The Turnover Dilemma: A Disease with Solutions.

An insidious persistent problem has plagued rehabilitation for several decades. This dilemma is both an enigma and a well known documented phenomenon. One aspect directly affects professional psychological well-being and occupational health, and yet another component threatens to undermine programs by severely degrading organizational effectiveness. This dilemma which continues unabated, and appears to be increasing, strikes at rehabilitation personnel turnover. This disease, as with all true epidemics, transcends artificial boundaries as research from New Zealand (Flett, Biggs, & Alpass, 1995b), Australia (Chinnery et al., 1995), and Israel (Rimmerman, 1989) has indicated.

Overwork, downsizing, cost containment, little reward or recognition, and a long list of other factors have been shown to lead to stress and burnout, and subsequently to people leaving jobs which cause them harm (Riggar, 1985). So pervasive are some of these variables in modern life that Hall and Ward (1996) reported that four of five internists/family practitioners indicate that for people as young as 35 years of age that work and personal stress contributed significantly (86%) to diminished memory and lack of concentration. However, factors such as job dissatisfaction, excessive paperwork, unfeeling bureaucracies, and other known particulars do not in and of themselves, with certainty, result in personnel turnover.

Although the number of articles concerning stress, burnout, job satisfaction, mental health, and working life/values in rehabilitation exceeds 126 in number (Riggar, Barrett, & Crimando, 1996) most of the studies address personal or personnel concerns primarily as individual phenomena related to work. While few studies have addressed fiscal cost, but rather psychological cost, even less are actual examinations of organizational bottom-line costs, namely, personnel turnover.

Adams, Barrett, and Flowers (1995) directed a recent needs assessment of community rehabilitation programs in RSA (Rehabilitation Services Administration) Region V (Illinois, Indiana, Ohio, Michigan, Wisconsin, and Minnesota), which included questions on staff turnover rates. Rates (see Table 1) averaged 18.3% for supervisory/management staff and 28.6% for direct service; they ranged from a low of 9% for supervisory/management staff in Ohio, to 57% among Illinois direct services staff. These data were the catalyst for this article. The purpose of this study was to examine the status of personnel turnover in rehabilitation agencies, facilities, and organizations, comparing the findings in past analyses to illustrate potential trends. In addition to negative personal aspects and decreased organizational capabilities, consequences of the dilemma -- often resulting in staff neglect -- are revealed through an examination of turnover costs.

Table 1

Average Annual Staff Turnover within Community Rehabilitation Programs in Region V

              Average Annual Turnover:     Average Annual Turnover:
            Supervisory/Management Staff     Direct Service Staff

REGION V                18.3%                        28.6%
(N=295)
ILLINOIS
(N=79)                  14%                          57%
INDIANA
(N=32)                  22%                          22%
MICHIGAN
(N=67)                  18%                          20%
MINNESOTA
(N=25)                  32%                          40%
OHIO
(N=65)                   9%                          15%
WISCONSIN
(N=27)                  15%                          18%

Method

Sample

Comprehensive needs assessment questionnaires were mailed to 1713 facilities, agencies, and organizations within RSA Region V (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin). The organizations receiving these surveys constituted all facilities accredited in the region by CARF - The Rehabilitation Accreditation Commission (CARF), in the areas of Employment and Community Support at the time of the mailing. The instrument consisted of demographic information, 13 "general" questions, including barriers and trends and training resources, and a list of 84 training topics to which respondents were asked to identify as a "high, "medium," or "low" priority. If the training topic was not a priority at all, respondents were directed to leave the space blank. Respondents were asked to estimate staff size and the number of staff that had left the organization in the past year. From these data, turnover rates were ascertained. Over 300 surveys were completed and returned from the 1713 CARF-accredited organizations in Region V. Of these returns 295 were useable and retained for this study; yielding an effective response rate of 17.2%.

Results

Consumer demographics

The average number of consumers served annually among the responding agencies was 992. Survey participants, asked to answer in percentages (hence, do not sum 100%), indicated that the average aggregate response concerning consumer demographics revealed: 51.5% developmental disabilities, 22.3% mental illness, 21.5% physical disability, 12.1% emotional disorder, 12% chemical dependency, 10.9% traumatic brain injury, 10.5% other disabilities, and 6.3% visual impairments.

Organization demographics

The average CARF facility in Region V employed 116.5 staff, of which the average number of supervisory/management staff was 25.9, and average number of direct service staff was 93.2. Annual budgets that provided the financial support for staff and consumers typically fell into the $1 to $2.5 and $2.5 to $5 million dollar ranges.

Conclusions

Turnover rates

To understand the importance of data from Adams et al. (1995) it is necessary to compare the results with other previous, yet similar, examinations. In 1985, Crimando, et al. (1986a) surveyed a fifty percent random sample of the nationwide CARF membership roster. In that study the average turnover rate among CARF facilities (N=321) was found to be 22.6%. In the current study of Region V CARF organizations (N=295), the personnel turnover rate was 23.5%. While the one percent increase is not statistically significant, it is clear that rehabilitation personnel turnover has either remained relatively stable, although at a high rate, or increased, somewhat, over the past decade.

Fiscal costs

To begin to understand the actual monetary cost of rehabilitation personnel turnover, data from a variety of studies must be examined (Crimando et al., 1986a; Crimando et al., 1986b; Riggar, Hansen, & Crimando, 1987). Table 2 illustrates the monetary sums, adjusted for 10 years of inflation, the costs of rehabilitation turnover to agencies, facilities and organizations today. For the average size facility in the current study (116.5 people), with an annual 18.3% turnover of supervisory/management personnel (5 people), and a 28.6% annual turnover of direct service providers (27 people), it would suggest that a total of 32 rehabilitation employees leave annually. These combined percentages account for an average turnover of 23.5%. With the best conservative data available (R. Sanborn, Illinois Bureau of the Budget, personal communication July 18, 1996; U.S. Department of Labor, 1986), adjusted for a decade of inflation (consumer price index), the actual current financial cost to a representative CARF organization would accrue to between $128,217 to $201,600 annually. This expense, which must not be considered insignificant, only begins to account for financial loss due to mistakes/confusion, systems disarray, disruptions to client programming, decreased staff morale, etc., resulting in lost productivity and new staffing costs.

[TABULAR 2 DATA OMITTED]

As noted in Table 2, the cost of turnover among all employees in 1985/1986 dollars, to a "typical" rehabilitation facility was approximately $117,792 per year. In 1995/1996 dollars, this annual personnel turnover expense amounts to $164,908. While CARF facilities vary in staff size, from just a few people to agencies and organizations with 250+ employees, an average facility of 116.5 people (Adams et al., 1995) describes the "typical" agency/organization. If one assumes a personnel monetary debt of nearly $165,000, year after year after year, it becomes clear that this continuing expenditure is not being used in the delivery of services to rehabilitation of consumers.

As "it is clear that traditional rehabilitation counselor education programs, while meeting some of the personnel needs, will be unable to meet all future demands to provide qualified rehabilitation personnel for state and private rehabilitation agencies"(Eldredge, 1995, p. 49) it is incumbent upon rehabilitation administrators and supervisors to retain qualified rehabilitation personnel. Constantly competing, recruiting, selecting, orienting and training new employees continues to maintain or increase the already high turnover costs; funds not addressing consumer needs.

To compound matters Cohen, Conley, Pelavin and McInerney (1993) observed that over 500 openings existed in state rehabilitation agencies alone. Approximately 40% of these openings had been vacant for over three months. The pool of qualified personnel with bachelors and masters degrees, those who have not withdrawn from the field of rehabilitation, are being competed for constantly by both CARF facilities and state rehabilitation agencies due both to expanding job opportunities, and to constant, continuing rehabilitation personnel turnover.

Unfortunately no evidence appears to exist accounting for funds expended by rehabilitation administrators to reduce or even eliminate personnel turnover, to what degree rehabilitation agencies spend the recommended 3-5% of each employees salary yearly for training and development (Riggar & Matkin, 1986), or if in fact rehabilitation facility management have conducted in-house studies to assess, determine and recognize this potential epidemic in their own organizations. Such descriptions reflect a portion of the personnel dilemma that remains an enigma. While the "typical" facility in the current study is 116.5 employees, research has indicated that higher turnover occurs in smaller facilities, and in fact that organizations of 100+ employees have considerably less turnover (Crimando et al., 1986a). These same larger facilities more carefully review and document personnel turnover, many smaller organizations not having a formal mechanism for reporting and accounting. The enigma continues as one reviews the available rehabilitation literature and discovers that why people leave rehabilitation agencies and organizations, and the causes of turnover are more than adequately reviewed.

Turnover Causes

Information concerning why rehabilitation employees leave their jobs and what apparently causes them to do so has been well documented. After surveying CARF directors nationwide concerning turnover rates and why personnel had left (Crimando et al., 1986a) a similar study (Crimando et al., 1986b) of state DVR administrators was conducted. With the data from these studies an effort was made to follow-up on those withdrawn personnel, the ex-rehabilitation employees, to determine why they had in fact left their jobs (Riggar et al., 1987). The study, presented in Table 3, surveyed 59 ex-employees in six states of two regions. Examination of the original research revealed that for each of the top four reasons defined by the ex-employees that CARF administrators and state administrators noted these same reasons as occurring with 2 to 5 times less frequency. For each of the researched groups the top four reasons they provided for "why" are listed in Table 3. Clearly the management groups view the "why" personnel leave considerably differently than do those who left. Potential reasons for this glaring disparity in perception can be found in the cause of rehabilitation employee turnover.

Table 3: Reasons For Turnover

                      Why

Ex-Rehab Employees
(Riggar et al., 1987)

Little Advancement Potential        18.3%
Little Job Satisfaction             15.2%
Stress/Burnout                      12.2%
Personality Differences with
Management/Supervision              9.8%

CARF Directors
(Crimando et al., 1986a)

Better Job in Rehab                  13.9%
Poor Pay/Low Salary                  12.5%
Left Rehab for Another Field         10.7%
Poor Job Performance                 10.3%

State Administrators/Supervisors
(Crimando et al, 1986b)

Better Job in Rehab                  16.3%
Other (maternity, sick,
paternity, retired)                  14.8%
Family/Personal Reasons              10.1%
Left Rehab for Another Field          7.8%

                           Causes

Negative Affect                     Least Liked Aspects
(Flett, Biggs, & Alpass, 1995)      (Szymanski & Parker, 1995)

Absence of Job Recognition          Paperwork
Work Overload                       Amount of Work
                                    Administration
                                    Management/Supervision

Aspects Disliked
(Garske, 1995)

Excessive Paperwork                  22.0%
Bureaucracies, Regulations,
 restrictions (Red Tape)             14.9%
Funding Resource Problems             9.3%
Dealing with Legal System             5.8%
Low Wages                             5.8%

                       Factors Disliked
                 (Taylor & Zimmerer, 1992)

Lower-Level Managers

Dissatisfaction with Work
Lack of Input to Job
Confused as to Duties

Middle-Level Managers

Dissatisfaction with Work
Lack of Input to Job
Dissatisfaction with Job

Upper-Level Managers

Lack of Input into Selection
 of Subordinates
Lack of Input to Job
Confused as to Duties

Dissatisfaction                     Dissatisfaction
(Williamson, 1995)                  (Garske, 1996)

Superiors (except                   Advancement 38.2%
immediate supervisor)               Recognition 32.5%
Bureaucratic Impediments            Company Policy & Admin 31.8%
Relative Salary                     Salary 28.9%
                                    Supervisor-Technical 28.9%
                                    Supervisor-Interpersonal
                                    Relations 22.4%

Dissatisfaction/Distress            Self-Esteem/Job Satisfaction
(Biggs, Flett, Voges,               (Garske, 1996)
& Alpass, 1995)

Organizational Commitment           Achievement
Organizational Conflict             Working Conditions
                                    Company Policy & Admin

Stress                              Burnout

(Marini, Todd, & Slate, 1995)       (Riggar, Godley, & Hafer, 1984)
Occupational Stress                 Interest in Job, Relation with
Occupational Role                   Employee & Job Info and
Personal Strain                     Status = Job Satisfaction
Insufficient Personal               Intensity/Frequency of
Coping Resources                    Personal Accomplishments
                                    & Emotional Exhaustion =

(Chinnery et al., 1995)             (Gomez & Michaelis, 1995)
Management Attitudes                Personal Accomplishment -
Organizational Change               More Consumer Contact
Uncertainty                         Less Paperwork
Paperwork                           Depersonalization
Insufficient Debriefing             Emotional Exhaustion
by Supervisor

Supervisor Style

(Wilkinson & Wagner, 1993)
High Supervisor Direction
 and Support
= Job Satisfaction

Leadership Style

(Bordieri, Reagle, & Coker, 1988)
Achievement, Responsibility, &
Work Itself = Job Satisfaction
Training, Advancement, & Salary
= Disincentives

Supervisor Behavior

(Stout, 1984)
High Supervisor Consideration
= JobSatisfaction

The causes of personnel leaving their rehabilitation positions also have been well documented. Again as noted in Table 3, the rehabilitation literature appears to approach the causes of personnel turnover from four perspectives. These researched variables involve: 1) negative aspects/least liked/disliked, 2) dissatisfaction/distress, 3) stress/burnout, and 4) leadership-supervisor style/behavior. While the cited research sought to answer varied questions it appears that whether the questions concerned likes/dislikes, satisfaction/distress, stress/burnout or actions of leaders and supervisors the respondents tended to answer in similar ways about the same basic work concerns. Upon reviewing all of the literature illustrating causes for withdrawal it appears that an excellent summary is simply listed in the Riggar et al., 1987 study. The research studies noted in Table 3 clearly confirmed the statements of those rehabilitation personnel who in fact left their jobs: Little Advancement Potential (achievement, recognition), Little Job Satisfaction (dissatisfaction, self-esteem, distress, policy & administration), Stress Burnout (lack of personal accomplishment, depersonalization, emotional exhaustion), and Personality Differences with Management/Supervision (lack of direction support, consideration, attitudes).

Discussion

Problem

The insidious problem of personnel turnover has plagued rehabilitation for several decades. For at least ten years the disease has been a known, researched and documented phenomenon. Given the continuing level of personnel turnover which has remained relatively high or even increased somewhat over the last decade it is evident that whatever remedial efforts rehabilitation administrators have implemented have either failed to address the real causes of personnel turnover or have failed to adequately curb the on-going epidemic. The disease of personnel turnover is afflicted by the dilemma that causes and solutions are identified and known commodities. Why is it then that despite all the information available, especially in such colloquially topical areas as stress and burnout (Freudenberger & Richelson, 1980; Long & Kahn, 1993; Phillips, 1995; Schaufeli, Maslach, & Marek, 1993; Stevens, 1995), that rehabilitation administrators have failed to contain this epidemic?

Perhaps the answer to the continuing, on-going high level of rehabilitation personnel turnover rests with two factors that relate directly to rehabilitation leadership, management and supervision. The first part of the answer concerns who in fact are those professionals who manage in rehabilitation today. Most of today's rehabilitation administrators have had little or no education or training concerning management and administration. In fact approximately 75% of practicing rehabilitation administrators do not have appropriate management/administration related educational degrees, training or experience for their positions (Bordieri & Riggar, 1989; Riggar & Lorenz, 1986; Riggar & Matkin, 1984). This is especially true of first time rehabilitation supervisors. "Frequently [the] first position post-graduation involves supervising bachelor level, and high school, or even GED employees who have been employed at the agency, facility, or organization for many years" (Riggar & Maki, 1997, p.273). A follow-up study by Riggar and Matkin (1984) of masters level rehabilitation counselors, vocational evaluators and work adjustment specialist degree graduates found that they were promoted very quickly to administration or supervisory positions; "advancement occurs, on the average, within 14.25 months following graduation for many despite having no previous work experience in administrative capacities" (p.12). Earlier studies (Emener, 1983, Matkin, et al., 1982; Sullivan, 1982) had found that rehabilitation personnel who were trained professionals in direct service areas were advanced to supervisory roles and functions within 18 months. A rehabilitation counselor is not a facility manager any more than a vocational evaluator is an agency administrator. The direct consumer education, training, experiences and learning required for competence and certification in such areas is not the same as the required role, function and knowledge required of rehabilitation administrators. Rehabilitation administration requires education and training in planning, organizing, leading, evaluating, and staffing (Crimando et al., 1989; Riggar et al., 1988). Not being trained and educated in personnel management, supervision of subordinates, and creating the proper organizational climate many administrators are simply not aware of what the impediments, conflicts, strain, workload, appropriate policies, and direction and support required for competent subordinate supervision.

The second factor related to rehabilitation administrators and personnel withdrawal is evidence that rehabilitation administrators have less burnout and more job satisfaction than do their subordinates (Riggar et al., 1984). Further evidence of this phenomenon is Table 1 which reveals that management/supervisor turnover is considerably less evidenced, in fact almost half that of their subordinate direct service providers. As burnout and job dissatisfaction do not afflict rehabilitation administrators with the same frequency and intensity as with direct service workers it is likely that many rehabilitation administrators do not attach the same importance to these, as well as other, critical worker-related factors, e.g., achievement and recognition (see Table 3). As Duchene (1996) notes "morale is one of the intangible aspects of leadership that many ... find difficult to quantify and substantiate" (p.79).

Two factors - 1) lack of education and training in their administrative role and function, and 2) less personal impact of burnout and job dissatisfaction - result in practicing rehabilitation administrators and supervisors who are unfamiliar with why employees leave, the factors involved in their withdrawal, or the specifics of subordinate needs, wants and requirements, and in fact the limitation of their own leadership and supervisory style and behavior as noted in Table 3.

Turnover Reduction

The solution for rehabilitation personnel turnover readily lies in an examination of the rehabilitation literature. Various articles have thoroughly determined how the causes of turnover might be diminished or eliminated. Most currently Flett, Biggs, and Alpass (1995b) emphasized coping strategies, organizational factors, social support, management skills and knowledge, and education and training. Riggar, Barrett and Crimando (1995) emphasize continuous performance appraisal in non-adversarial and empowering relationships. Flett, Biggs, and Alpass (1994) favorably researched the positive psychological outcomes of training and education. Barrett, Crimando and Riggar (1993) detail the process of becoming an empowering organization through trust, open communication, beliefs and expectations, and organizational structure and physical arrangements. Krakinowski (1992) details addressing staff shortages, controlling paperwork, helping staff set realistic goals, empowering employees, ensuring diverse caseloads, offering support, saying thank you, and providing employee assistance programs. Over a decade ago Riggar, Garner and Hafer (1984) detailed such organizational solutions as performance standards, involvement, tasks, training, expectations, job definitions/role, conflict resolution, management/supervision, sharing/communications, and rest.

Reduction of personnel turnover known and documented for over a decade continues to be researched, refined and presented in detail in the rehabilitation literature. Perhaps, when turnover increases beyond its current high rate of 23.5% (2-3 people of every 10 leaving their rehabilitation jobs every year; over 23 for every 100 employees; 32 for the average facility of 116.5 staff), and the base cost of replacement is nearly $165,000 for the average organization, year after year; then rehabilitation administrators will attend to personnel turnover by first gaining the education and training in rehabilitation administration so lacking (as evidenced by continuous, on-going funds being used to obtain professional staff rather than for the rehabilitation of consumers), and apply this learning and knowledge to the dilemma of personnel turnover.

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Karen Barrett

T.F Riggar

Carl R. Flowers

William Crimando

Tammy Bailey

Rehabilitation Institute Southern Illinois University at Carbondale

Karen Barrett, Program Manager Region V RCEP, Southern Illinois University at Carbondale, Carbondale, IL 62901-6703.3