How to Keep a Pulse on Your Team and Retention with Stay Interviews

The palliative care program at Penn Medicine—an academic medical center—serves seven hospitals, as well as outpatient and home care patients. As the program’s administrator, I am actively involved, alongside clinical leadership, in the recruitment and hiring of the palliative care team. In my four years here, I’ve experienced the excitement of finding and hiring fantastic talent, but also the disappointment of losing staff for other opportunities or from burnout. In a field that requires repeatedly making the case for palliative care’s value to increase staffing, failing to retain team members feels like a challenging setback towards building fully staffed, high-performing palliative care teams.

So, how can palliative care leaders focus on supporting their staff, especially with the high level of burnout in health care and the shortage of clinicians in our field? Besides integrating team health and resilience tools, leaders can focus on listening to their team members and investing in them as individuals—from asking about career goals, encouraging the pursuit of interests and professional development, and maintaining a work-life balance. Similar to a program “needs assessment,” one tool in our leader’s toolkit is the concept of “stay interviews.”

Stay interviews are opportunities for managers and employees to talk about what motivates an employee to stay in their role. Much like how performance reviews give us a big-picture opportunity to discuss professional development, stay interviews provide a structured way to ask about big-picture job fit from the employee’s perspective. Ultimately, the goal is to gain insight into how to keep that individual professionally fulfilled and engaged.

There are many different models for conducting a stay interview, but at their core, they all ask the same basic questions: What do you love about working here? What can I, as your manager, do to help you be happier at work? What things make you not want to work here? Rather than pretending that people don’t consider leaving their jobs, we should actively work to help them find reasons to choose to stay. Because those factors vary by person, each person needs a dedicated conversation.

As with any new tool, sitting down to do a stay interview for the first time can feel a little awkward! It can help to think of it as another way of getting feedback and building trust. Stay interviews allow employees to talk about what may be happening, what’s important to them, what they enjoy about their work, and what obstacles may exist. It provides them with a forum for open conversation in a setting that is less formal than an annual performance review. To diffuse any potential anxiety, ensure that your employees understand the nature and goals of the stay interview before you sit down with them.

Traditionally, there has been a great deal of focus on the exit interview, which occurs when an employee is already leaving the team. An exit interview can be helpful if an employee is willing to be honest and direct, and can help identify underlying issues the team should address in the future. However, waiting until the exit interview can mean hearing about issues when it is too late to fix them. Stay interviews move the conversation upstream when leaders can proactively address concerns.

Before you hold stay interviews with your team, my first recommendation is to request one with your own manager. As an individual, I find the exercise of going through stay interviews with my managers validating and positive. I’m often surprised by how much I appreciate the opportunity to talk big picture about how I feel about my work and what motivates me. As a manager, it makes me more confident to suggest it as a tool for our team since I’ve done it myself.

Much like palliative care, almost everyone can benefit from a stay interview. In general, it’s an appropriate tool for all employees (the exception would be those who are involved in active coaching or on a performance improvement plan). That said, if you are trying to prioritize conversations, think strategically and triage: Whose departures would have the biggest negative impact on your team? Those individuals should be your first stop.

What a stay interview essentially communicates to staff is, “I appreciate you. What you do here is really important. I want to know how I can help you do it better, and be engaged and gratified in your work.” It does not have to be formal. It is about creating an intentional relationship with the people that you work with so that you can demonstrate a sincere interest in them as individuals, and understand opportunities and challenges from their perspective.

Organizations should always work on a broad scale to improve their attractiveness as an employer—ensuring that benefits, pay, and overall culture makes them a strong market player and drive employee retention. Like many managers, I don’t have significant leverage in those areas. But what I can do is sit down and ask, “What’s important to you at work?” As a manager, I’m often surprised by the things that come up during these conversations that I do have the power to change or influence: bringing someone in on a project they’re interested in, rearranging office space for greater collaboration, or just changing work-from-home schedules.

In addition to helping with growth planning, these conversations help us to think ahead and prepare for potential turnover. Sometimes, retaining a strong employee isn’t possible—often because they’ve grown so much professionally that they need a next step that’s beyond your team, your program, or even your organization.

From my perspective, my first choice is always to keep people happy and fulfilled in their current roles or team. If I can’t, the next best thing is to retain them within our organization. People have tremendous institutional knowledge, and I don’t want to us lose that, even if it means helping them find their next step on a different team.

If retention within our organization isn’t possible and the individual takes a new role, I hope that the person remembers our program as a quality place to work, where they felt fulfilled and where their manager took the time to understand what was important to them. The palliative care world is small, and you just never know: That person might want to return, or they might someday have an excellent candidate to refer your way.

Since stay interviews are designed to gather information and build stronger relationships with your employees, it’s important to set aside dedicated time for these conversations. The exact amount of time needed can vary by person, but 45 minutes is a good estimate for most people. Depending on the size of your team, this can involve a significant outlay of time on your part, so you may want to conduct them over a wider period (e.g., spread them out over a few months if you do not have protected time, etc.).

Human resource experts advise that formal stay interviews focus on five key questions (and be conducted by the employee’s closest manager):

• When you travel to work each day, what do you look forward to?
• What are you learning here?
• Why do you stay here?
• When was the last time you thought about leaving, and what prompted it?
• What can I do to make the work experience better for you?

That said, stay interviews do not need to be that formal. You might choose to start by integrating some of these questions or approaches into one-on-one check-ins with your team members. Some things to try include: “Tell me more. What are you seeing? What are you thinking?” Alternatively, you can ask for focused feedback: “What are some things we can do around X? Do you have any ideas to address Y? What are some ways we could start to improve Z?”

While you may get concrete, actionable answers, focus on asking open-ended questions and practicing active listening. (As a non-clinician, I see so many parallels between core palliative care skills and core managerial skills!). Ensure that you leave opportunities for a response, as you would in your day-to-day practice with patients and families. Some employees will feel comfortable giving you answers in the moment. Others may want to take more time to respond and pick up the conversation at another time.

The beauty of these conversations is that they can lead to active collaboration between a manager and an employee. You may find yourself giving advice, sharing insights, brainstorming, prioritizing, and more. Ideally, you walk away with useful information in both the long and short term, but the ultimate goal is a trusted dialogue that leads toward greater employee engagement.

Coming full circle, there are some wonderful parallels between these conversations and palliative care. Stay interviews, whether formal or informal, are about learning employees’ professional goals and then committing to finding ways to work towards those goals together. This may mean supporting them in their current role or working towards a future one.

Edited by Melissa Baron. Clinical review by Andrew Esch, MD, MBA.