of the story. However, to extract deeper information on possible reasons of attrition, interviews of employees were conducted. The responses of employees during these interviews are reported below:
What are the major reasons for employee attrition in the organization?
Forty percent employees said that maximum employees resign if they are offered higher salary elsewhere. Another 13% said that favoritism/partiality and poor recognition for good work are also reasons for high attrition as that limits the career growth prospects. Eleven percent said that excessive workload is also one of the reasons for attrition as employees reach a stage of exhaustion and look elsewhere for job opportunities.
Hence, majority of the existing employees stated that the most important factors in determining the intention of employee to continue the job are related to a competitive pay package, fair work environment without partiality, recognition for good work, and competency mapping to best utilize employee skills. Rest of the employees said that they have not yet thought about leaving the organization and are unsure of the reasons for attrition. All these factors were pointed by existing employees to hold equal weightage for improving retention. Career growth opportunities marred by favoritism and unjust attitude of senior managers have a long-term ripple effect across the organization without remaining limited to the one who is directly affected. Further, excessive workload, uneven delegation, and distribution of work also contribute to employees losing intention to continue in the organization. Some of the important responses are quoted verbatim below:
A 24-year-old male finance executive said, "I don't get proper recognition in the organization even after contributing so much beyond my job responsibilities…. and because of this someday, I may leave the organization."
A 35-year-old female nurse said, "Strengths and weakness of employees are not known to reporting manager. Hence, no encouragement is received from the manager… so we don't approach manager for any problem and keep it to ourselves".
A 29-year-old female nurse said, "Only one-sided decision is taken by management, for instance, if any problem occurs… management will not listen to both the persons, so if this kind of partiality remains, then I will leave the organization."
A 30-year-old Medical Record Executive said, "I might leave the organization because of lack of career growth opportunities here."
How much do you feel that poorly utilized employee's skills and knowledge lead to attrition in the organization?
Forty-three percent employees said that the senior managers do not identify the capabilities, skills, and expertise of employees to assign the tasks. This way the strength of employees is not best used for strengthening the organization. Another 30% said that assigning challenging tasks can bring out the best in employees and identify hidden strengths and talents which are not the regular practice now and the work get monotonous. Ten percent employees said that verbal or nonverbal motivation provided at work through the way of gestures, recognition, promotions, and incentives drastically impacts retention as this paves the way for career growth. Another 12% emphasized that conducting training programs and providing opportunities for enhancing technical knowledge also goes a long way in improving retention.
A 29-year-old male customer care assistant said, "Employee-oriented policies, supportive working environment, and rewards and recognition on achievement ensure maximum utilization of employees…. But, this is not the reality."
A 28-year-old female nurse said, "If management takes care of assigning right tasks to right employees by finding out employee's talent and skills, then skills can be utilized in a proper way. If I feel that my knowledge and skills are not well utilized…. I will think about leaving the job."
Hence, most of the employees opined that the tasks are just assigned to employees without identification of their strengths and specific skills. Majority of the employees feel that their talents, knowledge, and skills are not used to the fullest. This may force the employees to look for a change of job where they can better utilize their skills and knowledge for work satisfaction and career progression. The heads of departments and senior managers must use skill mapping to assign tasks and get the best out of all the employees. Further encouragement and rewards reinforce the merit of performing better than others. An environment of healthy competition is necessary to motivate everyone in performing better every day.
What type of training programs are required by employees for career growth in the organization? Do training programs work as a strategy for retaining employees?
Eighty-five percent employees said that knowledge and skill upgradation programs provided by the organization have a great impact in reducing attrition largely because many employees change job due to saturation. Out of these 85% employees, different employees brought out varied types of training and development programs that would encourage them to continue working in the organization. The details are elaborated further.
Twenty-nine percent expressed need for behavioral and soft skills training for enhancing their communication skills, leadership capabilities, and personality development. Another 27% stated the need for specific knowledge and skill enhancement training related to Cath Laboratory, computed tomography/magnetic resonance imaging, laparoscopic instruments, and computer software such as MS Office (MS Word, MS Excel). Further, 19% employees said that they need skill upgradation programs pertaining to emergency medicine such as advanced cardiovascular life support, basic life support, pediatric advanced life support, and neonatal advanced life support. Remaining 10% said that they need training in financial tools such as billing, budget preparation, financial audits, and international financial reporting standards.
Remaining employees replied that they are unable to identify any specific training need presently. However, employees did respond positively to the fact that training and development programs pave the way for career growth. Training programs when provided at workplace reduce the need for employees to quit job for self-development. Such programs encourage employees to not only stay back in organization but also grow professionally as they are hopeful for career growth and progression.
What initiatives, if taken by the organization, can improve employee retention?
All the employees were of the opinion that timely initiatives from the organization could definitely control attrition. The largest group of employees (31%) said that deserving employees not getting promotions are one of the biggest reasons for attrition in the organization. This needs maximum attention if retention is to be improved. Twenty-nine percent stated that a good, supportive, and amicable work environment is needed most to improve retention. Twenty-two percent opined that adequate career growth opportunities through the way of employee engagement programs, training for knowledge, and skill enhancement and a strong work profile also go a long way in retaining employees. Loyalty to organization was identified as a strong factor for retention by 7% employees. Another 7% said that providing performance based increments from time to time further reduces attrition as employees feel happy to work for the organization. Remaining 4% highlighted the importance of sound and supportive HR policies for retaining employees.
Comparison of reasons for attrition cited by existing and leaving employees
The reasons for attrition and ways to improve retention cited by existing employees (Q.i. and Q.iv.) are summarized in [Figure 1].
|Figure 1: Possible reasons for attrition given by existing employees (feed forward) during qualitative interviews (n = 100)|
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[Figure 2] highlights the reasons for attrition stated by leaving employees during exit interview. The comparison of reasons cited by leaving [Figure 2] and existing employees [Figure 1] brings out some striking findings. There is a huge incongruity between the reasons quoted by leaving employees and those mentioned by existing employees for attrition in the organization.
|Figure 2: Reason of attrition given by leaving employees (feed back) during exit interviews (n = 40)|
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The comparison of the attrition reasons identified through feedforward and feedback modes clearly shows the incongruity between the opinions of the existing and leaving employees. On the one hand, majority of the existing employees quote salary issues, partiality/poor recognition for good work, improper assignment of tasks, and monotonous work as probable reasons for attrition. Whereas, majority of the leaving employees had cited "blanket reasons" such as better opportunity and personal reasons as the reasons for leaving the job. However, the actual reasons for leaving the organization may be much different than what is cited. The structured exit interview formats when handed over to leaving employees for being filled out cannot identify the "real" reasons for leaving the job. This hampers the extent to which the exit interview data could have been utilized as a tool for retention.
| Discussion|| |
The present study was conducted to identifying the predominant factors for employee attrition in a superspecialty hospital. Reasons cited by existing employees (feedforward) were compared to those stated by leaving employees (feedback) during exit interviews. In our study, attrition rate of 26% was observed and 95% of these employees did not complete even 1 year of service in the organization. This poses huge cost of staff replacement which is to be born again by the organization. Around 60% of this turnover is observed in nurses, which is comparable to previous studies reporting high nursing turnover.  Nursing turnover is a major issue impacting the performance and profitability of health-care organizations.
72.5% employees believed that exit interview is largely for record purpose, and rest of the leaving employees were also unaware of the ways, in which exit interview data are utilized. Previous studies , have also debated the perception of employees regarding the purpose and utility of exit interviews. Unless organizations can establish the significance of exit interview data by establishing its application in improving employee retention, the importance of exit interview process cannot be improved in the eyes of the employees.
During exit interviews, 70% leaving employees quoted blanket responses such as better opportunity and personal reasons as the reason for quitting the job. The employees were perhaps not probed to ascertain the "real" reasons for quitting the job. This can be largely attributed to the fact that the interviewer was not trained for interviewing. Besides, exit interview form was a closed-ended questionnaire to be filled up by the leaving employee without any face-to-face interaction.
Majority of the existing employees felt that appreciation is important at work but around 25% never receive rewards/recognitions for good work. Although we did not study its association with attrition, in previous studies no association has been observed.  Most of the employees said that they get opportunities to share ideas at work and some agreed that they have opportunities for growth. Most of the employees rated relations with their immediate manager between excellent to good levels.
However, qualitative interviews of existing employees brought out very different perspectives of attrition in the organization. Majority of the existing employees stated that a competitive pay package, fair work environment without partiality, recognition for good work, and competency mapping to best utilize employee skills largely contribute to employee retention. Most of the employees were of the opinion that salary issues and favoritism/partiality by senior manager are the two most crucial reasons for employee attrition. ,
Nevertheless, money and dissatisfaction from job are not the only reasons for employees parting from the organization.  Further results of our study support this observation. We observed that almost all employees say that they can share ideas at work and attend training programs and organization provides them opportunity for growth. However, many employees felt dejected due to low recognition for good work done beyond job responsibilities. Similarly, previous studies also indicate that lack of recognition contributes to loss of interest in work. ,
Unutilized or poorly utilized skills and capabilities due to improper job assignment or poor involvement of employees in decision-making are other factors that may hamper the employee's intention to continue working in the organization. This finding is corroborated by past studies that emphasize the importance of job assignment based on skill identification and mapping. , Employees were also of the opinion that motivation in any form and assigning challenging tasks makes the job interesting which can also hold the employees to continue working in the organization.  Lack of autonomy or poor involvement in decision making leads to employees feeling "boxed in," thereby reducing work performance. , This further hampers the willingness of employees to continue in the same organization.
High workload being a contributing factor for employee attrition is corroborated in previous studies.  Moreover, lack of career growth opportunities, improper job assignment, and partiality are also major deterrents to employee retention.  This affects the whole work culture of the organization in addition to the one directly affected. Repeated instances indicative of poor growth opportunities, partiality, and low motivational levels have a long-term ripple effect across the organization. With reduced loyalty toward the organization, the employees are always looking out for new jobs reducing the chances of retention. Hence, opportunities for career growth in the organization is an important determinant of retention. , A large number of employees strongly opined that regular training and skill/knowledge enhancement programs conducted by the organization also contributes to retention as it prevents employees to look for such opportunities outside the organization. Moreover, training programs provided at workplace reduce the need for employees to quit job for self-development. It was very interesting to observe the huge diversity of areas, in which employees wanted to be trained. These proposed areas were related to behavioral and soft skills, skill enhancement and equipment handling, emergency medicine, and financial tools.
A large number of existing employees, when asked about the ways in which organization can improve retention, stated that promotions, supportive and amicable work environment, and career growth opportunities are the most critical initiatives that should be taken by the organization. Employees felt that if employees are dissatisfied with any of these issues, they are most likely to switch the job. Some employees also said that performance-based incentives and supportive HR policies also contribute in retaining employees.
One of the most striking findings of our study is the incongruity between the reasons cited for attrition identified through the feedforward and feedback modes. On the one hand, majority of the existing employees quote salary issues, improper assignment of tasks, monotonous work, partiality, favoritism, and poor recognition for good work as the most common reasons for attrition. Whereas, majority of the leaving employees had cited "blanket reasons" such as better opportunity and personal reasons as the reasons for leaving the job. However, the reasons may be manifold and can be deduced only through a strictly confidential and detailed personal interview, by a trained interviewer,  rather than through a yes/no format or a simplistic rating questionnaire. A face-to-face interview can probe employees to better understand the reasons for quitting the job rather than mentioning blanket responses. The responses hence obtained may provide better insights to devise effective strategies for employee retention.
Authors feel that there are multiple reasons for exit interview data to be ambiguous and debatable. First, these interviews are highly structured with the responses being recorded in too discrete a manner. This leads to minimal unfolding of the hidden issues due to which the employee is leaving. Second, in-depth interviewing is hardly utilized to gather maximum possible information regarding reasons for quitting the job, destination (where and what is the new job like), chances of coming back to the organization, and the possible measures by organization that would have prevented them to take this decision. Previous studies also corroborate this finding that utility of in-depth interviewing has been undermined in exit interviews. ,, Qualitative data collected using open-ended questions extract rich descriptions and explanations of thought processes of employees. Qualitative data also enable deriving the precise reasoning for events such a decision to quit the job and derive fruitful explanations. 
Third, the person conducting exit interviews must be well trained and experienced to bring out the most relevant details that can guide in formulation of strategies to retain remaining employees.  Finally, anonymity and confidentiality must be promised and ensured as the person conducting the exit interview is an internal person. The leaving employee fears spilling the beans and avoids spoiling the relations for multiple reasons.
Although exit interviews can be utilized as a crucial tool by the organization to improve employee retention, in reality exit interviews are mostly viewed as a formality by the leaving employees. The extent to which exit interview data are actually utilized is uncertain. ,,, It is frequently argued by several studies that in contrast to the theoretical utility of exit interviews for improving retention, reducing organizational problems, enhancing quality of work environment, and improving reputation of the organization, the reliability and validity of responses received during exit interviews are highly questionable. ,, Hence, in addition to the structured exit interview format, leaving employees must be interviewed regarding reasons for quitting the job and the possible measures by organization that would have prevented them to take this decision.
| Conclusion|| |
Due to high cost of staff replacement in health sector, controlling attrition is a priority for organization. We found that during exit interviews leaving employees quote blanket responses such as better opportunity and personal reasons as the reason for quitting the job. However, existing employees when interviewed in-depth asked about reasons for attrition quote several issues such as low salary, partiality/poor recognition for good work, improper assignment of tasks, and monotonous work. However, none of these issues emerged during exit interviews. Hence, exit interviews somewhere fail to probe into the real reasons of attrition and existing employees are never asked about such issues. To improve retention, it is imperative that the hospitals keep track of their existing employee's intention to continue working in the organization. Further, any sign indicating a poor intention to continue the job must be addressed immediately to avoid ripple effect among other employees. Moreover, leaving employees must be interviewed in-depth and face-to-face to uncover the actual reasons for quitting the job. This will probably help the organization to use exit interview as a tool to improve employee retention and enhance reputation of the organization.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]