The issue of turnover in the provision of behavioral services.

Did you know that turnover rates for front-line staff in ABA services may average 48% annually (BHCOE, 2018)? That is an extraordinary number – it means that half of an organization's team leaves every year. It means that half of an organization's investment in their clinicians' development walks out the door, resulting in little to no return on investment. And it means that organizations must focus time, energy, money, and other resources on recruiting and hiring simply to maintain baseline staffing needs, deferring these resources from enhancing other areas of the organization such as quality of care or growth. The bottom line is high turnover rates directly impact an organization's ability to provide sustained high-quality care.

Data suggest the problem of turnover is pervasive in our industry.  You are likely to have endured its effects in your organization. Researchers have noticed too, and begun to investigate factors contributing to high turnover rates. Novack and Dixon (2019) reviewed factors that predict staff burnout, job satisfaction, and turnover. Among the organizational factors correlated with intent to turnover, the most influential appear to be job satisfaction and supervisor support. These correlate with lower levels of employee burnout and decreased intention to leave their current position. The data correspond with similar findings from Plativeau, Dounavi, and Virues-Ortega (2018), who investigated factors contributing to burnout for early-career behavior analysts. And while research specific to ABA service providers is lean, the findings align with our observations and experience. So, the question becomes, how does an organization arrange for improved job satisfaction and supervisory support?

 

Where to begin?
In running our organizations and consulting with others, we have found that the highest performing organizations with the lowest staff turnover rates tend to foster a performance-based culture with high employee engagement. Engagement refers to "the extent to which employees commit to something or someone in their organization, how hard they work, and how long they stay as a result of that commitment" (Corporate Leadership Council, 2004). In our experience, an engaged employee is also a supported and satisfied employee.

To establish a performance-based culture, organization leaders must first understand where responsibility for performance lies. In the Performance Thinking® Coach Program, we encourage leaders to think systemically about human performance because it is not the responsibility of just one person or level. The employee, manager, and organization are all responsible for performance. It is a collaborative process. In this two-part series, we share features of organizations that have established a performance-based culture, promote employee engagement, and reap the benefits of high rates of employee retention. As a leader, you are in a unique position to plan and arrange performance improvement initiatives to reduce burnout and subsequent turnover. By borrowing from or replicating these organizations' features, you can drive continuous performance improvement and optimize employee engagement. Today, in part one, we turn our attention to four key factors that affect the organizational-level of performance.

 

1. They Have a Roadmap.
High-performing organizations have a clear purpose, which often begins with a well-defined mission, vision, and values statements. An effective mission statement should, at a minimum, express three crucial facts about the organization: (1) its purpose or societal needs or opportunities the company addresses; (2) the methods and practices the company employs to address those needs or opportunities; and (3) the company's philosophy, values (briefly), and beliefs. A mission statement should direct employees' decisions and changes, steer employee performance goals, and guide employees' daily activities. Influential leaders and supervisors use these to help unite people around a common purpose. A vision statement describes what the organization looks like as it successfully implements its strategies, achieves its desired outcomes, and delivers value to its customers. Values are a set of preferences and judgments of what is important to groups and individuals in the organization (Bryson, 2018). When these three organizational components are in place, characteristic of the company, and well-articulated, they can have a powerful effect on employee performance and engagement. They serve as a roadmap for leaders to follow when establishing goals and objectives, developing and executing strategies, and evaluating overall company performance.

 

2. Their Leaders Are People-Focused.
Leaders in successful organizations focus on developing an organizational culture of internal communication, flexibility, innovation, opportunity, and a reputation of integrity. They are open to new ideas, deeply care about their employees, and prioritize performance development (Corporate Leadership Council, 2004). Leaders are proficient in setting clear goals & clarifying performance expectations, connecting employees' work to organizational strategy by linking their daily activities to accomplishments (what we call work outputs) and desired business results. They utilize the science of human performance to help arrange conditions to support optimal performance in their people. We have also observed effectual, caring, and empowering leaders do the following:

  • Articulate a clear vision and link it to organizational strategy

  • Build organizational values into the criteria for work outputs for each role and set clear expectations for desired practices and behaviors

  • Lead by example; model and reward values-based performance

  • Align expectations up and down the organization

  • Establish meaningful metrics for individual, team, and department performance and use ongoing measurement as feedback

  • Recognize exemplary behavior often and reward work outputs that meet or exceed performance expectations

  • Coach and support others to be influential mentors and supervisors

  • Provide ample, transparent career advancement opportunities

3. They Invest in Their People.
Employees are more likely to be happy and engaged members of their teams and departments (and produce valuable work outputs effectively and efficiently) when (a) managers have skills and strategies for improving their direct reports' performance, (b) access to updated performance management tools, and (c) a shared understanding of all the factors that influence human performance (Binder, 2009). That is why high-performing behavioral health organizations invest in talent development and continuous performance improvement. They equip their leaders and supervisors with evidence-based management strategies and simple, practical tools to develop people for expansion, promotion, team effectiveness, or other strategic goals. Leaders and supervisors focus on improving employees' performance and engagement by coaching for proactive development and maintaining a regular coaching cadence with their direct reports. Further, organizations with high employee engagement are adept at planning and arranging all the factors in The Six Boxes® Model across functions within the company and ensuring performance improvement strategies are standardized and systematically executed across leaders and supervisors.

 

4. They Invest in Their Infrastructure.
People like to have a nice place to work with tools and resources that support performance, rather than introduce extra challenges into an already difficult job. There are many components of a robust performance infrastructure. We chose to highlight ones related to processes, systems, and tools because they are often crucial leverage points for significant improvement. When organizations lack these components, it can substantially impact desired business results, including employee satisfaction and engagement. In our experience building performance infrastructures, both in our companies and our clients, we have worked diligently to design the following elements to support optimal performance:

  • Well-defined, documented, and supported internal business processes

  • Clear, up-to-date, and written policies and procedures

  • Easy-to-use and collaborative information and communication technology that supports effective and efficient internal communication and information sharing

  • Relevant and easy to access reference tools, templates, and job aids

  • Financial incentives delivered contingent on performance, and non-monetary rewards arranged based on employees' preferences

  • Current, user-friendly, and dependable hardware and software that support the production of valuable work outputs

Next steps for your organization.
Suppose your organizational metrics reveal low employee engagement and high staff turnover. In that case, you may want to start by first evaluating whether or not the above features of high-performing organizations are in place and the degree to which teams and departments are executing them effectively. Second, ask whether your organization is committed to creating a performance-based culture, a culture where the values, practices, and behavior by which employees get things done drive continuous performance improvement and optimize employee engagement. Third, come back next month; we will discuss models and proven strategies that leaders and supervisors can utilize to develop and support employee performance leading to high employee engagement levels.

About the authors:

Shane-Headshot

Shane Isley, M.S., BCBA, LBA

Shane Isley is an entrepreneur, performance thinking® practitioner, and management consultant who earned his bachelor’s and master’s degrees in behavior analysis from the University of North Texas. He serves as a Senior Consultant for the Performance Thinking Network and leads the company’s emerging Performance Thinking® For Behavioral Health/ABA Organizations service line. In his role, Shane works with a team of organizational performance consultants to deliver performance improvement programs and services to companies of all sizes to help them establish or improve their performance infrastructure, processes, policies and procedures, job definitions, and management capabilities. Shane collaborates with business owners and executives to develop and implement solutions that increase profitability and improve operational efficiency, employee engagement, and service quality.

Shane has over fifteen years of specialized experience and expertise in the behavioral health care market as a business owner, executive director, and performance improvement consultant. Shane remains committed to helping behavioral health organizations lay the foundation for sustainable, ethical, and profitable growth, focusing on organizational alignment, leadership & management development, and process improvement.

Jen

Jennifer Castellanos-Bonow, PhD, BCBA-D, LBA

Jennifer Castellanos-Bonow earned her PhD in Behavior Analysis from the University of Nevada, Reno  (UNR), an experience that laid the foundation for her work with children with autism and other behavioral disorders. Jen has extensive experience leading clinical initiatives, designing training programs, maintaining best practices in delivering behavioral and psychological services, and developing and managing processes to support ethical and compliant service delivery. After serving for several years as the clinical director for Blueprints, based in Bellevue, WA, in 2019, Jen transitioned back to her hometown of Reno, Nevada. In partnership with a group of behavior analysts,  she has helped establish The Learning Consultants, which aims to provide behavioral support and services to children with autism and parents and families facing acute behavioral challenges.

Jen serves as the managing partner and CEO applying her experience administering performance  management systems, designing processes and implementation planning, navigating healthcare  funding of behavioral services, and developing and maintaining policies and procedures to ensure  regulatory compliance. She is also actively involved in the behavior analytic community, most recently by serving as the President of the Nevada Association for Behavior Analysis. While her roots are in early intervention, Jennifer’s foundation from UNR and recent work has provided her with wide-ranging experiences applying the science of behavior.

References.
Behavioral Health Center of Excellence. (2018). Annual Report.

 

Corporate Leadership Council (2004). Driving performance and retention through employee engagement: A quantitative analysis of effective engagement strategies. Washington, DC: Corporate Leadership Council. Retrieved from: http://scholar.google.com/scholar_lookup?hl=en&publication_year=2004&author=+Corporate+Leadership+Council.&title=Driving+performance+and+retention+through+employee+engagement

 

Binder, C. (2009). A View from the Top. Human Performance in Organizations. A white paper available at http://www.sixboxes.com/_customelements/uploadedResources/155921_SixBoxesViewfromTop.pdf

 

Bryson, J.M. (2018). Strategic Planning for public and nonprofit organizations: a guide to strengthening and sustaining organizational achievement. Hoboken, NJ: Wiley.

 

Novack, M. N. & Dixon, D. R. (2019). Predictors of burnout, job satisfaction, and turnover in behavior technicians working with individuals with autism spectrum disorder. Review Journal of Autism, 6, 413-421, https://doi.org/10.1007/s40489-019-00171-0

 

Plantiveau, C., Dounavi, K., & J. Virués-Ortega (2018) High levels of burnout among early-career board-certified behavior analysts with low collegial support in the work environment, European Journal of Behavior Analysis, 19:2, 195-207, https://doi.org/10.1080/15021149.2018.1438339

About CentralReach.

CentralReach is a leading provider of EMR, practice management and clinical solutions that enable applied behavior analysis (ABA) and related behavioral health practices to deliver quality autism care for superior outcomes. The company is revolutionizing the ABA space with cutting-edge solutions including precision teaching, clinical data collection, scheduling, billing, learning management, fully-digital evidence-based programming and more.

 

Trusted by more than 100,000 clinicians and educators, CentralReach is committed to ongoing product improvement, market-leading industry expertise, world-class client satisfaction, and support of the ABA community to propel industry practitioners into a new era of excellence. For more information, please visit CentralReach.com or follow us on LinkedIn, Facebook, and Twitter.

 

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