A national-level intervention reduces nurse turnover by 4.5%, prevents 11,400 deaths

The Retention Direct Support Programme (RDSP), a national-level intervention aimed at increasing nurse retention in NHS hospital providers, has demonstrated remarkable success by reducing the nurse turnover rate by 4.5%, which ultimately contributed to the prevention of 11,400 deaths, according to a study led by the University of Surrey.

The study examined the impact of the RDSP, which provided NHS hospitals with data and guidelines to enhance the non-monetary aspects of nursing jobs – such as giving nurses more flexibility at work, bringing clarity to a hospital's mission and providing more training and professional development.

The findings indicated a substantial decrease in the nurse turnover rate by 4.49%, resulting in a 5.38% decrease in nurse exits from the public hospital sector. Remarkably, the program also contributed to a 3.45% reduction in mortality rates, which is equivalent to preventing 11,400 deaths.

Dr Giuseppe Moscelli, lead investigator of the study and Associate Professor of Economics at the University of Surrey, said:

"Excessive turnover in organizations can have a detrimental impact on performance, and the public hospital sector is no exception. However, Surrey's recent study, using high-quality administrative data, has revealed a promising solution.

"Our findings also suggests that the impact of the RDSP on managerial behavior played a crucial role in its success – with middle managers possibly being the main actors in curbing employee turnover.

"Moreover, the RDSP had a positive impact on hospital quality, particularly in disease-specific areas where the UK NHS historically performed poorly, such as respiratory conditions and maternity services."

The RDSP launched in July 2017, by NHS Improvement (NHSI), which is a governing body responsible for overseeing the NHS Trusts. The program was rolled out in five cohorts at different times, and Trusts were allocated to cohorts based on their past turnover rates and trends. The program required Trusts to come up with their own retention strategies in an action plan, which was agreed upon with NHSI. NSHI then monitored each Trusts' progress in the 12 months following the start and provided targeted support where needed.

The research also shed light on the trade-off between centralization and decentralization in the management of public organizations. Preserving a certain level of centralization, in terms of disseminating information and providing guidance on best practices, appeared to help decentralized units overcome information irregularities and improve outcomes.

The success of the RDSP was attributed to its ability to bridge information gaps and disseminate best practices at an organization level. This gives us hope that the challenges of nurse retention and hospital quality in the public sector can be met. We hope that future policymakers and hospital administrators can use these research findings to inform and design more effective strategies to improve workforce retention and patient outcomes."

Professor Jo Blanden, co-author of the study and researcher, University of Surrey

This study has been published as an IZA working paper.