Initiatives aiming to improve staff retention often focus on the individuals in those roles, instead of improving the system and environment in which they work. Yet the data shows us these are system level issues. For example, in 2024, turnover among Patient Care Technicians was more than 34 percent and for Certified Nursing Assistants (CNAs) it reached more than 36 percent. CareFront, an IHI-led initiative, aims to reduce turnover in these roles. With funding from the Ralph C. Wilson Jr. Foundation, we are testing a theory of change that creates the conditions for health care workers at all levels to feel valued and thrive in a collaborative environment.
Direct care workers (DCWs) such as Patient Care Technicians and Certified Nursing Assistants provide hands-on care and support. A lack of recognition, low pay, inflexible work schedules, and challenging staffing ratios are among the challenges leading to high turnover rates among these vital members of the health care workforce.
CareFront’s work began in March 2023 through a 90-Day IHI Learning and Testing Cycle to structure an inquiry into promising innovations. Through this process, which included synthesis of existing literature and materials, key informant interviews, and collaboration with subject matter experts, the team developed a theory of change that reflects key drivers of DCW retention and associated change ideas.
Together with six hospitals and one nursing home participating in CareFront, IHI is learning about and refining the theory of change and building a set of tools and resources.