High turnover among direct care workers (DCWs) such as Patient Care Technicians and Certified Nursing Assistants (CNAs) is a major challenge in healthcare. In 2024, turnover rates exceeded 34% for Patient Care Technicians and 36% for CNAs. These frontline workers are essential to patient care, yet many face low pay, inflexible schedules, and lack of recognition.
The CareFront initiative, led by the Institute for Healthcare Improvement (IHI) with funding from the Ralph C. Wilson Jr. Foundation, is tackling this issue. Instead of focusing solely on individual retention, CareFront aims to improve the work environment and system-level factors, creating conditions where DCWs feel valued and supported.
Engaging Direct Care Workers in Solutions
One of the most impactful steps CareFront teams have taken is actively engaging DCWs in developing and testing solutions. By including them on multidisciplinary teams, DCWs provide valuable insight into the challenges of their roles and help design practical improvements. Their participation not only strengthens team credibility but also encourages broader engagement—DCWs are now contributing to shift huddles, mentoring peers, and taking on leadership roles within their positions.
Building Trust and Partnerships
Trust is foundational to retention. Teams asked workers what matters most to them, gathering insights on what brings joy to their work and identifying small frustrations (“pebbles in your shoes”). By acting quickly on these suggestions and visually displaying progress, teams created a virtuous cycle of engagement: workers see that their ideas are valued and implemented, which encourages further contribution and collaboration.
Providing Knowledge and Resources
Ensuring DCWs have the tools they need to perform their roles efficiently is another key factor. Simple changes, like improving the timely delivery of linens or creating a “Float Guide” for staff temporarily assigned to other units, have reduced frustration and improved workflow. Providing resources tailored to DCWs enhances both patient care and workforce satisfaction.
Early Results and Benefits
After 14 months of collaboration with six hospitals and one nursing home, early results are promising. Pilot units have shown improved retention of direct care workers and are spreading successful changes to other units. These improvements are also contributing to better patient outcomes, including reductions in patient falls and rates of central line-associated bloodstream infections (CLABSI).
The CareFront initiative demonstrates that system-level improvements, intentional engagement, and a supportive work environment are key to retaining direct care workers. By listening to their needs, providing resources, and fostering trust, healthcare organizations can create a workplace where DCWs thrive, benefiting both staff and patients.
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