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The moderating role of knowledge, motivation, and organizational influences on employee turnover: A gap analysis

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The moderating role of knowledge, motivation, and organizational influences on employee turnover: A gap analysis

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Content Running head: INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

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THE MODERATING ROLE OF KNOWLEDGE, MOTIVATION, AND ORGANIZATIONAL
INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

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Summer L. Allen

_________________________________________________________________________

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

August 2018

Copyright 2018 Summer L. Allen

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DEDICATION
To my grandmother, Annie Allen I dedicate this dissertation to you. You have been the
main inspiration in my life from day one. You have never placed limitations on me, and have
always pushed me to be the best version of myself that I could be. You have been an example of
strength and determination and I have taken those values to accomplish something great. You
taught me to not just be, but be great. I love you more than you will ever know and words
cannot adequately thank you for all you have done for me. I love you granny!
To my family, who has supported and loved me through this long process. I have missed
many holidays and family gathers trying to pursue my dream. When I would “go underground,”
you would call just to make sure I was still alive and that I was okay. Through it all, your
support and love never wavered. Thank you and I love you!
To my friends, words cannot express how much I love you guys and how I could not
have made it through this process without you. You ladies have been there for me from day one
of this journey and through it all, you have motivated me, pushed me, and held me accountable
for staying on track, when I so wanted to slack off. You have kept me alive during the process
with food and a few much needed happy hours. More importantly, just you being in my life, and
the laughter and positivity that you all bring me. I love you ladies to the moon and back.
To my future self, when you were little you said, “When you grow up, I want to be a
doctor.” Little did you know, this is what you meant. Keep that as a reminder, that whenever
you say you want to something and you set your mind to it, it happens. Nothing has ever come
easy to you, and this was no exception. You have been through a lot on this journey. Through
separation, divorce, non-stop travel, huge work projects, role changes, moving across the
country, staring a new business, fatigue, illness, stress, and just life, you did it. You have
INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

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accomplished something amazing, despite the obstacles that have come your way. You’ve
proven to yourself that, with God and love from friends and family, you can do anything. Take
time to reflect on your accomplishment, be proud of yourself. You deserve it!

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ACKNOWLEDGEMENTS
There are many who have contributed to the accomplishment. First and foremost, this
work would not have been done without my dissertation chair, Dr. Melora Sundt. I would like to
thank my dissertation chair, Dr. Melora Sundt. Where do I start? There is no way I could have
made it through this process without you. I have learned so much from you, both academically
and professionally. Thank you for every writing workshop that you went out of your way to
arrange for us; your amazing feedback on my writing; and the numerous times you talked me off
the ledge when I would get frustrated. With everything going on in my life, you were so patient
with me, so I truly thank you for pushing me and never giving up on me! To my committee
member, Dr. Monique Datta and Dr. Kathy Hanson. Thank you so much for your thoughtful
feedback and guidance. You have been an amazing asset and I will forever be grateful.
To my OCL Cohort, you all are absolutely AMAZING! We met as strangers, but we
have grown so close thought out this journey. Many of us have become so close and will be
lifelong friends. Special mention to our Saturday “mini-cohort.” I love the No Doctors Down
motto we had and everyone’s unwavering dedication and support to one another. I have never
seen such a fun, strong, and smart group of individuals. Love you guys!
To my work family, I began working at the company, and one week later, I got my
acceptance letter to USC. You all were so excited for me, and through this process you all have
been so supportive. Some of you have taken time to read and proofread my work. While others
have filled in the gaps when I had to take weeks at a time off work to write. I am a firm believer
that everything in life happens for a reason, and I am most certainly sure that me being here was
no accident. So thank you all so much for your support, advice and encouragement.

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TABLE OF CONTENTS
Dedication 2
Acknowledgements 4
List of Tables 7
List of Figures 9
Abstract 11
Chapter 1: Introduction 13
The Staffing Shortage in Publicly-Funded Health Programs 13
Background of the Problem 15
Importance of Addressing the Problem 16
Organizational Mission and Context of Proposed Project Site 19
Organizational Performance Status 21
Organizational Performance Goal 22
Description of Stakeholder Groups 23
Stakeholders’ Performance Goals 25
Stakeholder Group for the Study 25
Purpose of the Project and Questions 26
Conceptual and Methodological Framework 27
Definitions 27
Organization of the Dissertation 28
Chapter 2: Review of the Literature 29
Employee Turnover and Retention 29
Employee Turnover: A Conceptual Framework 30
Factors Influencing Employee Retention and Turnover 37
Stakeholder Knowledge, Motivation, and Organizational Influences 42
Chapter 3: Methodology 76
Purpose of the Project and Research Questions 76
Conceptual and Methodological Framework 77
Assessment of Performance Influences 81
Participating Stakeholders and Sample Selection 90
Data Collection 90
Data Analysis 98
Reliability and Validity 99
Credibility and Trustworthiness of Data 100
Role of Investigator 101
Ethics 101
Limitations and Delimitations 104
Summary 105
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Chapter 4: Results and Findings 106
Definition of Validation 106
Results 109
Summary 154
Chapter 5: Solutions, Implementation, and Evaluation 157
Recommendations for Practice to Address KMO Influences 158
Integrated Implementation and Evaluation Plan 175
Limitations and Delimitations 201
Recommendations for Future Research 202
Conclusion 204
References 206
Appendices 237
Appendix A: Survey Questions 237
Appendix B: Interview Protocol 241
Appendix C: Informed Consent / Information Sheet 245
Appendix D: Recruitment Email 247

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LIST OF TABLES
Table 1. Organizational Mission, Global Goal and Stakeholder Performance Goals 25
Table 2. Intrinsic Motivational Variables that Contribute to Employee Retention 38
Table 3. Extrinsic Motivational Variables that Contribute to Employee Retention 40
Table 4. Knowledge Factors 59
Table 5. Motivation Factors 65
Table 6. Organizational Factors 72
Table 7. Summary of Factors Addressed in Study 73
Table 8. Assumed Knowledge Influences and Proposed Assessments 82
Table 9. Assumed Motivational Influences and Proposed Assessments 85
Table 10. Assumed Organizational Influences and Proposed Assessments 87
Table 11. Survey Question #10 Results 110
Table 12. Survey Question #4 Results 112
Table 13. Survey Questions #7 and #9 Results 117
Table 14. Survey Question #5 Results 122
Table 15. Survey Question #11 Results 124
Table 16. Survey Question #12 Results 127
Table 17. Survey Question #13 Results 130
Table 18. Summary of Validation 156
Table 19. Summary of Knowledge Influences and Recommendations 160
Table 20. Summary of Motivation Influences and Recommendations 166
Table 21. Summary of Organization Influences and Recommendations 173
Table 22. Outcomes, Metrics, and Methods for External and Internal Outcomes 181
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Table 23. Critical Behaviors, Metrics, Methods, and Timing for Leaders 183
Table 24. Required Drivers to Support Leaders' Critical Behaviors 185
Table 25. Training Plan Recommendations 190
Table 26. Components of Learning for the Program 192
Table 27. Components to Measure Reactions to the Program 194
Table 28. Dashboard Metrics 199
Table 29. Dashboard Key 199

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LIST OF FIGURES
Figure 1. Employee turnover 30
Figure 2. Conceptual framework 78
Figure 3. Clark and Estes gap analysis methodology 80
Figure 4. Data from survey question #6 115
Figure 5. Data from survey question #8 120
Figure 6. Data from survey question #14 132
Figure 7. Data from survey question #15 133
Figure 8. Data from survey question #16 136
Figure 9. Data from survey question #17 139
Figure 10. Data from survey question #19 140
Figure 11. Data from survey question #18 141
Figure 12. Data from survey question #21 143
Figure 13. Data from survey question #22 144
Figure 14. Data from survey question #20 145
Figure 15. Data from survey question #23 148
Figure 16. Data from survey question #24 150
Figure 17. Data from survey question #25 151
Figure 18. Kirkpatrick New World Model 178
Figure 19. Evaluation methods 179
Figure 20. Human capital dashboard 187
Figure 21. LMS reporting tools 195
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Figure 22. Training evaluation dashboards 198
Figure 23. Expected outcomes 201

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ABSTRACT
The purpose of this research project was to evaluate the degree to which XYZ Healthcare is
achieving its goal of reducing employee turnover from 14.5% to 12% by the end of 2018. The
analysis focused on knowledge, motivation and organizational influences on leaders within XYZ
Healthcare related to achieving their organizational goal. While a complete evaluation project
would focus on all XYZ Healthcare stakeholders, for practical purposes the stakeholders focused
on in this analysis were leaders. As such, the questions that guide this study were the following:
(1) What knowledge, motivation, and organizational influences are potentially inhibiting leaders
within XYZ Healthcare Company from decreasing employee turnover? (2) What are the
knowledge, motivation, and organizational solutions for leaders within XYZ Healthcare that will
decrease employee turnover? This study utilized the Clark and Estes’s Gap Analysis Framework
to examine how leadership behaviors influence employee turnover in an organizational setting.
The purpose of this study was to examine the knowledge, motivation, and organizational (KMO)
influences and how they may be impacting the organization’s ability to decrease employee
turnover. The methodology employed in this study included a mixed methods approach, of
analyzing data from both interviews and surveys. A purposeful sample of anonymous leaders
within XYZ Healthcare (a pseudonym for the organization), to evaluate gaps in the areas of
knowledge, motivation, and organization. From the data, gaps were either validated, partially
validated, or not validated. The study found several gaps related to knowledge, motivation, and
organizational influences. The most notable findings related to the knowledge levels around
employee coaching and goal setting, along with subsequent motivational and organizational
influences around lack of accountability systems, and organization support in terms of training
and resources available to leaders. The results from the data collected were used to drive
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recommendations for the organization that would support them in meeting their organizational
goals. A framework for addressing the identified validated gaps used the Kirkpatrick and
Kirkpatrick New World Model to design and implement recommendations.

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CHAPTER 1
INTRODUCTION
The Staffing Shortage in Publicly-Funded Health Programs
According to the Bureau of Labor Statistics 2016 press release, nearly 59 million
employees left their jobs in 2015 (Bureau of Labor Statistics 2016 press release, 2016). Of that,
almosr one quarter (33.4million) of US employees voluntarily quit their jobs (Bureau of Labor
Statistics 2016 press release, 2016. Almost two-fifths (37%) of this population are thinking of
leaving their jobs (Bureau of Labor Statistics 2016 press release, 2016. Like other sectors of
employment, the U.S. healthcare industry is constantly evolving and constantly in search of
qualified personnel to fill critical roles. Even before the Affordable Healthcare Act and managed
care dominated the industry, attracting, hiring, and retaining medical staff was already a
challenging process. With the implementation of the Affordable Healthcare Act, the
organizational landscape of health care is being rearranged (Auerbach, Staiger, Muench, &
Buerhaus, 2013). To improve health care access and quality, while reducing cost, Managed Care
Organizations are reinventing themselves as coordinated care delivery systems in order to meet
the needs of individuals with complex health needs (Sparer, 2012). As a result, the nation’s
hospitals are merging, consolidating, and aligning at a dizzying pace. Where the majority of
medical professionals use to reside exclusively in hospital settings, today more than 40% of
medical professionals are now practicing in managed care organizations (Shortell, Gillies, &
Anderson, 1994).
Like many industries, healthcare is impacted by a high demand for specialized
employees, but is also suffering from high levels of turnover within these roles (Chew &
Entrekin, 2011). Government health programs, also known as publicly-funded health programs
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such as Medicaid and Medicare, historically experience a shortage of providers, certain
specialists, and nurses willing to work with Medicare and Medicaid population (Miller & Luft,
1997). The challenges facing the staffing up of government health programs are three-fold: (1) a
shortage of individuals entering health profession preparation programs; (2) a shortage of trained
medical professionals choosing to work in the public sector vs more lucrative alternatives; and
(3) high turnover of staff within government health programs, themselves (Petterson et al.,
2012). According the World Health Organization, poor retention of health care workers
negatively affects an organization by increasing workload, creating disruptions and inefficiencies
in work processes, causing loss of knowledge and experience, reducing the quality of services
being delivered, and diminishing team morale (World Health Organization, 2010). Without
immediate attention on employee retention in healthcare, a system overload is inevitable
(Heisler, 2013).
The focus of this study was understanding more about the knowledge, motivation and
organization factors within a large Managed Care Organization (MCO) in the United States that
affect leadership’s ability to impact employee retention. For the purpose of anonymity, the
organization is referred to as XYZ Healthcare Company. The findings from this study were
intended to help the organization develop a plan to reduce employee turnover, in particular by
focusing on how specific leadership behaviors influence employee turnover. Although an
organization within the healthcare industry was the chosen site for this study, the findings and
recommendations may be instructive to other organizations.
This chapter will look at the organizational context and mission of XYZ Healthcare and
will review its organizational performance goals, related literature, the importance of the
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evaluation, the identified stakeholder groups, the purpose of the project, the methodology
utilized in the study, as well as provide an overview of the overall of the dissertation.
Background of the Problem
Along with a dire medical staff shortage in the U.S. healthcare system, clinical staff
turnover in managed care organization is a prevalent and expensive problem. Annual staff
turnover among managed care organizations can be as high as 60% (Sparer, 2012). According to
the U.S. Bureau of Labor Statistics (2015), the average turnover rate in the healthcare industry is
16.8% for 2015. Conversely, healthcare providers are rapidly reaching retirement age.
According to Dall, West, Chakrabarti, & Iacobucci (2015) about a third of the nursing
workforces are 50 or older, and 40% of physicians are 55 and older. It has been estimated that
more than half of the nursing workforce has expressed an intention to retire within the next ten
years (Hader, Saver, & Steltzer, 2006). This claim was gained further validity in the 2006 results
of the Nursing Management’s exclusive Aging Workforce Survey of nearly 1,000 nurses, where
55% of the respondents expressed an intention to retire in the next 10 years (Hader et al., 2006).
Even with the continuous flow of nurses flowing into the industry from college, the study
identifies there may not be enough nurses to replace the number planning to leave the profession
(Hader et al., 2006). With the influx of aging patients and the growing number of aging
healthcare workers, as with other healthcare companies, employee retention is a top priority for
XYZ Healthcare (pseudonym used for organization). With such a shortage of skilled labor in the
healthcare industry, along with a high industry turnover rate, hiring and retaining skilled
workers, such as nurses and other healthcare workers, is essential to providing the necessary
quality and access to care for members, a focus on employee retention is even more imperative.
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While the Affordable Care Act increased the number of eligible members, it did not increase the
number of medical professionals that serve those members (Auerbach et al., 2013).
According to Abbasi and Hollman (2000), when an organization loses a core employee, a
top performer or one with critical skills, there is negative impact on innovation, consistency in
providing service to guests may be jeopardized, and major delays in the delivery of services to
customers may occur. There can also be a decline in the standard of service provided to guests
that could also adversely affect the satisfaction of internal and external customers and,
consequently, the profitability of the organization. Evidence of the negative impact turnover can
have on an organization is shown in Kacmar, Andrews, Van Rooy, Steilberg, and Cerrone’s
(2006) two-year study, where they found that employee turnover has an immediate effect on an
organization’s efficiency, and over time, on its performance. The impact of negative employee
turnover in a medical setting is emphasized in the research by O’Brien ‐Pallas, Duffield, and
Hayes (2006), which focuses specifically on the impact of nurse turnover. Through a
retrospective, cross sectional study of data from two hospitals from 4 different countries, the
study reveals that the loss of a seasoned or specialized nurse significantly contributed to reduced
continuity of care, lower productivity, as well as increased risk for patients within a hospital.
With this information, unlike blanketed approaches, HR practitioners can now deploy focused
HRM strategies that are tailored to specific target audiences. These strategies are more
beneficial to avoid organizations creating an environment where they may be keeping low
performers while still losing their key talent (Steel, Griffeth, & Hom, 2002).
Importance of Addressing the Problem
Employee retention is an important element of success in any organization, and even
more so in healthcare. Beyond the costs of replacing employees, high turnover in healthcare
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negatively impacts continuity of care for patients and as well as quality. The importance of
employee retention in healthcare is also compounded by the shortage of skilled healthcare
workers.
In order for XYZ Healthcare to fulfill its mission of providing accessible and quality
healthcare to its Medicaid members, while being profitable, it will have to focus closely on costs.
Although turnover of any type creates cost, both tangible and intangible, the financial impact of
turnover is dependent on who leaves and who stays (Mobley, 1982). On average, U.S.
companies spend around $1.7 billion annually on employee turnover (Karsan, 2007). The
findings of Boushey and Glynn’s (2012) qualitative study of thirty case studies taken from the 11
research papers on the costs of employee turnover demonstrate that it costs businesses about one-
fifth of a worker’s salary to replace that worker. When performance is taken into account, the
cost incurred by high attrition rates of top performing employees is even more costly to
corporations (Chew & Entrekin, 2011). Research suggests that direct replacement costs of an
entry-level employee can reach as high as 50–60% of an employee’s annual salary, and as high
as 100–300% of the base salary for specialized, high performing employees (Allen, 2008).
Individuals that have critical skills or top performer turnover costs considerably more
since these employees’ impact and contribution are greater than that of typical employees (Scott,
McMullen, & Royal, 2012). Based on the formula developed by Tziner and Birati (1996), when
performance is taken into account, the cost of dysfunctional turnover (replacing a key employee)
of a single employee can cost an organization $103,434. While some turnover may be
beneficial, in order for an organization to develop an effective retention strategy, organizations
need to take into consideration the costs and benefits associated with turnover (Allen, 2008).
Retaining skilled employees’ knowledge and skills has become key for companies to be
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economically competitive (Hiltrop, 1999). Dalton and Todor (1979) predict that the ability for
organizations to attract and retain top talent will become more vital as talent shortages increase
into the next decade. Hence, impeding organizational survival as global competition becomes
more intense.
Another aspect of providing quality is access to care. According to the U.S. Bureau of
Labor Statistics (2015), the average turnover rate in the healthcare industry is 16.8% for 2015.
Conversely, healthcare providers are rapidly reaching retirement age. According to
Bodenheimer and Smith (2013), about a third of the nursing workforces are 50 or older, and 40%
of physicians are 55 and older. In a recent survey, more than half of the nursing workforce has
expressed an intention to retire within the next ten years (Buerhaus, 2008). With the influx of
aging patients and a lot of aging healthcare workers, employee retention is a top priority for XYZ
Healthcare. With such a shortage of skilled labor in the healthcare industry, along with a high
industry turnover rate, hiring and retaining nurses and other healthcare workers is essential to
providing the necessary access to care for members, making a focus on employee retention even
more imperative.
It is important to understand the complexities of employee retention and turnover in order
to retain top talent. In a highly competitive marketplace, retention of key talent is imperative for
organizational success. By solving this problem, organizations can increase their understanding
of the dynamics of employee turnover and retention in order for them to deploy the appropriate
retention strategies to ensure they are creating a healthy environment where they are creating a
balanced workforce by truly retaining identified top talent.
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Organizational Mission and Context of Proposed Project Site
Organizational Mission
For over 35 years, XYZ’s mission has been to provide quality healthcare to people
receiving government assistance, and this goal serves as the key focus area and driver to all
decisions made within the organization (XYZ website). The purpose of this project was to
evaluate employee turnover and retention in XYZ Healthcare. Specifically, this project sought to
evaluate the degree to which XYZ Healthcare is achieving its goal of reducing overall employee
turnover from 14.5% to 12% by the end of 2018.
Organizational Context
XYZ Healthcare is a Managed Care Organization (MCO) that was founded in 1980 by an
ER physician who identified a need to provide low-income individual access to quality
healthcare. As an ER physician, he identified many individuals with Medicaid who utilized the
ER as their primary care physician because they were being turned away by physicians who
would not accept Medicaid (XYZ website). What started as one clinic in Southern California as
a way to meet the needs of those who had Medicaid, quickly grew into one of the top five
Medicaid Managed Care Organizations (MCOs) in the US. Today, XYZ Healthcare is a Fortune
200 company that has more than 20,000 employees, operates in 31 states, and services over 4.5
million Medicaid and Medicare members (XYZ website).
For the past two years, XYZ Healthcare has experienced 14.5% employee turnover
resulting in increased administrative costs and lower profit margins. With almost 25,000
employees, a turnover rate of 14.5% could cost the company an estimated $32 million dollars
annually. It is important to study the intrinsic and extrinsic influences that are impacting
employee turnover in order to identify solutions to reduce administrative costs. Not addressing
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employee turnover for XYZ Healthcare will cause them to continue to diminish its
administrative budget as well as reduce its ability to provide quality service to its members and
reduce its administrative budget. Left unaddressed, the effects of this could impact the long-term
stability of the organization.
Reducing employee turnover has a direct impact on the company’s performance,
specifically their ability to increase quality of care, access, patient outcomes, member
satisfaction, and member retention. Over 75% of the organization’s current 20,000 employees
are considered “member facing.” This means that approximately 15,000 of the employees work
directly with members in some capacity, thus directly impacting the quality of service they
receive and member retention. Hiring, engaging and retaining these employees are essential to
the organization’s ability to maintain and increase membership while providing value and
quality. When turnover is low and employees are engaged, productivity increases, morale is
higher and employees provide a better quality of service to customers (Dey, 2009). Members do
not have many interactions with staff, so every interaction counts.
As an MCO for a state for Medicaid / Medicare programs, XYZ Healthcare is
contractually responsible for the reduction of healthcare costs, increasing quality of care,
improving patient outcomes, access to care, and positively managing the financial performance
of State Medicaid / Medicare programs. In return for managing the healthcare of enrolled
Medicaid / Medicare beneficiaries, the State pays XYZ Healthcare a monthly premium for each
member. Through contracts, the MCO is responsible to the State and the States use both
financial and non-financial incentives to drive quality and ensure access through the MCO.
High employee turnover in managed care can have a negative impact on employee
engagement and morale, patient satisfaction and safety, and quality measures, impacting
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reimbursement rates and ultimately the organization’s bottom line. According to the VHA’s
Center for Research and Innovation (2002):
Work force instability, as demonstrated by high rates of staff turnover and lingering
vacancy rates, continues to be a major challenge facing health care organizations. The
impact is manifested in workflow inefficiencies, delays in delivering patient care, and
dissatisfaction among patients and staff, all of which can have significant negative effects
on quality of care and patient safety. In addition, the staggering administrative costs
created by a transient workforce threatens healthcare organizations financial viability.
(p. 15)
Organizational Performance Status
With the inception of the Affordable Care Act (ACA) in 2014, XYZ has experienced
rapid growth. Before the Affordable Care Act (ACA), 15% of the US population was uninsured.
One of the most notable benefits of the Affordable Care Act is its expansion of Medicaid. This
increase in access to health coverage for people and families with low incomes increased access
added an estimated 16-18 million new people to Medicaid (cms.gov). With Medicaid being
XYZ’s primary book of business, this increased eligibility increased the company’s Medicaid
membership by 50% in the past two years. XYZ’s Medicaid membership has grown from 2.5
million in 2014 to over 4.5 million in 2016 (cms.gov). Growth has become such a commonality,
the CEO made a point to state that they intentionally do not set growth margins anymore, as they
have “consistently surpassed them.”
While many Managed Care Organizations have struggled with some aspects of the
Affordable Care Act, XYZ Healthcare has thrived under healthcare reform. XYZ’s profits more
than doubled in 2015, totaling $153 million dollars. The rush of new Medicaid members, as well
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as renewals of state Medicaid contracts, the launch of dual-eligible health plans and several
acquisitions pushed XYZ’s 2015 revenue past the $14 billion mark. That means XYZ ended the
year with a razor-thin 1% profit margin, but that was still higher than the 0.6% margin from
2014.
With XYZ experiencing such rapid growth, hiring must continue and associated costs
cannot be cut, in fact, they have increased. However, retaining employees and reducing turnover
costs can be evaluated and reduced. In 2014 and 2015, XYZ experienced 14.5% voluntary
employee turnover, resulting in a loss of over 4,000 employees. According to Boushey and
Glynn (2012), the direct and indirect turnover costs for low to mid-level employees, per
employee, can range from $4,000 to $8,000. Projections estimate turnover for 2016 will remain
between 14-15%. With over an estimated 25,000 employees in 2017, the loss of 4,000
employees can potentially cost XYZ between $16 and $32 million dollars of its $1.4-billion-
dollar administrative budget. As a result, a top organizational goal is to decrease voluntary
employee turnover from 14.5% to 12% by the end of 2018.
Organizational Performance Goal
XYZ Healthcare’s goal was to decrease administrative costs and increase profits for
2018. Specifically, the organization aimed to decrease administrative costs and increase profits
by focusing on reducing the costs associated with the loss of skilled workers within the
organization. To accomplish this, XYZ set a goal to have 100% of its leadership team reduce
employee turnover from 14.5% to 12% by December 2018. Because XYZ’s mission is to
“provide quality healthcare to those receiving government assistance,” it considers itself
“stewards of public funds.” This mission communicates an important distinction from traditional
“commercial” insurance companies. For over 30 years, XYZ has only provided insurance to
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Medicaid and Medicare members, meaning all of their profits come from the state and federal
government. This is unlike all other healthcare companies who also operate a commercial line of
business and aim for a 4 to 5% profit margin. XYZ annually sets a goal of reaching a net profit
of 2%. For 2017 this goal equates to $20.3 billion dollars. Such a thin profit margin goal makes
XYZ unique, but also vulnerable. As Americans get older and the cost of healthcare continues to
rise, managing costs while still providing quality care is XYZ’s top organizational goal.
In order for XYZ to accomplish its goal, it must maintain an administrative cost of less
than 6.7%, or $1.4 billion dollars for 2017. Like many organizations, human capital is the
costliest, accounting for approximately 50% of the narrow 6.7% administrative budget. As a
result of this rapid market growth XYZ has experienced over the past two years, the organization
has experienced a significant increase in human capital costs. XYZ’s staff has grown from a
little over 10,000 employees in 2014 to over 20,000 as of 2016. In order to maintain an
administrative budget of 6.7% in order to achieve an after tax profit margin of 2%, a focus on the
cost of human capital has become one of the organization’s performance top goals. Hiring and
retaining the right people is a key organizational strategy.
Description of Stakeholder Groups
For this study, key stakeholders were identified as individuals who directly contributed to
the success of accomplishing the organizational goal and have a vested interest in its success.
Since stakeholders are individuals or groups who will be impacted by, or can influence the
success or failure of the organization’s goal, three key stakeholders were identified for this
research study. The three internal stakeholders for this study included front-line employees,
leaders within XYZ Healthcare, and the Human Resource team.
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Employees are increasingly recognized as the most important asset an organization has.
The ability of the business to drive key business results and add value rests in its employees, or
human capital. Front-line employees within XYZ Healthcare are key to the organization’s day-
to-day operations and the vital group of focus for any reduction of employee turnover.
The second stakeholder group consisted of leaders within XYZ Healthcare. For this
study, the title of leader included supervisors, managers, directors, and Associate Vice Presidents
(AVPs), and Vice Presidents (VPs). Leaders were identified as the key stakeholder group
because leadership and leadership behaviors have been documented as having a significant
influence on employee engagement and retention (Mendes & Stander, 2011).
The third stakeholder group was the Human Resource Team. Human Resources plays a
major role in an organization’s performance and their employee retention (Barney & Wright,
1998). This group is responsible for developing and executing the organization’s HRM (Human
Resource Management) strategies to achieve the performance goal of reducing employee
turnover from 14.5% to 12%.

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Stakeholders ’ Performance Goals
Table 1
Organizational Mission, Global Goal and Stakeholder Performance Goals
Organizational Mission
The mission of XYZ Healthcare is to provide quality healthcare to people receiving
government assistance.
Organizational Global Goal
Our goal is to maintain high levels of performance by attracting and retaining the best people
and providing an environment that allows them to flourish.
Organizational Performance Goal
By the end of 2018, XYZ Healthcare will reduce employee turnover from 14.5% to 12%.
Stakeholder 1 Goal
Front-line Employees
By December 2018,
increase employee
engagement survey by 3%.
Stakeholder 2 Goal
Leaders in XYZ
By December 2018, leaders will
better engage with their employees
through effective coaching/
feedback, goal setting, and
positive leader/member exchange.
Stakeholder 3 Goal
Human Resources
XYZ Healthcare has not
established explicit
performance goals for
this group.

Stakeholder Group for the Study
While reducing employee turnover is a joint effort of all within an organization, the
stakeholder group of focus for this study is leaders within XYZ Healthcare Company. Leaders
were identified as the stakeholder group of choice because of the documented influence they
have on an employee’s organizational commitment, job satisfaction, commitment and ultimately
employee turnover (Portoghese, Galletta, Battistelli, & Leiter, 2015).
Retention is a vital management “outcome” (Chia, Lee, Ooi, Tan, & Tan, 2014).
Management was identified as a key stakeholder because leadership has a significant influence
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on employee engagement and retention (Boon & Biron, 2016). Wakabi (2013) conducted an
intensive literature review from empirical studies to identify how leadership styles influence
employee turnover intentions. The study famously concluded that employees leave their boss
and not the company and that the responsibility of employee retention ultimately lies in the
hands of an employee’s immediate supervisor. Employees have difficulties in meeting the needs
of their patients if their own needs are not met; therefore, addressing employee engagement and
retention at the leadership level is an important factor for both the internal staff and external
patients.
Knowing that employee retention and engagement directly influence member retention
and organizational profits, understanding more about the barriers impacting leaders and how they
engage their employees will allow the organization to better identify how specific intrinsic and
extrinsic factors may be impacting its employee retention.
Purpose of the Project and Questions
The purpose of this project was to evaluate the degree to which XYZ Healthcare is
achieving its goal of reducing employee turnover from 14.5% to 12% by the end of 2018. The
analysis focused on knowledge, motivation, and organizational influences of leaders within XYZ
Healthcare related to achieving this organizational goal. While a complete evaluation project
would focus on all XYZ Healthcare stakeholders, for practical purposes the stakeholders focused
on in this analysis were leaders.
As such, the questions that guided this study were the following:
1. What knowledge, motivation, and organizational influences are potentially inhibiting
leaders within XYZ Healthcare Company from decreasing employee turnover?
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2. What are the knowledge, motivation, and organizational solutions for leaders within
XYZ Healthcare that will decrease employee turnover?
Conceptual and Methodological Framework
Clark and Estes’ (2008) gap analysis, a systematic, analytical method that helps to clarify
organizational goals and identify the knowledge, motivation and organizational influences, was
adapted into an evaluation model and implemented as the conceptual framework for the study.
The methodological framework was a mixed methods study with descriptive statistics. Assumed
influences such as knowledge, motivation and organizational influences on leaders that impact
XYZ Healthcare’s organizational goal achievement were generated based on purposeful
sampling and a related literature. These influences were assessed by using surveys and
interview. Research-based solutions were recommended and evaluated in a comprehensive
manner.
Definitions
Employee Retention: Employee retention is the strategy employed by the organization to
encourage employees to remain in the organization. Through these strategies, the employer
creates an environment where the employee is committed to and wants to stay with the
organization.
Employee Turnover: The unplanned loss of key workers for any reason; which in turn, is
the direct result of the organization’s employee retention efforts and strategies.
Turnover Culture: A type of culture that has “the systematic patterns of shared cognitions
by organizational or sub-unit members that influence decisions regarding job movement” (Deery
& Iverson, 1996, p. 71).
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Voluntary Turnover: Voluntary turnover is initiated by the employee; for example, the
worker quits to take another job.
Organization of the Dissertation
Five chapters are used to organize this dissertation. This chapter provided the reader with
the key concepts and terminology commonly found in a discussion about decreasing employee
turnover. The organization’s mission, goals and stakeholders and the framework for the project
were introduced. Chapter 2 provides a review of current literature surrounding the scope of the
study. Topics of employee turnover, Human Resource Management interventions, leadership
influences, and organizational culture are addressed. Chapter 3 details the knowledge,
motivation and organizational influences examined, as well as methodology which determined
the choice of participants, data collection, and analysis. Chapter 4 will detail the results and
findings from data collection, while Chapter 5 seeks to answer Research Question 2, “What are
the knowledge, motivation, and organizational solutions for leaders within XYZ Healthcare that
will decrease employee turnover?” Recommendations will be offered in this chapter based on
the Clark and Estes (2008) Gap Analysis of knowledge, motivation, and organizational
influences there were identified in the literature review as impacting leader behavior.
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CHAPTER 2
REVIEW OF THE LITERATURE
This chapter provides a review of existing literature in the area of employee turnover and
retention. The first part of the chapter begins with a broad review of the literature on the
definition of employee retention and turnover, as well as the associated conceptual and
theoretical frameworks. With job satisfaction and motivation being identified as key factors for
the retention of employees, this chapter will concisely review both concepts as they relate to
employee retention (Bonenberger, Aikins, Akweongo, & Wyss, 2014). This is then followed by
a synthesis of this and additional research into the knowledge, motivational, and organizational
factors that influence a leader’s impact on employee turnover.
Employee Turnover and Retention
Employees leave organizations for a variety of reasons. Studies conducted by a variety
of researchers have identified numerous factors that influence employee turnover, ranging from
organizational, interpersonal, and personal, to environment and work (Lee & Mowday, 1987;
Lockwood & Ansari, 1999; Porter & Steers, 1973). Some employees leave for reasons that are
outside of the control of the organization, such as finding other sources of employment,
retirement, relocation, or taking care of a sick relative, and some simply decide to leave a
company in order to explore full-time education (Allen, Bryant, & Vardaman, 2010). Others
leave organizations due to internal organizational factors such as pay structure, hiring practices,
management style, workload, and workplace environment (Scott et al., 2012). All of these
scenarios represent employee turnover in an organization.
While it is inevitable that every employee will eventually leave an organization for one
reason or another, influencing turnover is not beyond an organization’s control. Baysinger and
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Mobley (1984) argue that it is ineffective for HR Professionals to focus their attention on
influencing those varying individual and personal reasons, such as family changes or relocation.
Instead, a macro perspective should be utilized in order to understand the overall organizational
retention rate as it pertains to the specific organization and the specific internal factors that may
be within their control.
Employee Turnover: A Conceptual Framework
Employee turnover is a complex phenomenon that Griffeth and Hom (2001) represented
as shown in Figure 1.

Figure 1. Employee turnover (Griffeth & Hom, 2001)

Voluntary vs. Involuntary Turnover
Historically, turnover was addressed as a broad concept pertaining to the loss of any
employee under any circumstance and the conceptualization of the concept of turnover was
generally neglected (Hom & Griffeth, 1995). Although turnover has been researched since 1917,
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March and Simon (1958) were the first to develop a formal employee turnover model in 1958
(Hom, Lee, Shaw, & Hausknecht, 2017; Ramesh & Gelfand, 2010). March and Simon (1958)
introduced the concepts of job satisfaction and job mobility, and became the cornerstone for
more complex turnover models (Hom et al., 2017). One of the earliest dissections of turnover
was by Price in 1977 when he identified the need to differentiate turnover by how employees
were exiting an organization. Price separated organizational turnover into two categories:
voluntary and involuntary (Price, 1977). Voluntary turnover, or employee withdrawal, is
turnover that is initiated by the employee; for example, the worker quits to take another job
(Allen, 2008).
Voluntary turnover is associated with employee turnover intentions. Employee turnover
intentions are referred to as the estimated probability or willingness of an employee to
voluntarily leave an organization (Griffeth, Hom, & Gaertner, 2000; Hellman, 1997; Hom &
Griffeth, 1995; Price, 2001; Radzi, Ramley, Salehuddin, & Othman, 2009). Empirical studies
have shown that an employee’s turnover intentions may be the best predictor of actual turnover
(Cotton & Tuttle, 1986; Griffeth et al., 2000; Lambert, Hogan, & Barton, 2001; Price, 2001).
Conversely, involuntary turnover refers to termination actions imposed by the
organization on an employee who otherwise would have stayed on the job. Involuntary turnover
is initiated by the organization and is the formal dismissal of an employee that the organization
no longer wants or needs. For instance, a company may terminate an employee due to poor
performance or lay off an employee due to an organizational restructuring (Campion, 1991).
Research suggests that in order for an organization to positively reduce turnover, it should focus
on voluntary turnover as the dependent variable (Dalton & Todor, 1982).
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Functional vs. Dysfunctional Turnover
Departing from the conventional belief that all turnover is negative, researchers suggest
that, depending on who is leaving the organization, turnover can actually prevent stagnation and
complacency, facilitate change and innovation, as well as displace poor performers (Griffeth &
Hom, 1995). Dalton, Todor, and Krackhardt (1982) refined the turnover criterion and introduced
a revised taxonomy that classified voluntary turnover in terms of functionality, where turnover
functionality emphasizes the performance between stayers and leavers (Hollenbeck & Williams,
1986). According to Campion (1991), Dalton, Krackhardt, and Porter (1981) defined
functionality in terms of the organization’s evaluation of the leaver’s and stayer’s performance
level and value to the organization. Voluntary turnover was classified as either “functional”
(good performers stay and poor performers leave) or “dysfunctional” (good performers leave and
poor performers stay (Abelson & Baysinger, 1984). Hansen (2005) suggested there is a clear
need for organizations and HRM practitioners to distinguish between the two and determine the
actual value of the employee’s work, when assessing the impact of and trying to address turnover
issues.
Dalton et al. define dysfunctional turnover as turnover that happens when the
organization prefers to retain the individual (Dalton et al., 1981). Along with the loss of
desirable talent, dysfunctional turnover is also disruptive and costly to the organization because it
is usually unplanned and unwanted, which can be harmful to the organization’s success and
performance. With dysfunctional turnover, an organization loses effective, high performing
employees or employees with hard to replace skills (Griffeth & Hom, 2001). This unplanned
departure of highly skilled or trained employees can place a strain on the organization if it is
unable to fill the positions with equally qualified individuals.
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Dalton et al. (1981) defined functional turnover as an employee who wants to leave the
organization, and the organization is unconcerned, usually because of the employee’s poor
performance. Planned and anticipated turnover initiatives, such as layoffs or downsizing, are
also considered functional turnover. Although functional turnover is still disruptive, it can
actually be beneficial to the organization. For example, according to Scott et al. (2012), the exit
of poor performers or employees whose talents are easy to replace is deemed beneficial to the
organization and thus classified as functional turnover.
Realizing that many organizations significantly overstate the impact of turnover on their
organization, Dalton et al. (1981) used the termination records of 1,389 bank tellers from 190
branches over seven months to identify the extent of functional/dysfunctional turnover to
accurately identify the turnover rate of Western Bank branches. The assignment of “functional”
or “dysfunctional” to the employee’s departure was based on three questions: (1) Was the
individual a poor performer? (2) Would the organization be reluctant to rehire the individual?
(3) Can the individual easily be replaced? Focusing on voluntary turnover, Dalton et al. (1981)
was able to determine the bank had an overall turnover rate of 32%. While this number may
seem high, after Dalton et al. reviewed the performance appraisals of these employees, they were
able to divide the quit rate into functional and dysfunctional. The dysfunctional turnover rate
was significantly reduced to 18%. When drilled down even further to determine replaceability, it
reduced to 9%. The findings allowed the bank to understand the true status of its turnover
problem and to strategically focus its attention on developing strategies around the 9% and 18%
versus the 32%.
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Avoidable vs. Unavoidable Turnover
Within the category of “voluntary dysfunctional” employee turnover, Abelson (1987)
further identified “avoidable,” and “unavoidable” quits. Unavoidable quits represent turnover
over which employers have little to no control. These include quits due to childbirth, family
moves, going back to school, acute medical issues, and many others (Griffith & Hom, 2001).
Despite these leaves appearing unavoidable, many organizations attempt to positively impact
these leaves by offering an array of benefits and programs to assist employees in resolving work-
life conflicts. Using a mixed method of 120 interviews and 3,500 electronic questionnaires of
employees in seven case organizations, Anderson and Kelliher (2009) found when organizations
offer flexible working environments, this positively impacts employee engagement and
commitment, thus increasing employee retention.
Avoidable turnover are quits that the employer may be able to directly influence (Allen,
2008). These include departure due to low job satisfaction, poor working conditions,
incompatible corporate culture, dissatisfaction with compensation or pay, management, or a
perceived lack of training or career development (Abbasi & Hollman, 2000; Paré & Tremblay,
2007). Lin and Chang (2005) in a study of employees from two Taiwan-based financial
institutions through questionnaires, found that commitment and retention was higher among
employees who experienced in-house promotions and learning. As a result, many organizations
attempt to reduce avoidable turnover through numerous tactics.
According to Al-Emadi, Schwabenland, and Wei (2015), an abundance of research
demonstrates avoidable turnover can be minimized through the deployment of human resource
practices, such as providing internal promotion and growth, effective employee orientation,
performance-based promotions, employee participatory programs, cross-training or cross-
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utilization, and training focused on future skill requirements. With a sample size of 329,
Rahman and Nas (2013) collected data from 16 public university employees and identified that
employees perceive simple practices, such as career development as one of the predictors of
turnover intentions.
Retaining Core Employees
Although turnover of any type creates cost, both tangible and intangible, a number of
turnover studies (Ananthan & Rao, 2011; Clarke & Herrmann, 2007; De Vos & Meganck, 2008;
Dysvik & Kuvaas, 2010) argue that retention strategies should focus their efforts on managing
voluntary, dysfunctional, and avoidable turnover. Strategic retention initiatives should be
targeted and focus on the retention of top performers versus all employees. This process is
effective because it has been well documented that employees have disparate levels of
knowledge, skills, and abilities that affect performance and differentiate organizational
contribution (Nyberg, 2010). According to Mahal (2012), top performing employees tend to
generate high-performance business outcomes as measured by increased sales, improved
productivity, and profitability. Compared to lower-performer turnover, higher-performer
turnover can be disproportionately detrimental to organizational success (Wright & McMahan,
1992).
Defining core employees. Core employees are defined as employees who are considered
the strongest performers, have high potential, or are in critical jobs (Scott et al., 2012). Turnover
of core employees is critical to an organization because it negatively impacts the quality and
innovation of service an organization delivers (Abbasi & Hollman, 2000). Organizations that
fail to accurately understand turnover will have a hard time truly retaining core employees and
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will inevitably be left with an understaffed, less qualified workforce that ultimately hinders their
ability to remain competitive (Hausknecht, Rodda, & Howard, 2009).
To put the importance of employee capability in perspective, according to Hunter,
Schmidt, and Judiesch’s (1990) meta-analysis study, the top 1% of employees outperforms
average performers by 52% in low-complexity jobs, by 85% in medium-complexity jobs, and by
127% in high-complexity jobs. Given the magnitude of the output differences among varying
degrees of workers, the specific problem of retaining top talent is important to address because
losing key talent is critical to an organization’s success.
An organization that disproportionately loses a high number of good performers would
have more cause for concern than one that loses predominantly poor performers. In other words,
the organizational consequences of turnover are dependent on exactly who stays and who leaves.
Understanding the complexities and importance of retaining top talent in today’s organizations is
important to practitioners because many organizations are not effective at identifying who is
leaving and who is staying, causing them to deploy organizational wide “blanket” HRM
strategies to decrease overall turnover.
Distinguishing core from non-core employees. According to Scott et al.’s (2012)
research, 5,000 senior level members from numerous organizations provided survey responses
indicating that more than half (53%) of their organizations have a clear definition of core
employees, and 60% have identified the individuals who make up core employees. More than
75% of respondents stated that core employees were defined as employees who are top
performers, demonstrate high potential, or are in critical jobs. When they conducted an analysis
of bivariate correlations, they found that organizations that “have a clear definition of core
employees” and “have identified core employees” were more confident in their ability to retain
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core employees. Organizations that report that they are more confident in their ability to retain
employees believe that their retention rate is above average for their industry. The data indicate
that a best practice for organizations is to clarify the meaning of the term “core employees,”
define in relation to employee groups, and develop retention programs targeted specifically for
these groups (Scott et al., 2012, p. 58).
Along with the lack of clarity of employee turnover, many organizations find themselves
ineffective at clearly defining, identifying and retaining the people they actually want to keep,
their core employees. In today’s competitive world, organizations must acknowledge that high-
performing employees are looking for more than “attractive” compensation packages and
benefits as a way to retain them. Today’s employees are looking for interesting and challenging
work, flexibility, feeling valued, and having training and advancement opportunities. All of
these are among the major factors that are influencing highly sought after employees’ decision to
change jobs (Cunningham, 2006).
Factors Influencing Employee Retention and Turnover
Employee Motivation
Motivation, in the context of the working environment, has been described as a set of
psychological, emotional, and transactional processes between the organization and the
employee. Motivation is both psychological and emotional because the thoughts and feelings
that an employee has regarding their working environment have been shown to both drive and
justify the employee’s behaviors at work. Work motivation is also transactional because it is the
result of the interactions between the employee and their work environment. All of which
contributes to employees’ turnover intentions, commitment, effort, satisfaction, performance, and
quality of work. Willis-Shattuck et al. (2008) conducted an extensive literature review on nurse
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turnover and identified a mix of intrinsic and extrinsic motivational variables as necessary and
core factors to positively affect their retention (Willis-Shattuck et al., 2008).
Intrinsic motivation. Intrinsic motivation is commonly defined as someone “doing
something for its own sake” (Cho & Perry, 2012, p. 384). Intrinsic motivators are intangible,
and are largely associated with feelings such as esteem, enjoyment, satisfaction, growth, and
challenge. This includes variables such as the pursuit of an instrumental goal, achievement,
informal recognition, responsibility, appreciation, and advancement (Herzberg, Mausner, &
Snyderman, 1959). Employees are intrinsically motivated when they engage in an activity at
work purely to seek enjoyment, interest, satisfaction, or personal challenge (Amabile, 1993). For
example, intrinsic motivation is when an employee volunteers to work a project in order to gain
more knowledge or experience (Reiss, 2012). Table 2 shows a few examples of intrinsic
motivational variables that contribute to employee retention.

Table 2
Intrinsic Motivational Variables that Contribute to Employee Retention
Self-esteem Appreciated / Valued Self-efficacy / Confidence Interesting
Satisfaction Informal Recognition Flexibility Valance
Growth / Learning /
Advancement
Achievement Competence Instrumentality
Stimulating / challenging
work
Sense of Belonging Self-worth Acceptance
Enjoyment Job Security Feels cared for Interpersonal
relatedness
Self-determination Autonomy Meaningfulness /
Fulfillment
Expectancy
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Extrinsic motivation. Conversely, extrinsic motivation is a form of motivation that
comes from expectations and tangible rewards (Cho & Perry, 2012). This type of motivation is
external from the employee, and lies within the organization. Extrinsic variables include
competitive salary/benefits, prestige/status, company policies, formal feedback from a leader,
positive recognition for good work from others, good interpersonal relationships with co-
workers, job security, the physical work environment, and a friendly working environment
(Reiss, 2012). Employees are extrinsically motivated when they engage in an activity at work in
order to obtain a goal that is a part of the work (Amabile, 1993). While Herzberg et al. (1959)
cite that extrinsic variables do not necessarily motivate an employee to do something, empirical
studies (Kinnear & Sutherland, 2001; Maertz & Griffeth, 2004; Meudell & Rodham, 1998) have
discovered that extrinsic motivators are important and necessary factors that positively contribute
to employee retention. Table 3 provides a few examples of extrinsic motivational variables that
contribute to employee retention.
Despite the fact that individuals are endowed with intrinsic motivational tendencies,
motivation only appears to be expressed under specific conditions (Deci & Ryan, 2000). Leaders
must realize the importance of facilitating a working environment focused on both intrinsic and
extrinsic motivators in order to increase job satisfaction and employee retention.

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Table 3
Extrinsic Motivational Variables that Contribute to Employee Retention
Salary / Benefits Formal Recognition Goal Clarity Accountability for
Performance
Workload Formal Coaching /
Feedback
Interpersonal
Relationships
Support Provided
Leadership Style Training &
Development
Opportunities
Skill / Task
Variety
Task Difficulty
Procedures Culture Pay for
Performance
Career Advancement
Opportunities
Necessary resources
/ tools/ technology
Policies / Practices Task Significance Communication /
Information Flow
Rewards Fairness / Justice Working
Conditions
Compliance / Quality
Standards

Job Satisfaction
Job satisfaction is a frequently studied motivational outcome in employee retention
literature (Bonenberger et al., 2014). Job satisfaction is defined as the extent to which an
employee likes (satisfaction) or dislikes (dissatisfaction) their job (Spector, 1997). According to
Mobley, Griffeth, Hand, and Meglino (1979), job satisfaction is the state in which an employee’s
needs and the outcome of the role match well. Tett and Meyer (1993) and Robbins (2001)
defined job satisfaction as the gap between expected satisfaction and actual satisfaction. Davis
(2004) believed that job satisfaction is the level of like an employee has towards their job. If
work characteristics are seen as favorable by the employee, satisfaction is high.
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There is ample support in the literature that shows that job satisfaction and employee
turnover are strongly linked (Ahuja, Chudoba, Kacmar, McKnight, & George, 2007; Billingsley
& Cross, 1992; Delfgaauw, 2007; Falkenburg & Schyns, 2007; Gersten, Keating, Yovanoff, &
Harniss, 2001; Griffeth et al., 2000; Kerr & Slocum, 1987; Mudor & Tooksoon, 2011; Park &
Rainey, 2007; Price & Mueller, 1981; Rajendran & Chandramohan, 2010; Ramlall, 2003, 2004;
Samuel & Chipunza, 2009). Behavioral and social science research suggests that job satisfaction
is directly correlated with employee retention and job performance, and has repeatedly been cited
as the single most important reason why employees leave their jobs (Abu Elanain, 2014; Allen &
Griffeth, 2001; Egan, Yang, & Bartlett, 2004; Wright & Bonett, 1992). High job satisfaction
leads to low turnover. Thus, an employee who is satisfied with his/her job, performs better and
is less likely to leave the organization (Awang & Ahmad, 2010).
In healthcare, this issue is even more critical because high turnover rates and poor job
performance adversely affect the medical care provided to patients and patient outcomes
(Dall’Ora, Griffiths, Ball, Simon, & Aiken, 2015). In a 2014 empirical study, 1200 nurses from
four hospitals participated in a cross-sectional study that identified that low job satisfaction led to
a decrease in productivity, performance and quality of patient care (Khamisa, Oldenburg, Peltzer,
& Ilic, 2015). Consequently, by creating an environment that promotes job satisfaction and
employee retention, an MCO can develop employees who are motivated, productive, and
fulfilled, in turn contributing to higher quality patient care, outcomes, and patient satisfaction.
Importance
In any industry, it is important to understand the scope of employee turnover and the
moderating factors affecting it in order to retain core employees (top /critical talent). While the
literature provides extensive information on the numerous intrinsic and extrinsic factors that
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leaders can use to positively improve employee turnover and satisfaction, many leaders have
failed to identify and properly utilize the most impactful variables as retention strategies (Samuel
& Chipunza, 2009).
Stakeholder Knowledge, Motivation, and Organizational Influences
The literature review above shared how organizational factors, all ultimately driven by
leaders, are key influencers of an employee’s motivation, organizational commitment, job
satisfaction, and ultimately employee turnover (Portoghese et al., 2015; Vroom, 1964).
Therefore, it is of interest to identify the key drivers that permit leaders to create a culture where
core employees want to stay. To better understand this phenomenon, this literature review
utilized the Clark and Estes (2008) gap analysis framework to understand knowledge,
motivational, and organizational factors influencing leaders’ ability to retain core employees.
Clark and Estes’ (2008) gap analysis operates under the assumption that all performance
gaps stem from three distinct categories: knowledge and skill, motivation and will, and
organizational factors. These three categories are referred to as the “Big Three” (Clark & Estes,
2008, p. 43) causes of performance gaps or KMO (knowledge, motivation, and organization).
While each of the “Big Three” is distinct, large organizational performance gaps are often
complex and involve elements of all three. Once the KMO influencers have been identified, they
must then be analyzed to either validate the influence is either a positive (asset) or negative (gap)
that may be contributing to, or detracting from the organizational goal. Based on this analysis,
the practitioner should be able to offer solutions to the organization that will assist in
implementing solutions that will improve and/or close the identified performance gap. As in any
system, the new system must be evaluated and monitored.
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Simply knowing what to do is often not enough; leaders must also know why certain
practices are important, why they should be utilized, and how to effectively apply them. The
remainder of this chapter will pull from existing literature to detail the assumed knowledge,
motivational, and organizational factors that could contribute to a leader’s ability to effectively
create a working environment that increases functional employee turnover. The first section
reviews assumed knowledge influences impacting leaders’ ability to retain employees.
Knowledge will be broken down into the three knowledge types: (1) declarative; (2) procedural;
and (3) metacognitive. Leaders need to know the terms and concepts of employee retention and
functional turnover; how to engage in activities that promote functional turnover, and have a
self-awareness of their understanding and thinking of employee retention and their role in it.
A review of literature of will dive into three motivational theories to identify the assumed
motivational factors influencing leaders’ ability to retain employees then follows. The
motivational theories of focus for this research include: (1) self-efficacy; (2) interest; and (3)
expectancy theory. This chapter will conclude with a look at the organizational related elements
that impact leaders’ ability to retain employees.
Knowledge and Skills
Declarative knowledge. Krathwohl (2002) revised Bloom’s Taxonomy and identified
four distinct knowledge types: factual, conceptual, procedural and metacognitive. Declarative
knowledge, or knowledge of “that,” comprises both factual and conceptual knowledge. It is
knowledge that one is aware of and can articulate clearly (Phillips & Carr, 1987; Sahdra &
Thagard, 2003).
Factual knowledge. Factual knowledge includes simple, stateable facts such as dates,
terminology, symbol, names, components, specific details, etc. (e.g., the name of a body part)
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(Unger, 1968). Conceptual knowledge includes having a deeper level of understanding of a
concept, principle, or theory and the relationship between the various components of that
concept, principle, or theory (e.g., understanding how the cardiovascular system works within
the human body) (Krathwohl, 2002).
Conceptual knowledge. Conceptual knowledge makes the facts useable and valuable. In
terms of leadership, with the fast pace of a work environment and high workloads, managing
tasks does not always require leaders to go beyond the surface of a concept or situation to access
its deeper meaning (Chi, Feltovich, & Glaser, 1981; Gott et al., 1989). The use of surface
knowledge is seen in tasks like providing coaching and feedback to employees. Although
coaching and feedback is a complex communication concept, it has become such a common
“task” requirement of most leaders, they often do not look beyond the surface of the concept.
However, without a deeper understanding of what coaching and feedback is and what should be
involved, the leader’s interaction with the employee may simply become a quick and
meaningless conversation in an effort to mark the task complete. According to Chi et al. (1981),
deep conceptual knowledge is required for high performance.
Procedural knowledge. Procedural knowledge, also known as knowledge of “how,” is
exercised in one’s ability or in understanding how to do something (Krathwohl, 2002).
Procedural knowledge comprises techniques, skills, and abilities and enables a person to take
action and is derived from rules, processes, or instructions (Star, 2002). McCormick (1997)
proposes that there are three levels within procedural knowledge. The first level is specific to a
person knowing how to do something that is common or routine to them. The second level is
one’s ability to break up tasks, while the third level involves the ability to observe and rearrange
the order or change direction when necessary. The role of higher level procedural knowledge is
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45
important when engaging in non-routine activities and complex problem solving (Gott et al.,
1989). In leadership, because people are the focus, high procedural knowledge is paramount to
manage the complexity and uniqueness of each human interaction.
Metacognitive knowledge. Lastly, the metacognitive knowledge category is more
abstract and is the learner’s knowledge of “self” (Krathwohl, 2002). It includes strategic
knowledge and a leader’s self-awareness of their own knowledge of the topic and how they
conceptualize the topic. To ensure effective leadership, all four of the knowledge dimensions are
important. This literature review will identify the factual, conceptual, and metacognitive aspects
of knowledge as they pertain to XYZ’s leaders and how their knowledge can influence employee
retention rates.
Assumed declarative knowledge influences. In order to meet the organizational goal of
decreasing dysfunctional voluntary turnover, leaders must first have the necessary declarative
knowledge to truly know and understand the goals of the organization. Employee turnover is
complex. To meet the goal and successfully create an environment where core/key employees
want to remain, leaders must know what the literature says about the employee retention of core
employees and how their role as a leader influences turnover.
Leaders need to know their role as a leader and how their role influences employee
turnover. While there are many factors that contribute to employee retention in an organization,
leaders can credit themselves, and their behavior, with having the most significant influence on
employee retention (Chitra, 2013). “People don’t quit companies, they quit their managers”
(Anonymous). Leaders have been tied to employee turnover through this well-known adage for
years, and research has proven that it is true. The 1995 study conducted by McNeese-Smith
(McNeese-Smith, 1995) found that an employee’s perception of an organization was strongly
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46
influenced by their relationship with their supervisor. Previous research has shown this to be
true. According to numerous authors, an employee’s direct leader is a key factor in an
employee’s intention to voluntarily stay with or leave an organization (Ansari, Kee Mui Hung, &
Aafaqi, 2007; Dunegan, Uhl-Bien, & Duchon, 2002; Gerstner & Day, 1997; Griffeth et al., 2000;
Jordan & Troth, 2011; Mobley et al., 1979; Morrow, Suzuki, Crum, Ruben, & Pautsch, 2005;
Mosadeghrad, 2013; Schyns, Torka, & Gössling, 2007; Vecchio & Norris, 1996). Leaders are
not only a source of information; leaders also influence employees’ perceptions of their work
climate within the organization (Park & Shaw, 2013).
Employee turnover is a complex phenomenon; and leaders must be equipped with variety
of skills in order to both manage, and positively influence it. DuBrin (2015) defines leadership
as one’s ability to inspire employees so that they are confident and able to achieve a common
goal. DuBrin’s definition is a mix of interpersonal technical skills. Leadership is a balance of
relationships (inspire) and strategy (goal). In order to be effective, leaders must understand how
to manage the people side of their role, as well as the strategic side.
The importance of these leadership functions has played out in the literature through the
long fought debate of management versus leadership. According to Kotter (2001), management
is the role of an individual who manages tasks through the key functions of planning, budgeting,
organizing, problem solving, and controlling, in order to achieve a desired goal (administrative).
On the other hand, leadership is the role of an individual who sets direction, aligns people,
motivates, inspires, encourages, and develops people (interpersonal). In the book Instant
Leadership, Paul Birch noted that managers devoted more of their time and attention to the tasks
that needed to be accomplished, while leaders were more concerned about the people completing
the tasks (Birch, 1999).
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Kotter (2001) considers leadership and management complimentary and both necessary
to achieve organizational goals. The same is true in terms of critical leadership behaviors for
managing employee retention. Factors influencing employee retention are a combination of both
leadership and management characteristics. Several authors have identified the relationship they
have with their leader, as well as specific leadership behaviors such as appreciation, support,
encouragement, respect, and an opportunity to be heard as having a direct correlation to
enhancing employee retention (Butcher & Kritsonis, 2007; Howard & Gould, 2000). On the
other hand, research confirms that management attributes such as providing goal clarity and
opportunities to learn and develop enhance employee retention (Arnold, 2005; Herman, 2005;
Hiltrop, 1999). It is clear that employees value a leader that they can have a trusting relationship
with, as well as respect. To enhance employee retention, leaders will have to know how to build
positive relationships with their employees and set strategy to accomplish results.
Leaders need to know what growth and development opportunities are and how growth
and development opportunities contribute to functional employee turnover. An important
aspect of an employee’s turnover intentions is their perception of the promotion and career
advancement and development opportunities available to them (Hausknecht et al., 2009).
According to the Business & Management Dictionary (2007), career development (i.e., career
growth) is defined as: “progression through a sequence of jobs, involving continually more
advanced or diverse activities and resulting in wider or improved skills, greater responsibility
and prestige, and higher income” (p. 1353). Growth and development occurs in an organization
where employees receive encouragement and support in the development of their job
performance and interpersonal skills. To promote learning and development, organizations
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48
provide employees with a wide range of internal and external opportunities, such a goal setting,
training, coaching and feedback and mentor programs.
In order to maximize the efforts of employees, employers must hire the best and retain
their key knowledge and skills. Employee retention is most effective when employers know
what their employees expect from them. Numerous studies have shown that employees expect
opportunities for training and development (Anis, Ijaz-Ur-Rehman, & Safwan, 2011; Arnold,
2005; Britt, Dickinson, Greene-Shortridge, & McKibben, 2007; Hay, 1999; Herman, 2005;
Hiltrop, 1999; Hytter, 2007; Kotze & Roodt, 2005; Kyndt, Govaerts, Dochy, & Baert, 2011;
Markinor, 2003; Ramlall, 2004; Rodriguez, 2008; Samuel & Chipunza, 2009; Shelton, 2001).
According to Arnold (2005), effective development activities such as training and development
increase the probability that employees will be successful in their roles and improve the
likelihood of retention.
A 1999 Gallop poll listed a lack of opportunities to learn and grow as the top reason for
employee dissatisfaction (Chew & Entrekin, 2011). Employees expect to learn new skills and
knowledge and have an opportunity to apply them on the job (Noe, 2012).
According to a survey conducted by the American Management Association (Tompson,
2008), currently, only “thirty-eight percent of U.S. organizations reported that their organization
uses development, frequently or a great deal, as a way to improve retention rates” (p. 13).
However, employers are beginning to see that employees are increasingly seeing development
opportunities as valuable and portable job perks. An analysis of the AMA survey (Tompson,
2008) showed that the largest percentage of respondents (60%) report that their organization uses
development tools, either a lot or a great deal, to retain high potentials.
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Assumed procedural knowledge influences. In addition to a conceptual understanding
of the impact certain leadership practices have on employee retention, leaders must also know
how to effectively put those practices into play. To be successful and meet the organizational
goals, leaders need to understand their role as a leader and what impact their practices and
behaviors have on employee retention. This involves leaders having the procedural knowledge
of five identified leadership behaviors that positively contribute to functional voluntary turnover,
including (1) identifying core employees; (2) goal setting; (3) relationship building; (4) coaching
and development; and (5) training and development.
Leaders need to know how to define and identify core employees in order to retain
them. Following the above distinction between functional and dysfunctional turnover, it is
important that a leader is able to identify who is leaving in order to correctly manage turnover.
According to Mobley (1982), understanding the true impact of turnover is dependent on who
leaves and who stays. According to the literature, core employees, or top performers and critical
employees, are defined as permanent workers that have a full-time position within an
organization and are individuals whose knowledge and performance significantly contribute to
the success and performance of the organization (Segal & Sullivan, 1997). Core employees
contribute greatly to an organization’s ability to be competitive in the marketplace (Chew &
Entrekin, 2011). It is critical for leaders to identify individuals in critical positions, as well as
distinguish top performers from average and low performers. If the goal is to retain top
performers and critical employees, leaders must first define who these individuals are. In order
for leaders to accurately identify top / core performers, they have to know the roles of their
employees, what performance in those roles look like, and have an accurate way to measure the
performance in comparison to others in that role (Scott et al., 2012).
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Leaders need to know how to provide effective goals to employees. Providing goal
clarity and directedness are critical roles for leaders (Cho & Perry, 2012). Goal clarity is
important to employees as it guides them in a specific direction, and assists them in
understanding the most effective channel to direct their efforts (Ghosh, Satyawadi, Prasad Joshi,
& Shadman, 2013). Locke and Latham’s (1990) goal setting theory hypothesizes that when
leaders provide employees with clear and challenging goals, motivation increases. Chun and
Rainey (2005) further demonstrated the impact of goal setting on employees with their empirical
study of federal agencies, where they found that employees who were given ambiguous goals
suffered from low performance. In Ghosh et al.’s (2013) empirical study, factor analysis
revealed that goal clarity of organizational goals is important to all employees, and that it is vital
to employees’ turnover intentions that employees feel their job / role plays an imperative part in
achieving the goals.
In an effort to identify proactive measures an organization should take in order to retain
core/key performers, Ghosh et al. (2013) conducted an empirical study of 100 employees to
identify the predictors of an employee’s intent to stay with a company. Initial data from factor
analysis identified seven initial factors: goal clarity, autonomy, employee engagement, affective
commitment, organizational culture, benefits, and normative commitment. Discriminant analysis
was then conducted on these factors to identify the best predictors of employee turnover
intentions. Results showed that affective commitment, normative commitment, and goal clarity
were the best predictors of an employee’s turnover intentions. Similarly, Moncarz, Zhao, and
Kay (2009) conducted an empirical study of 24 management companies in the U.S. lodging
industry which identified four key factors that reduce non-management employees’ turnover
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51
intentions. These include organizational mission, goals and direction, employee recognition, and
rewards and compensation.
Ghosh et al. (2013) conducted an empirical study of 100 employees and concluded five
specific leader behaviors of goal setting that positively influence employee retention intentions.
First, the study highlighted that goal clarity was important to all employees and plays an
imperative role in achieving organizational goals. It further contends that it is important that
leaders communicate the goals clearly and in a timely manner. The study also reveals that
employees aspire to participate in the development of their own goals. Lastly, for employees to
feel satisfied, the needs and goals of the employees must be in alignment with the goals of the
organization.
Leaders need to know how to build effective relationships with their employees. As
stated earlier, while there are many factors that influence employee retention, an employee’s
direct leader is a key factor in an employee’s turnover intentions (Allen et al., 2010). Many
researchers have reinforced the correlation between interpersonal relationships and employee
turnover by finding that constituent attachment at work, with a direct leader or coworkers, is a
primary force that embeds employees in an organization, thus promoting employee retention
(Maertz & Campion, 2004; Maertz & Griffeth, 2004). According to Hausknecht et al. (2009),
constituent attachment is the degree of attachment to individuals associated with the
organization, such as supervisors, coworkers, or customers. As Duck (1985) noted, relationships
affect every aspect of the human experience, including an employee’s work.
Constituent behavior is related to the interpersonal skills and behaviors necessary for a
leader to build trusting relationships with their employees. A leader’s relationship with their
employees is an important component of employee commitment, job satisfaction, and retention
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52
(Lorber, Treven, & Mumel, 2018). As a result, leaders must know how to build quality, trusting,
and respectful interpersonal relationships with their employees. Tews, Stafford, and Michel
(2014) noted that low-quality interpersonal relationships between leaders and their employees
have negative organizational consequences, such as increased employee turnover. Ledingham,
Bruning, Thomlison, and Lesko (1997) conducted a qualitative study and, through focus groups
of employees, identified a strong correlation between an employee’s commitment and turnover
intentions and specific leader characteristics. These interpersonal characteristics include:
integrity, respect, competence, character, trust, reliability, truthfulness, and open communication.
In the aspect of effective leadership practices, Porter and Steers (1973) identified high
turnover rates among employees when they felt their direct leaders treated them poorly, were
inconsiderate, or did not meet their needs regarding providing recognition or adequate coaching
and feedback. In order to increase retention among core employees, leaders have to know how
to build trusting and respectful relationships with their employees.
Leaders need to know how to provide effective coaching and feedback. For leaders to
assist their employees’ growth and development, they need to know to provide effective
coaching and feedback. According to Sandhya and Kumar (2014), leaders could better manage
employee retention by motivating their employees by means of open communication.
A major responsibility of a leader is to provide their employees with effective coaching
and feedback. Coaching and feedback is an organizational communication process, initiated by
the leader, that helps employees understand workplace expectations and identifies opportunities
for growth and development (Ashford & Cummings, 1983). Coaching and feedback
conversations provide employees with an opportunity to gain valuable knowledge about
themselves, increasing their self-awareness, thus allowing them to learn to improve their
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53
behavioral and technical skills in an effort to enhance their overall performance (Muda, Rafiki, &
Harahap, 2014). According to a 2000 Gallup study, employees who are satisfied with the
frequency, level, and quality of the performance feedback they receive, are found to be more
engaged and committed to the organization, and therefore more likely to be retained (Saks,
2017).
Coaching and feedback is not just a conversation between a leader and an employee. It is
a structured dialogue focused on the growth and development of the employee. Feedback
conversations are geared around the effectiveness of an employee’s performance. There are two
forms of feedback, developmental and constructive. Developmental feedback is where the leader
engages the employee in a learner-centered conversation that is focused on developing human-
capitol (Ellinger & Bostrom, 1999). Through a collaborative discussion, the leader encourages
and motivates the employee to learn and build esteem.
Conversely, constructive feedback indicates that an employee’s performance does not
meet expectations. In this case, the supervisor should provide the employee with “coaching”
which addresses how performance can be improved. Both feedback and coaching are essential
to enhancing an employee’s performance and are a part of a larger system called performance
management. Low-performing employees were cited as the recipients of constructive feedback.
According to the American Management Association survey (Tompson, 2008), leaders cited
spending a great deal of the time coaching low performers. Historically, coaching conversations
were focused exclusively on under-performing employees as an attempt to save a career. Now,
however, it is more likely to be seen as a way to groom talented employees in order to build on
their existing talents and strengths (Jarvis, Lane, & Fillery-Travis, 2006).
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Organizations employ coaching of their staff for three purposes, for growth, retention and
improvement. The first, growth coaching, is coaching that is designed to foster employee
development for promotions, lateral moves, or special projects and assignments. These coaching
conversations allow individuals to assess where their career is now and where they may want it
to go. Coaching is also used as a tool to retain high potential and core employees. Lastly,
coaching is utilized by leaders to improve performance of an employee that is off track
(Underhill, McAnally, & Koriath, 2007).
Researchers such as French and Bazalgette (1996) have acknowledged that “teaching as a
core leadership competency” has largely been ignored in literature and asserts that “management
is learning and teaching” (p. 114). Serving as a teacher, however, does not mean that the leader
is an “authoritarian expert” whose job is to teach their employees “the correct” way of doing
things (Senge, 1990, p. 11). Instead, the leader is more of a coach and facilitates an environment
that makes learning and professional growth easier and more accessible for the employee
(McGill & Slocum, 1998; Mink, Owen, & Mink, 1993). With coaching and feedback having
such a significant influence on employee retention, leaders within XYZ Healthcare will have to
ensure they have the necessary knowledge and skills to effectively provide coaching and
development to their employees.
Leaders need to know how to help their employees plan and develop their long term
career objectives. In an era of constant industry changes and technological advances, leaders
need to know that the training of their staff is a necessity in order for their organization to remain
competitive (Stewart & Waddell, 2003). Career development is comprised of a variety of
strategic activities aimed to prepare employees within an organization with the necessary skills
and knowledge to meet current and future goals of the organization (Peteraf, 1993). Human
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Resources often regard training and development as a systematic approach that involves learning
activities aimed at improving job performance of individuals within the organization and
organizational effectiveness (Goldstein & Ford, 2002; Stavrou, Brewster, & Charalambous,
2004). Without adequate training programs, an organization runs the risk of suffering in the
areas of quality and implementation (Barden, 1997).
However, development programs are more beneficial than just increasing knowledge and
productivity within an organization. Providing training and development to employees has been
identified as a key retention for top performing and core employees. According to research,
employee learning has a strong effect on retention (Echols, 2007; Gershwin, 1996; Rodriguez,
2008). As a result, leaders today need to have the necessary skills and knowledge to use training
and development as a tool to meet the learning needs of their employees. Learning is especially
important to the turnover intentions of top performers. According to Rodriguez (2008):
If employees feel they aren’t learning and growing, they feel they are not remaining
competitive with their industry peers for promotion opportunities and career
advancement. Once top employees feel they are no longer growing, they begin to look
externally for new job opportunities. (p. 53)
Training and development provides employees with new skills and also can be
proactively used to mitigate deficiencies in performance (Gomez-Mejia, Balkin, & Cardy, 1995).
Hay (2001) surveyed employees from 330 companies in 50 different counties to measure
satisfaction and employee turnover intentions. Training and development proved to be the most
significant retention factor in their study. Specifically, the report identified that employees were
most likely to leave when they felt their skills or talents were not properly developed or when
their leader failed to take an interest in their career development.
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While Hassan, Razi, Qamar, Jaffir, and Suhail (2013) identified that training and
development is not a strong independent variable that will increase turnover intentions alone,
however, when paired with additional extrinsic factors, such as compensation and promotion,
training and development was found to be a strong dependent variable for increasing employee
retention. As noted by Ramlall (2004), a leader’s demonstrated lack of commitment to the
employee’s long-term development results in a lack of commitment from the employee.
Employee training. In order to be effective, leaders need know how to use employee
training as a tool to improve employee retention. Leaders need to be able to identify the training
and development needs of their employees and establish a strategic and customized plan of
action to improve or enhance employee performance. Employee training is defined as the
development of the knowledge, skills, and abilities that employees require to perform their jobs
competently (Nordhaug, 1989). Training is any activity provided by the organization to advance
learning and increase the knowledge and abilities among members within the organization (Al-
Emadi et al., 2015). The knowledge gained from employee training increases skills needed to
carry out specific activities or tasks, and is intended to be a tool to assist employees to contribute
to the organization and be successful in their role (Fitzgerald, 1992). Hay (2001) report shows
that organizations and their leaders can begin fighting turnover by recognizing training and
development as a core way to keep staff. In order for training to impact employee turnover, an
employee must perceive the training as valuable to them. Value is found when the employee
perceives the training as relevant to them and something they will be able to use to broaden their
knowledge and experience. This is very different from trainings that simply reinforce old skills.
Leaders need to know that training of their employees should begin on day one, with an effective
orientation and continue throughout the employee’s career (Arnold, 2005).
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Employee development. Alternatively, development refers to the career development of
employees within an organization. Development is the management and acquisition of new
knowledge and skills with the purpose of personal growth (Aguinis & Kraiger, 2009). Learning
through development activities can be used in the employee’s current role or in a future position.
Unlike training, development is individualized and the knowledge gained from development
activities is intended to be for the long-term growth and benefit of the employee (Fitzgerald,
1992).
When employees feel they are developing new skills, they are more likely to remain with
the organization (Deckop, Cirka, & Andersson, 2003). Employee development is multifaceted
and can be designed in many ways. Leaders need to know how to use development activities
such as providing effective and consistent coaching and developmental feedback to employees,
establishing a mentor program, advocating for cross-training, developing career tracks, or
allowing an employee to work on a project to effectively assist their employees in their career
development.
Assumed metacognitive knowledge influences. A leader gravitates towards a particular
leadership philosophy and style based on their past experiences with leadership. It is these
experiences and belief system that impact the decision making process of a leader. The question
is how does one develop or examine their own belief system? Through deliberate reflection, the
underpinnings of one’s belief system can be examined, and through this thoughtful examination
growth can occur that will provide an opportunity for increased performance and relationships
within an organization (Van Mullem & Stoll, 2012).
Leaders need to reflect on how their current leadership behaviors impact employee
retention. Leading is widely recognized as requiring complex cognitive and social problem-
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58
solving skills and capacities (Mumford, Friedrich, Caughron, & Byrne, 2007). Metacognitive
ability has been defined as the capacity for higher order processing, or simply, an individual’s
ability to think about the way he or she thinks (Flavell, 1987; Nelson & Narens, 1994). In terms
of leadership, one’s metacognitive ability could be represented by the leader’s ability to examine
his or her own theory of leadership and to consider and make amendments to the theory on the
basis of new experiences accumulated over time. Metacognitive ability is how one is thinking
about their thinking (Nelson & Narens, 1994). This form of “second order” thinking entails
awareness of one’s cognitive processes, cognitive strengths and weaknesses, and cognitive self-
regulation. Also, in the context of this article, such meta-abilities relate to the individual’s
capacity for examining his or her own self-construct.
According to Krathwohl (2002), leaders need to reflect and have a certain level of self-
awareness as it relates to their current leadership behaviors and how they are impacting
employee retention. Metacognition requires critical thinking and inquiry, which is then
predicated upon one’s awareness and ability to take responsibility and control in order to
construct meaning and confirm the meaning (Akyol & Garrison, 2011). In order for leaders to
do this, they will need to see feedback from peers and employees regarding their leadership skills
and reflect upon the responses as it relates to their effectiveness. Reflection is considered the
cornerstone of learning and of personal and professional development (Van Mullem & Stoll,
2012). Researchers support the need for reflection and encourage leaders to examine their
beliefs about their leadership behaviors and how to use that knowledge to construct positive
change (Burgoyne & Reynolds, 1997; Cunliffe, 2002; Lanzara, 1991; Raelin, 2001, 2007;
Reynolds, 1998; Reynolds & Vince, 2004; Vince, 2002).
Table 4 summarizes the knowledge types discussed in this section.
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Table 4
Knowledge Factors
Factor Selected Citations
Knowledge Types Krathwohl (2002)
Declarative Knowledge Krathwohl (2002)
Leaders need to know
their role as a leader and
how their role influences
employee turnover.
Ansari et al. (2007), Arnold (2005), Birch (1999), Butcher and
Kritsonis (2007), Chitra (2013), Dunegan et al. (2002), DuBrin
(2015), Gerstner and Day (1997), Griffeth et al. (2000),
Herman (2005), Hiltrop (1999), Howard (1997), Howard and
Gould (2000), Jordan and Troth (2011), Kotter (2001), Lorber
et al. (2018), McNeese-Smith (1995), Mobley et al. (1979),
Morrow et al. (2005), Mosadeghrad (2013), Schyns et al.
(2007), Vecchio and Norris (1996), Wadhwa and Koul (2012)
Leaders need to know
what growth and
development
opportunities are and
how providing growth
and development
opportunists contributes
to functional employee
turnover.
Anis et al. (2011), Arnold (2005), Business & Management
Dictionary (2007), Britt et al. (2007), Chew and Entrekin
(2011), Echols (2007), Hassan et al. (2013), Hausknecht et al.
(2009), Hay (1999), Herman (2005), Hiltrop (1999), Hytter
(2007), Kotze and Roodt (2005), Kyndt et al. (2011), Markinor
(2003), Noe (2012), Ramlall (2004), Rodriguez (2008),
Samuel and Chipunza (2009), Shelton (2001)

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Table 4, continued
Factor Selected Citations
Procedural Knowledge Krathwohl (2002)
Leaders need to know
how to define and
identify core employees
in order to retain them.
Chew and Entrekin (2011), Mobley (1982), Scott et al. (2012),
Segal and Sullivan (1997)
Leaders need to know
how to provide effective
goals to employees.
Cho and Perry (2012), Chun and Rainey (2005), Ghosh et al.
(2013), Latham (1990), Moncarz et al. (2009)
Leaders need to know
how to build effective
relationships with their
employees.
Allen et al. (2010), Chiok Foong Loke (2001), Duck (1985),
Hausknecht et al. (2009), Ledingham et al. (1997), Maertz and
Campion (2004), Maertz and Griffeth (2004), Porter and
Steers (1973), Tews et al. (2014)
Leaders need to know
how to provide effective
coaching and feedback.
Ashford and Cummings (1983), Ellinger and Bostrom (1999),
French and Bazalgette (1996), Jarvis et al. (2006), McGill and
Slocum (1998), Mink et al. (1993), Muda et al. (2014), Saks
(2017), Sandhya and Kumar (2014), Senge (1990), Underhill
et al. (2007)
Leaders need to know
how to help their
employees plan and
develop their long term
career objectives.
Aguinis and Kraiger (2009), Al-Emadi et al. (2015), Anis et al.
(2011), Arnold (2005), Barden (1997), Deckop et al. (2003),
Echols (2007), Fitzgerald (1992), Gershwin (1996), Goldstein
and Ford (2002), Gomez-Mejia et al. (1995), Hay (2001),
Nordhaug (1989), Peteraf (1993), Ramlall (2004), Rodriguez
(2008), Stavrou et al. (2004), Stewart and Waddell (2003)
Metacognitive Knowledge Krathwohl (2002)
Leaders need to reflect
on how their current
leadership behaviors
impact employee
retention.
Akyol and Garrison (2011), Burgoyne and Reynolds (1997),
Cunliffe (2002), Lanzara (1991), Van Mullem and Stoll
(2012), Raelin (2001, 2007), Reynolds (1998), Reynolds and
Vince (2004), Vince (2002)

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Motivation Influences
Clark (2003) defined motivation as the desire and willingness that generates the mental
effort that drives someone to apply their knowledge and skills to do something. Further, Clark
and Estes (2008) contend that motivation is made up of active choices made by the individual.
Buchanan and Huczynski (2004) defined motivation as the cognitive decision making process
through which goal directed behavior is initiated, energized, directed and maintained. Butler and
Rose (2011) described motivation as the course of movement, the inspiration behind activity, and
the feeling within an individual that makes him want to achieve personal need or expectation.
Within organizations, leaders are the creators and drivers of vision, strategy, and change.
In order for organizations to be successful, they must entrust the fate of their company to people,
specifically leaders. Leaders are the drivers of change and motivation is a critical component
when trying to drive change in an organization. According to Deci and Ryan (2000), “to be
motivated means to do something” (p. 54). The goal of this motivation gap analysis is to explore
the motivational influences that will drive a leader’s choices and efforts to alter certain
leadership behaviors in an effort to increase employee retention. Motivation is an important
component when trying to drive organizational change because motivation influences the type of
task a person chooses to engage in, their initiation to take on the task, the level of intensity and
vigor exerted to the task, the performance level given to the task, and the level of drive
persistence given, despite any obstacle or adversity they may face.
The aim of this section is to discuss assumed motivational influences important for
leaders to be effective in improving dysfunctional voluntary turnover. Two long standing
perspectives on motivation that will be reviewed in this chapter are Expectancy Value Theory
and Self-efficacy Theory. Expectancy is when an individual engages in activities and tasks that
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they feel they are capable of accomplishing. Once engaged, their efficacy beliefs influence how
much effort they devote to the task and how long they will persist at the task, even as adversities
or obstacles arise (Bandura, 1977).
Expectancy-value theory. Expectancy-value theory (EVT) suggests that motivation is
driven by an individual’s expectancy of the preferred outcome and the strength of the
attractiveness of that outcome to the individual (Dugguh & Dennis, 2014). According to Vroom
(1964), motivation is driven by what an individual expects to gain from engaging in an activity
or task, what effort they will need to expend, and whether it is worth it to themselves depending
on their personal goals. EVT is based on three concepts: valance, instrumentality, and
expectancy (VIE). Valance is the perceived value of the outcomes from the activity or task
(Vroom, 1964). Instrumentality is the belief that a reward will be given if the performance
expectation is met. Lastly, expectancy is the degree to which an individual feels their effort in
engaging in the activity will result in a desired outcome. The theory proposes that valance,
instrumentality and expectancy influence an individual’s choice to engage in an activity; their
attitude toward the activity; the amount of effort they will exert toward the activity; their
performance level; and even how persistent they will be in completing the activity (Dugguh &
Dennis, 2014). EVT is a valuable tool that can be used to predict a variety of leadership
behaviors once the valance and probabilities an individual attaches to an outcome are known.
Leaders need to see the value in reducing employee turnover. Individuals are motivated
to engage in an activity if they think it will lead to outcomes that they highly value; and they will
work hard if they believe that their efforts will lead to outcomes they highly value (Wigfield &
Eccles, 2000). It is imperative that leaders understand the impact of employee turnover and see
the value in reducing it. Hale (1998) measured the cost incurred when employers lose a critical
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employee. Employers cited recruitment costs of 50 to 60% of an employee’s first year’s salary
and up to 100% for specialized and high-skilled positions (Ramlall, 2003).
In a 2003 qualitative study, Ramlall (2003) sought to understand the challenges of
employee turnover intentions of critical employees at a large industrial organization. Through a
series of surveys, observations and interviews, Ramlall (2003) identified factors influencing
employee turnover. Out of 78 employees that responded to the survey, approximately 15% of
the respondents cited that they were “likely” or “highly likely” to seek employment elsewhere
within the next one to two years. Regression analysis showed that job satisfaction, lack of
opportunity and growth, lack of recognition, ineffective leadership, and feedback were top
factors influencing this decision.
During the interview sessions, leaders expressed (1) cost, (2) the organization’s ability to
achieve strategic business goals and objectives, and (3) maintaining a competitive advantage as
key benefits for them to retain critical/core employees within their organization. According to
Ramlall (2003), rather than taking the risk of reducing productivity and profitability as a result of
turnover of critical employees, leaders voiced the importance of taking action to identify their
critical/core employees and their motivation to proactively retain critical/core employees.
Leaders need to see the value in adopting and implementing specific leadership
behaviors in an effort to increase employee retention. People are motivated to perform an
activity when they feel they will achieve the thing(s) they want from doing so (Lin, 2007).
According to Vroom (1964), expectancy is the belief that one’s effort will result in the
achievement of the desired outcome (Eccles, Wigfield, & Schiefele, 1997). It is one’s belief that
increased effort will lead to increased performance (Watson & Hewett, 2006). In the case of
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leadership, leaders need to believe that they have the ability to change their leadership behaviors
and that their efforts will positively influence employee retention.
Self-efficacy. Bandura’s (1986) social-cognitive model of motivation focused on the
individual’s perception of themselves in relation to the task. According to Bandura (1986), self-
efficacy is the belief that one has the capability to perform a particular task, which has been
found to influence decisions about what actions to perform and how much effort to exert in
attempting to perform the actions (Bandura, 1977, 1986; Gist, 1987). Greater self-efficacy
strengthens an individual’s belief that effort will result in successful completion of the action.
Thus, self-efficacy should have a positive influence on expectancy, or one’s belief in the
relationship between effort and the achievement of the desired outcome (Galbraith & Cummings,
1967).
Leaders need to believe they are capable of successfully adopting and implementing
specific leadership behaviors in an effort to increase employee retention. In order to decrease
dysfunctional voluntary turnover, leaders need to believe they are capable of successfully
altering their behavior. Like EVT, self-efficacy contends that an individual considers the
outcome and themselves in deciding motivation. Under self-efficacy theory, two expectations
are taken into account: outcome expectations — a person’s belief that certain behaviors will lead
to certain outcomes; and efficacy expectations — a person’s belief about whether one can
perform the behaviors necessary to produce the outcome. The two expectations presented in the
self-efficacy model are distinct in nature because a person can believe a certain behavior will
produce a certain outcome, but not believe they can perform the behavior. Bandura believes that
an individual’s efficacy expectations play major roles in goal setting, activity choices, effort, and
persistence (Bandura, 1986). Therefore, leaders need to believe that they have the capabilities
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necessary to successfully adopt and implement specific leadership behaviors in an effort to
increase employee retention.
Table 5 summarizes the motivational theories discussed in this section.

Table 5
Motivation Factors
Factor Selected Citations
Motivation Types Bandura (1977), Buchanan and Huczynski
(2004), Butler and Rose (2011), Clark (2003),
Clark and Estes (2008), Deci and Ryan (2000)
Expectancy Value Theory Dugguh and Dennis (2014), Vroom (1964)
Leaders need to see the value in
reducing employee turnover.
Eccles et al. (1997), Lin (2007), Vroom (1964),
Watson and Hewett (2006)
Leaders need to see the value in
adopting and implementing specific
leadership behaviors in an effort to
increase employee retention.
Hale (1998), Lin (2007), Ramlall (2003),
Wigfield and Eccles (2000)
Self-Efficacy Theory Bandura (1977, 1986), Galbraith and Cummings
(1967), Gist (1987)
Leaders need to believe they are
capable of successfully adopting
and implementing specific
leadership behaviors in an effort to
increase employee retention.
Bandura (1986)

Organizational Influences
Organizational culture is defined as a way an organization communicates “who we are”
to its external customers and “how we do things around here” to internal members (Drennan,
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1992). Fitz-enz (1990) and Sheridan (1992) describe organizational culture as the invisible
forces that shape the life of the organization. These are the spoken and unspoken beliefs, rituals,
values and attitudes that guide the organization, describing acceptable social norms.
Specifically, organizational culture encompasses management philosophies, practices, and styles,
communication protocols, hierarchy establishment, change processes, and policies, procedures
(Chew & Entrekin, 2011).
The concept of organizational or corporate culture refers to the managerial praxis of
creating internal harmony, uniformity, and ethical unison among its members, and offers
practitioners a comprehensive and symbolic view of their company and how they are
distinguishable from other organizations (Ravasi & Van Rekom, 2003). By articulating a set of
values and then reinforcing those values through formal policies, mission statements, informal
norms, language, stories, and rituals, leaders can use corporate culture as a way to articulate
expected behavior and discourage dysfunctional work behavior (Ogbor, 2001). Culture denotes
the ties that bind members in an organization together. These include “the shared philosophies,
ideologies, values, assumptions, beliefs, expectations, attitudes as well as formal and informal
norms” (Kilmann, Saxton, & Serpa, 1986, p. 88). The many informal norms include gender
roles, dress, language, play, formality, behavior, attitude and a host of others that uniquely make
up who the organization is.
This section focuses on the organizational influences that potentially impact leaders’
ability reduce voluntary, dysfunctional turnover. The “O” in the KMO framework encompasses
specific organizational factors within the organization’s culture, such as processes, procedures,
and resources (Clark & Estes, 2008). These factors play an important role in the organization
reaching its performance goals.
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Cultural models and cultural settings. Some scholars have suggested that
organizational features are more influential in increasing employee engagement than an
employee’s personal attributes (Bakker & Demerouti, 2008). Abelson (1993) introduced the
term “turnover culture” and defined this type of culture as “the systematic patterns of shared
cognitions by organizational or sub-unit members that influence decisions regarding job
movement” (p. 361). Abelson argues that systems and people within an organization may
unintentionally create a culture that promotes high turnover. Abelson argues that in addition to
Schein’s three levels of culture, a fourth level may be included to explain this type of culture
focus. Deery and Iverson (1996) found that turnover culture was the key determinant in an
employee’s intention to leave an organization, significantly impacting overall turnover rates
within an organization.
Cultural models. Organizational culture is present beyond the conceptual. For many
organizations, it is perpetuated through their reward and recognition programs, further defining
what behavior and success within that organization should look like (Wallace, Hunt, & Richards,
1999). A cohesive culture involves shared beliefs and values of the organization and its
members, give it its own unique meaning and provides members with rules for behavior. While
culture is effective in identifying the organization’s beliefs and values, it can also impose its
attitudes, beliefs and behaviors on members in an effort for them to acclimate and become
successful. This has led to a trend of organizations adjusting their recruiting practices to look for
candidates who they consider to be an “organizational fit,” or individuals who fit into their mold
(Trefry, 2006).
Human resource strategies within the organization are aligned with and support the
goal of decreasing voluntary dysfunctional turnover. Kerr and Slocum (1987) argue that
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employee retention might directly be related to an organization’s cultural evidence, suggesting
that an organization’s cultural values influence the human resource strategies it implements,
inadvertently influencing the results of these efforts (employee retention). An example of a
Human Resource strategy is the use of incentive plans to increase employee productivity and
retention. However, if the design and implementation of an incentive plan is influenced by the
organization’s culture, it may also influence the results — the employee’s productivity and
retention.
Kerr and Slocum (1987) studied the reward systems of 14 Fortune 500 companies in the
Northeast and Midwest regions of the United States. In order to identify the impact of
organizational culture on incentive programs, 75 tenured and experienced managers were
interviewed. The results suggested that an organization’s human resource strategies are
inherently influenced by its cultural values, including selection and hiring policies, internal
advancement and training promotion and employee development, and reward systems. The
combination of varying HR strategies selected by an organization, based on its organizational
culture values, result in the development of specific “psychological climates and norms that
foster varying levels of employee commitment and retention” (Deery & Shaw, 1999, p. 395).
Thus, from this analysis, the authors correlated that employee retention at varying performance
levels is closely associated to an organization’s cultural values.
The organization culture is seen as balanced, valuing both people and performance.
Kerr and Slocum (1987) suggest that in some organizational cultures, employee retention might
vary greatly depending on the employee’s job performance. Their research further identified two
distinguishable values in organizational culture: people and performance. Some organizations
have cultures that emphasize values of shared goals, teamwork, security, and interdependence
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(Kerr & Slocum, 1987). However, when there is an emphasis on teamwork, relationships, and a
lack of individual accountability, these cultural values have a tendency to “foster a culture of
loyalty and long-term commitment to the organization among all employees, regardless of job
performance” (Sheridan, 1992, p. 1038).
Other organizations have cultures that emphasize individual performance and reward
employees for accomplishing specific work objectives that impact the bottom-line, regardless of
method of accomplishment. Performance focused cultures tend to place emphasis on rankings
and metrics rather than employee development and constructive feedback. While these cultures
have more quantifiable means of measurement, they foster an individualism and
“entrepreneurial” mindset whereby the “organization does not offer long-term security and the
employees do not promise loyalty” (Sheridan, 1992, p. 1038). In this environment, Kerr and
Slocum (1987) argue that weaker performers would quit more frequently while stronger
performers would stay only to take advantage of the current organization until a better
opportunity presented itself somewhere else. Consequently, in this culture, employee retention
rates may be uniformly high for both strong and weak performers.
Through the use of multivariate statistical analysis, Sheridan (1992) examined
organizational culture and retention rates by looking at 904 college graduates hired in six public
account firms over a six-year period. He assessed the positive relationship between the type of
organizational culture and employee retention by defining culture in a 3-level model developed
through the use of the Organizational Culture Profile (OCP) (O’Reilly, Chatman, & Caldwell,
1991). Sheridan (1992) divided culture values into work tasks and interpersonal relationships
and argued that the relationship between an employee’s job performance and their retention
varies significantly depending on the focus of the organization’s culture and values. When an
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organization’s culture and values are more focused on interpersonal relationships (teamwork,
communication), Sheridan found that overall retention was significantly higher. Hofstede’s
(1998) survey of 2,590 employees in a Danish insurance company confirms that an
organization’s communication and cooperation can negatively or positively impact employee
attitudes (Hofstede, 1998). Conversely, individuals voluntarily quit their jobs at a much higher
rate when the organization’s culture and values are focused predominantly on work tasks.
Cultural settings.
The organization is perceived as being supportive. Perceived organizational support
(POS) is an employee’s belief concerning the extent to which the organization values their
contributions and cares about their well-being (Eisenberger, Huntington, Hutchison, & Sowa,
1986; Shore & Shore, 1995). POS is also assurance that the necessary assistance and resources
will be available from the organization when they are needed to carry out one’s job effectively
and to assist the employee in dealing with stressful situations on the job (Kottke & Sharafinski,
1988). POS addresses the emotional and psychological needs of an employee and is based on
reciprocity. First, POS should provide employees organizational values, vision statements, and
missions that encourage an employee to feel obligation to care about the organization and the
motivation to reach its goals. Second, the culture should fulfill an employee’s socio-emotional
needs by encouraging organizational membership and providing an environment that is caring,
accepting, and respectful. Third, POS involves creating a feeling of safety for an employee
through job security (Allen, Shore, & Griffeth, 1999). The fourth characteristic of POS is
providing an employee clarity through processes, procedures, goals, and role clarity. Several
studies have shown role ambiguity and role conflict moderators in employee turnover intentions
(Rhoades & Eisenberger, 2002).
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The organization provides advancement and growth opportunities. In order to retain
core employees, organizations need to provide them with career growth opportunities.
Employees who perceive that their current organization provides them opportunities to attain
their career goals, or develop new/better job skills, have higher levels of commitment and are
less likely to leave that organization (Weng, McElroy, Morrrow, & Liu, 2010). Opportunities for
learning at work have also become an important determinant of employee job satisfaction, job
attitudes, and commitment (Lankau & Scandura, 2002). On the other hand, people who perceive
little or no opportunity for promotion or growth have far less commitment and an increase in
turnover intentions (Meyer & Allen, 1991). Weng et al. (2010) reinforce this with their
empirical study of 961 employees in 10 cities in China. Weng et al. (2010) conceptualized
career growth as consisting of four distinct dimensions: career goal progress, professional
development availability, promotion speed, and compensation growth. Survey data collected
showed that all four dimensions of career growth were positively related to increased employee
commitment, thus increasing an employee’s turnover intentions.
The organizational culture is seen as transparent, fair, and just. Park and Kim (2009)
found that organizational culture is directly associated with job satisfaction and employee
turnover intentions. Results from a factor analysis showed that employees consider
organizations with a culture of transparency, fairness, and justice as favorable (Joo & Park,
2010). Joo and Park (2010) further contend that having a transparent organization with fair
hiring and promotion policies can better retain key performers.
Table 6 summarizes the organization influences. At the conclusion of this chapter, Table
7 summarizes the key knowledge, motivational, and organizational factors discussed in this
chapter.
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Table 6
Organizational Factors
Factors Selected Citations
Organizational Cultures Chew and Entrekin (2011), Clark and Estes (2008),
Deery and Iverson (1996), Drennan (1992), Fitz-enz
(1990), Hofstede (1980), Kilmann et al. (1986),
Nahavandi and Malekzadeh (1988), Ogbor (2001),
Ravasi and Van Rekom (2003), Sheridan (1992),
Trefry (2006)
Cultural Models & Settings Abelson (1993), Deery and Iverson (1996), Wallace
et al. (1999)
Cultural Models
Human resource strategies within
the organization are aligned with
and support the goal of
decreasing voluntary
dysfunctional turnover.
Deery and Shaw (1999), Kerr and Slocum (1987),
Sheridan (1992)
The organization culture is seen
as balanced, valuing both people
and performance.
Hofstede (1998), Kerr and Slocum (1987), O’Reilly
et al. (1991), Park and Kim (2009)
Cultural Settings
The organization is perceived as
being supportive.
Allen et al. (1999), Eisenberger et al. (1986), Kottke
and Sharafinski (1988), Rhoades and Eisenberger
(2002), Rhoades, Eisenberger, and Armeli (2001),
Shore and Shore (1995)
The organization provides
advancement and growth
opportunities
Lankau and Scandura (2002), Meyer and Allen
(1991), Tansky and Cohen (2001), Weng and Hu
(2009), Weng et al. (2010)
The organizational culture is
seen as transparent, fair, and just.
Joo and Park (2010), Park and Kim (2009)

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Table 7
Summary of Factors Addressed in Study
Factor Selected Citations
Declarative Knowledge Krathwohl (2002)
Leaders need to know their role as a
leader and how their role influences
employee turnover.
Ansari et al. (2007), Arnold (2005), Birch (1999), Butcher and
Kritsonis (2007), Chitra (2013), Dunegan et al. (2002), DuBrin (2015),
Gerstner and Day (1997), Griffeth et al. (2000), Herman (2005),
Hiltrop (1999), Howard (1997), Howard and Gould (2000), Jordan and
Troth (2011), Kotter (2001), Lorber et al. (2018), McNeese-Smith
(1995), Mobley et al. (1979), Morrow et al. (2005), Mosadeghrad
(2013), Schyns et al. (2007), Vecchio and Norris (1996), Wadhwa and
Koul (2012)
Leaders need to know what growth
and development opportunities are
and how providing growth and
development opportunists contributes
to functional employee turnover.
Anis et al. (2011), Arnold (2005), Business & Management Dictionary
(2007), Britt et al. (2007), Chew and Entrekin (2011), Echols (2007),
Hausknecht et al. (2009), Hay (1999), Herman (2005), Hiltrop (1999),
Hytter (2007), Kotze and Roodt (2005), Kyndt et al. (2011), Markinor
(2003), Noe (2012), Ramlall (2004), Rodriguez (2008), Samuel and
Chipunza (2009), Shelton (2001)
Procedural Knowledge Krathwohl (2002)
Leaders need to know how to define
and identify core employees in order
to retain them.
Chew and Entrekin (2011), Mobley (1982), Scott et al. (2012), Segal
and Sullivan (1997)
Leaders need to know how to provide
effective goals to employees.
Cho and Perry (2012), Chun and Rainey (2005), Ghosh et al. (2013),
Latham (1990), Moncarz et al. (2009)
Leaders need to know how to build
effective relationships with their
employees.
Allen et al. (2010), Duck (1985), Hausknecht et al. (2009), Ledingham
et al. (1997), Lorber et al. (2018), Maertz and Campion (2004), Maertz
and Griffeth (2004), Porter and Steers (1973), Tews et al. (2014)
Leaders need to know how to provide
effective coaching and feedback.
Ashford and Cummings (1983), Ellinger and Bostrom (1999), French
and Bazalgette (1996), Jarvis et al. (2006), McGill and Slocum (1998),
Mink et al. (1993), Muda et al. (2014), Saks (2017), Sandhya and
Kumar (2014), Senge (1990), Underhill et al. (2007)
Leaders need to know how to provide
their employees training and
development opportunities.
Aguinis and Kraiger (2009), Al-Emadi et al. (2015), Anis et al. (2011),
Arnold (2005), Barden (1997), Deckop et al. (2003), Echols (2007),
Fitzgerald (1992), Gershwin (1996), Goldstein and Ford (2002),
Gomez-Mejia et al. (1995), Hay (2001), Nordhaug (1989), Peteraf
(1993), Ramlall (2004), Rodriguez (2008), Stavrou et al. (2004),
Stewart and Waddell (2003)

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Table 7, continued
Factor Selected Citations
Metacognitive Knowledge Krathwohl (2002)
Leaders need to reflect on how their current
leadership behaviors impact employee
retention.
Akyol and Garrison (2011), Burgoyne and Reynolds (1997),
Cunliffe (2002), Lanzara (1991), Van Mullem and Stoll (2012),
Raelin (2001, 2007), Reynolds (1998), Reynolds and Vince
(2004), Vince (2002)
Motivation Types Bandura (1977), Buchanan and Huczynski (2004), Butler and
Rose (2011), Clark (2003), Clark and Estes (2008), Deci and
Ryan (2000)
Motivation (Expectancy Value Theory) Dugguh and Dennis (2014), Vroom (1964)
Leaders need to see the value in reducing
employee turnover.
Eccles et al. (1997), Lin (2007), Vroom (1964), Watson and
Hewett (2006)
Leaders need to see the value in adopting
and implementing specific leadership
behaviors in an effort to increase employee
retention.
Hale (1998), Lin (2007), Ramlall (2003), Wigfield and Eccles
(2000)
Motivation (Self-Efficacy Theory) Bandura (1977, 1986), Galbraith and Cummings (1967), Gist
(1987)
Leaders need to believe they are capable of
successfully adopting and implementing
specific leadership behaviors in an effort to
increase employee retention.
Bandura (1986)
Organizational Cultures Chew and Entrekin (2011), Clark and Estes (2008), Deery and
Iverson (1996), Drennan (1992), Fitz-enz (1990), Hofstede
(1980), Kilmann et al. (1986), Nahavandi and Malekzadeh
(1988), Ogbor (2001), Ravasi and Van Rekom (2003), Sheridan
(1992), Trefry (2006)
Cultural Models & Settings Abelson (1993), Deery and Iverson (1996), Sigler and Pearson
(2000)
Cultural Models
Human resource strategies within the
organization are aligned with and support
the goal of decreasing voluntary
dysfunctional turnover.
Deery and Shaw (1999), Kerr and Slocum (1987), Sheridan
(1992)
The organization culture is seen as
balanced, valuing on both people and
performance.
Hofstede (1998), Kerr and Slocum (1987), O’Reilly et al.
(1991), Park and Kim (2009)

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Table 7, continued
Factor Selected Citations
Cultural Settings
The organization is perceived as
being supportive.
Allen et al. (1999), Eisenberger et al. (1986), Kottke and Sharafinski
(1988), Rhoades and Eisenberger (2002), Rhoades et al. (2001), Shore
and Shore (1995)
The organization provides
advancement and growth
opportunities
Lankau and Scandura (2002), Meyer and Allen (1991), Tansky and
Cohen (2001), Weng and Hu (2009), Weng et al. (2010)
The organizational culture is seen
as transparent, fair, and just.
Joo and Park (2010), Park and Kim (2009)

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CHAPTER 3
METHODOLOGY
Purpose of the Project and Research Questions
This chapter describes the two major sections on the methodology of this research study:
(1) the research design, and (2) the gap analysis model. The purpose of this research project was
to conduct a gap analysis to evaluate the assumed knowledge, motivational, and organizational
influences that hinder leaders within XYZ Healthcare from achieving their goal of reducing
employee turnover from 14.5% to 12% by the end of 2018. The study aimed to assess the
assumed knowledge, motivational, and organization influences that impact the specific leader
behaviors that were influencing employee retention. The researcher examined the problem from
the perspective of the leader and the challenges they face in engaging and retaining their team
members. As such, the following questions guided this study:
1. What knowledge, motivation, and organizational influences are potentially inhibiting
leaders within XYZ Healthcare Company from decreasing employee turnover?
2. What are the knowledge, motivation, and organizational solutions for leaders within
XYZ Healthcare that will decrease employee turnover?
While a complete evaluation study examining employee turnover within an organization
would focus on all of XYZ Healthcare stakeholders, for practical purposes, the stakeholders that
were chosen as the focus in this analysis were all individuals identified as a “leader,” or anyone
with at least one direct report, within XYZ Healthcare. As noted in Chapter 1, leaders were
chosen as the stakeholder group of focus because of the substantial amount of qualitative and
quantitative research that has shown the significant impact that leadership behaviors have on job
satisfaction, employee engagement, and employees’ turnover intentions.
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Conceptual and Methodological Framework
Conceptual Framework
Maxwell (2013) asserts that a conceptual framework is “a theory, however tentative or
incomplete” (p. 40) that presents the “ideas and beliefs that you hold about the phenomena
studied” (p. 39) and that it is “primarily a conception or model of what is out there that you plan
to study, and of what is going on with these things and why” (p. 39). He goes on to explain that
conceptual frameworks are “constructed, not found” (p. 41). Figure 2 provides the conceptual
framework guiding this research study.
In this research study, the focus was to validate the assumed influences on leaders’ ability
to meet the goal within XYZ Healthcare utilizing the Clark and Estes’ (2008) gap analysis
problem-solving model as the base for the conceptual framework. In order to meet the
organizational goal of decreasing employee turnover from 14.5% to 12% by the end of 2018, this
study focused on assisting leaders in improving certain leader behaviors and practices by
identifying organizational, knowledge, and motivational influencers impacting their
performance.

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Figure 2. Conceptual framework

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Methodological Framework
This study utilized the Clark and Estes (2008) gap analysis problem-solving methodology
to examine factors that were influencing leader behaviors, thus contributing to the high employee
turnover rate. Clark and Estes’ (2008) gap analysis is a systematic and analytical method that
can be used to identify and evaluate influencers that may be contributing to or hindering
organizational effectiveness. The gap analysis process begins with defining measurable goals
within an organization. Once a goal has been defined, the practitioner must then determine any
gaps in performance, or the “performance gap.” This involves measuring current/actual
performance against the desired performance goal. The next step in the gap analysis process is
hypothesizing the possible factors or influencers that are causing the gap in performance. Clark
and Estes’ (2008) gap analysis operates under the assumption that all performance gaps stem
from three distinct categories: knowledge and skill, motivation and will, and organizational
factors. These three categories are referred to as the “Big Three” (Clark & Estes, 2008, p. 43)
causes of performance gaps or KMO (knowledge, motivation, and organization). While each of
the “Big Three” is distinct, large organizational gaps are often complex and involve elements of
all three. Once the KMO influencers have been identified, they must then be analyzed to either
validate whether the influence is a positive (asset) or negative (gap) that may have been
contributing to, or detracting from the organizational goal. Based on this analysis, the
practitioner was able to offer solutions to the organization that assisted in implementing solutions
that will improve and/or close the identified performance gap. As in any system, the new system
must be evaluated and monitored.
Figure 3 illustrates the common process used to diagnose and solve organizational
problems through the gap analysis methodology.
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Figure 3. Clark and Estes gap analysis methodology

In order to effectively utilize the gap analysis methodology, data was collected from the
stakeholders to validate assumed influences causing the identified performance gaps. For the
purpose of this study, a mixed methods approach was utilized that involved the use of a survey
instrument and in-depth interviews. The focus of quantitative research is the use of sound
instruments to collect objective measures and the statistical, mathematical, or the numerical
analysis of that data (Creswell & Clark, 2011). Creswell (1994) defines quantitative research as
the exploration of a phenomenon by collecting numerical data that is analyzed through the use of
mathematical methods. Cohen (1989) defines empirical statements as descriptive statements
about what is the case as it is seen in the real world.
Qualitative research is used to study a phenomenon already isolated and defined in prior
research, and it focuses on meaning and understanding in order to answer specific research
questions within that phenomenon (Loh, 2013). In qualitative research, to gain more insight on a
phenomenon, the focus is on exploring, examining, and describing people and their natural
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environments (Orb, Eisenhauer, & Wynaden, 2001). Unlike quantitative research, the
significance of qualitative research is driven by the researcher’s fundamental desire to
understand the why? The goal of the qualitative researcher is to isolate and define phenomena
during the research process in order to comprehend and learn more about them.
By having direct access to leaders within XYZ Healthcare for individual interviews, and
surveys, a mix of both quantitative and qualitative methods of study were used in order to clearly
identify, validate, and discuss perceived and assumed influences on employee retention. The
basic premise of mixed methods is that the integration of both methodologies allows for a more
rich and comprehensive data collection process (Creswell, Fetters, & Ivankova, 2004). To
conduct an explanatory sequential study, the researcher used qualitative data to explore and
better understand findings from the quantitative data sources. The study used instruments such
as surveys and interviews within the environment in which the phenomenon exists.
Assessment of Performance Influences
Knowledge Assessment
Literature revealed eight possible knowledge influences related to leadership behaviors
that influence employee retention, as displayed in Table 8. Two were declarative, five were
procedural and one was metacognitive. The table includes a description of how each assumed
influence was assessed through the use of a survey and/or in-person interview questions.

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Table 8
Assumed Knowledge Influences and Proposed Assessments
Assumed Knowledge
Influences
Knowledge Influence Assessments
Leaders need to know
their role as a leader and
how their role influences
employee turnover. (D)
Survey Question(s):
As a leader, I have a direct impact on my employees’ level of
engagement intent to leave (Declarative)
a. True
b. False
Interview Question(s):
Thinking of your employees, in general, what do you think they
need from you as a leader to positively influence their
retention? (Declarative)
Leaders need to know
what growth and
development opportunities
are and how providing
growth and development
opportunities contribute to
functional employee
turnover. (D)
Survey Question(s):
Which of the following are growth and development
opportunities? (Declarative)
a. Training and development
b. Mentor program
c. Succession planning
d. Coaching and feedback
e. Goal Setting
f. All of the above
Interview Question(s):
In your current role as a leader, describe to me how you have
specifically been able to help an employee develop their career?
(Declarative)
Leaders need to know
how to define and identify
core employees in order to
retain them. (P)
Survey Question(s):
N/A
Interview Question(s):
How do you define a “critical/ key employee”?

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Table 8, continued
Assumed Knowledge
Influences
Knowledge Influence Assessments
Leaders need to know
how to provide effective
goals to employees. (P)
Survey Question(s):
Which of the following are components of Goal Setting:
a. S.M.A.R.T. Goals
b. Cascading Goals
c. Goal Alignment
d. All of the above
e. None of the above
Interview Question(s):
Please describe the activity of cascading a goal and its
importance.
If possible, briefly provide an example from your department.
Leaders need to know
how to build effective
relationships with their
employees. (P)
Survey Question(s):
An employees’ trust in their leader is an important part of
employee engagement and employee retention. (Procedural)
a. True
b. False
Effective, open and honest communication are vital to building
trust and mutual respect with my employees. (Procedural)
a. True
b. False
Interview Question(s):
As a leader, what do you specifically do to ensure you are
building a positive, trusting relationship with your employees?

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Table 8, continued
Assumed Knowledge
Influences Knowledge Influence Assessments
Leaders need to know
how to provide
effective coaching and
feedback. (P)
Survey Question(s):
Effective coaching and feedback include the following. Check all
that apply: (Procedural)
a. A relationship of trust
b. Preparation
c. Specific behavioral examples
d. A completed coaching form
e. Coaching form from previous discussion
f. Data to support performance
Interview Question(s):
Describe the components necessary to have an effective
constructive coaching and feedback discussion with an employee
when they are not meeting performance expectations.
Leaders need to know
how to help their
employees plan and
develop their long-
term career objectives.
(P)
Survey Question(s):
Career development conversations benefit who:
a. The employee
b. The organization
c. Both
d. No One
Interview Question(s):
Identify 2-3 specific growth and development activities that are
available to employees on your team within the organization?
Leaders need to reflect
on how their current
leadership behaviors
impact employee
retention. (M)
Survey Question(s):
My employees and other team members would say that I regularly
ask them for feedback on my performance.
a. True
b. False
Interview Question(s):
Give me an example of a time when you received feedback from
one your employees about your behavior/performance and what
you did with that feedback.
* Abbreviations for Knowledge Types: (D) = Declarative; (P) = Procedural; (M) = Metacognitive

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Motivation Assessment
Literature revealed three possible motivation influences related to leadership behaviors
that influence employee retention, as displayed in Table 9. Two related to valance, while one
focused on self-efficacy. The table includes a description of how each assumed influence was
assessed through the use of a survey and/or in-person interview questions.

Table 9
Assumed Motivational Influences and Proposed Assessments
Assumed Motivation
Influences Motivation Influence Assessments
Leaders need to see
the value in reducing
employee turnover.
(V)
Survey Question(s):
Retaining top performers and employees with critical skills is
important to the organization in order to maintain a competitive
advantage.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
Retaining top performers and employees with critical skills is
important to the organization in order to maintain a competitive
advantage. Why is that of value to you and the organization?
How have you personally experienced not being able to retain top
employees and how has that impacted your department?

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Table 9, continued
Assumed Motivation
Influences Motivation Influence Assessments
Leaders need to see
the value in adopting
and implementing
specific leadership
behaviors in an effort
to increase employee
retention. (V)
Survey Question(s):
There is value is providing employees clear goals, coaching and
feedback, growth and development, and advancement opportunities.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
What do you think the value is in providing your employees clear
goals, coaching and feedback, growth and development, and
advancement opportunities?
Leaders need to
believe they are
capable of
successfully adopting
and implementing
specific leadership
behaviors in an effort
to increase employee
retention. (SE)
Survey Question(s):
On a scale of 1 to 5, 1 being the lowest, 5 being the highest, tell me
how confident you are in your ability to do the following:
a. Accurately identify your critical employees / top performers
b. Establish effective goals for your employees
c. Provide effective coaching and feedback
d. Build trust among your employees
e. Provide career development opportunities
As a leader, I am confident that I have what I need to effectively
establish and communicate clear expectations and goals for 100% of
the employees on my team for this year.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
On a scale of 1 to 5, 1 being the lowest, 5 being the highest, tell me
how confident you are in your ability to do the following and please
state why you chose that rating:
a. Accurately identify your critical employees / top performers
b. Establish effective goals for your employees
c. Provide effective coaching and feedback
d. Build trust among your employees
e. Provide career development opportunities
* Abbreviations for Motivation Types: (V) = Valance; (SE) = Self-efficacy

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Organization/Culture/Context Assessment
Literature revealed five possible organizational influences related to leadership behaviors
that influence employee retention, as displayed in Table 10. Two were cultural models, three
were cultural settings. The table includes a description of how each assumed influence was
assessed through the use of a survey and/or in-person interview questions.

Table 10
Assumed Organizational Influences and Proposed Assessments
Assumed Organizational
Influences Organizational Influence Assessment
Human resource
strategies within the
organization are aligned
with and support the goal
of decreasing voluntary
dysfunctional turnover.
(CM)
Survey Question(s):
Our current Human Resource practices, including: selection &
hiring, onboarding, internal advancement & promotion, training
& development, and reward systems are effective practices in
reducing employee turnover.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
Describe how effective you feel the current human Resource
practices, including selection and hiring policies, internal
advancement and training promotion and employee
development, and reward systems are in reducing employee
turnover.

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Table 10, contined
Assumed
Organizational
Influences Organizational Influence Assessment
The organization
culture is seen as
balanced, valuing on
both people and
performance. (CM)
Survey Question(s):
Do you see the organization investing resources to ensure employees are
engaged and satisfied?
a. Yes, I do
b. No, I do not
Based on how the organization spends its time, resources, focus, and energy,
what do you think they value the most?
a. People
b. Performance
c. There is good balance of both
The organization is committed to holding employees accountable for high
performance.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
In what ways, if at all, do you see the organization investing resources to
ensure employees are engaged and satisfied?
The organization is
perceived as being
supportive. (CS)
Survey Question(s):
Effective workflows, processes, and procedures are established and
documented in a way that allows my employees to do their job effectively.
a. Yes, I agree
b. No, I disagree
As a leader, I feel supported by the organization.
a. Yes, I agree
b. No, I disagree
The organization provides me and my team the necessary resources, tool,
and systems needed to do our jobs effectively.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
Do you feel effective workflows, processes, and procedures are established
and documented in a way that allows your employees to do their job
effectively? Why? Or Why not?

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Table 10, continued
Assumed Organizational
Influences Organizational Influence Assessment
The organization
provides advancement
and growth opportunities.
(CS)
Survey Question(s):
There are sufficient advancement and growth opportunities that
exist within the organization that enable me to support my
employees in their professional development and growth.
a. Yes, I agree
b. No, I disagree
Interview Question(s):
To what degree do you feel employee development and growth
opportunities are readily available in the organization?
The organizational
culture is seen as
transparent, fair, and just.
(CS)
Survey Question(s):
Practices within the organization, such as hiring, promotions,
and reward systems are fair and transparent.
a. Yes, I agree
b. No, I disagree
The organization creates a culture where I can communicate
effectively, openly, and honestly with my team.
a. True
b. False
Interview Question(s):
Please describe your perceptions of the following:
a. Transparency of communication and changes
b. Fairness in decision making
c. Fairness in promotions and raises
d. Justice when dealing with discipline
* Abbreviations for Organizational Types: (CM) = Cultural Models; (CS) = Cultural Settings

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Participating Stakeholders and Sample Selection
The stakeholder group of focus in this study consisted of individuals with the title of
leader, or anyone who had at least one direct report. Within XYZ Healthcare, this included
supervisors, managers, directors, and, AVPs and VPs. Leaders were identified as the key
stakeholder group because leadership has a significant influence on employee engagement and
retention (Mendes & Stander, 2011). In total, individuals designated as leaders represent
approximately 5% (1,000) of the organization’s 20,000 total employees.
Data Collection
The study utilized a mixed methods approach to evaluate the key assumed knowledge,
motivational, and organization influences that impact the specific leader behaviors influencing
employee retention. Quantitative data was collected from leaders via self-report questionnaires;
while quantitative data was collected via in-person interviews.
Survey
Since surveys can be widely disseminated and are the most time-efficient method of
collecting data from respondents, a survey questionnaire was deemed the most effective tool for
this research study (Pease, 2005). Self-reporting questionnaires are the most commonly-used
instrument (Robins & John, 1997). Hoepfl (1997) asserts that self-reporting is a suitable method
for the study of human characteristics, and may be the best method because it allows respondents
to directly provide perceptions of themselves and their world. However, the main disadvantage
of self-reporting is the potential problem of validity. A general weakness of surveys is that the
researcher must assume the respondent is telling the truth. Since the data is idiosyncratic, people
may not always have a “realistic” self-awareness of themselves in order to provide valid data. A
common challenge is respondent bias. One type of bias, known as self-serving bias, is the
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tendency for a respondent to take credit for successes while denying responsibility for failures
(Fiske & Taylor, 1991). In order to off-set this possibility and increase validity, multilevel
triangulation was used.
Survey sampling. This study aimed to look at the particular behaviors of leaders that
influence turnover intentions of employees within XYZ Healthcare. In order to validate the self-
perceptions documented in leaders’ responses, qualitative data from the in-depth interviews were
collected and aggregated against the quantitative data from the survey instrument.
Due to time and budget restraints, purposive, non-probability sampling was utilized for
the survey portion of the research. XYZ Healthcare employs approximately 20,000 employees
in 13 states. Due to the size of the organization, randomly sampling the entire leadership
population was not conducive. A purposive, non-probability sampling approach allowed the
researcher to select a specific segment of the population to sample on the basis of their
accessibility or personal judgment of the researcher (Merriam & Tisdell, 2016). This research
study limited its sample population to leaders in three office locations (Texas, New Mexico, and
California) and not leaders in the entire organization. The subjects were purposely selected
because they share the characteristics of other leaders in XYZ Healthcare and aided in creating a
sample with the intention of making generalizations for the general base of leaders within XYZ
Healthcare as a whole.
Leaders from the three office locations were systematically selected. The criteria for
selecting the three office locations included: (1) the size of the site; and (2) the location of the
site. Once the three sites were identified, the following criteria were used to determine eligibility
for the potential participation in the survey.
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Criterion 1. Participants must be an existing employee of XYZ Healthcare Company in
Texas. This study was conducted exclusively for XYZ Healthcare Company as an initiative to
increase employee retention. Therefore, all participants must be a current employee of the XYZ
Healthcare Company.
Criterion 2. Participants must be in a leadership position within XYZ Healthcare
Company. The title leadership included roles such as: supervisor, manager, director, AVP, or
VP. For this study, along with the aforementioned titles, leaders must also currently be identified
in the HR system as an individual who is responsible for more than one full-time direct report.
Criterion 3. Participants must have been leaders within the organization for more than
three months. Although the tenure of the leader is an important factor, it will not be taken into
consideration as a moderating factor. For the purposes of this study, tenure was a criterion only
because a leader with less than 90 days with their team may not have had an opportunity to fully
meet their teams, establish leadership rapport, or provide feedback to their employees, thus
having no impact on employee retention.
Criterion 4. Participants must have access to a computer or laptop with internet
connection.
Survey Recruitment Strategy and Rationale
Human Resources provided the researcher with the company’s most current
organizational chart, and an Excel spreadsheet that included an up-to-date list of all of their
leaders. From this list, the researcher deliberately selected potential participants to participate in
the study from at least three different locations and at least three different departments. The
researcher sorted the list of leaders by title, department name, tenure, and location. With this
information, three different locations were systematically be selected. The selection of the sites
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and individuals involved was an important part of the process, as it added value to the depth of
understanding of the central phenomenon of employee retention and employee engagement
within an entire organization. From this list, a total of 30 leaders were identified.
Survey instrumentation. A survey was designed to address the assumed causes
identified in Chapter 2. The survey was designed to specifically measure the leader’s
perceptions of their own behaviors, as well as their perceived knowledge, motivation, and
organization influences that impact the specific leader behaviors that are influencing employee
retention.
In order to assess the personal experiences and perceptions of leaders regarding the “Big
Three” influencers of employee turnover, a survey instrument was developed that was comprised
of 25 closed-ended structured questions. The survey items assessed the “Big Three” influencers
on the leader’s ability to decrease voluntary dysfunctional employee turnover at XYZ Healthcare
and three questions were demographic in nature. The questions were formulated based on
identified assumed influences and from the turnover literature. Following each closed-ended
structured question, the survey included a general open-ended question in the form of “Please
add any additional comments on the question here.” This allowed respondents the opportunity to
voice their opinions on the topic, and provided the researcher with additional clarification and
insight on the respective topics. An additional question was added to gather consent to be
contacted to participate in a virtual interview. The survey instrument appears in Appendix A.
Survey data collection process. The data was collected through an on-line self-
administered questionnaire. The surveys were administered electronically through Qualtrics and
sent to leaders’ work email addresses. The email addresses were gathered from the Human
Resources department. Employees within XYZ Healthcare speak a variety of languages.
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However, because English was the primary and required language, the survey was designed in
English. The email message included an explanation of the study, an invitation to participate and
a link to the survey. See Appendix D for the invitation message.
Completion of the survey was estimated to take approximately twenty-five to thirty
minutes. As requested by Human Resources, participants were asked to complete the survey
during their regular work schedule. Once the respondent clicked on the link, the first page that
was displayed included the Informed Consent. They were instructed to read the consent form
and choose between the options “I Agree” or “I Do Not Agree.” If they checked the box “I
Agree,” they were directed to start the survey. If the respondent selected the “I Do Not Agree”
box, they were redirected out of the survey and not allowed to proceed.
Participants had 14 business days to complete the survey. A restriction was added to the
survey and participants were not able to access the link after the 14 day timeframe. They were
also restricted from being able to access and take the survey more than once. Those who
completed the survey were sent a thank you email for their participation. The Qualtrics software
allowed customized notifications and reminders to be sent to survey participants. If the
respondent had not opened the survey within seven days of receiving the link, a follow-up email
was sent. A third notification was sent in the remaining 24 hours prior to the close of the survey.
The researcher checked the response rate every three days to determine if additional notifications
needed to be incorporated.
Interviews
The qualitative phase of this research study utilized one-on-one interviews of leaders to
collect in-depth data and understand the “why” behind what was influencing employee retention
inside of XYZ Healthcare. Leaders were the stakeholder group of focus for interviews. In-
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person, in-depth interviews were chosen over focus groups because of the sensitive nature of the
study and the population. Many survey questions had to do with personal leadership behaviors
that some participants may not be comfortable discussing in a group setting. Reducing the
likelihood that one participant may influence or dominate the discussion was another drive of
why in-person interviews were chosen.
Interview sampling. In order to gain a deeper understanding of the survey results, 17 in-
depth interviews were conducted. Through purposeful sampling, participants chosen for
interviews were representative of the group studied, not randomly selected, and were sought
based on the information the researcher needed (Krueger, 1988). In order to better understand
the beliefs and opinions expressed in the survey, individuals designated to participate in the
interviews represented individuals who completed the initial quantitative survey instrument.
The survey instrument included an inclusion question that asked the respondent if they
would be interested in participating in a one-hour interview. Participants that successfully
completed the survey and selected the response “Yes, I would like to participate” to the inclusion
question were chosen for the interviews. The following criteria were used to determine
eligibility for interview participants.
Criterion 1. Participants must be an existing employee of XYZ Healthcare Company in
Texas. This study was conducted exclusively for XYZ Healthcare Company as an initiative to
decrease employee turnover within the organization. Therefore, all participants must be a
current employee of the XYZ Healthcare Company.
Criterion 2. Participants must be in a leadership position at XYZ Healthcare Company.
Leadership positions can include roles such as: supervisor, manager, director, AVP, or VP. For
this study, along with the aforementioned titles, leaders must also currently be identified in the
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HR system as an individual who is also responsible for more than one full-time direct report.
Although the focus of the study is on employee retention, the stakeholder group for the study is
leadership within XYZ Healthcare Company.
Criterion 3. Participants must have been a leader within the organization for more than
three months. Although the tenure of the leader is an important factor, it was not taken into
consideration as a moderating factor within the study.
Criterion 4. Participants must have access to a computer or laptop with internet
connection, as well as connectivity to the on-line, virtual WebEx application.
Criterion 5. Participants must have already taken the initial survey and responded “Yes,
I would like to participate” to the inclusion question.
Interview Recruitment Strategy and Rationale
Individuals who were identified as wanting to participate were contacted via email until a
minimum of 15 respondents replied back, both agreeing to participate and providing potential
dates and times of availability. These leaders were then sent an Outlook invitation with a
message advising them they had been selected to participate in an interview. The message also
included a PDF of the consent form, the time and date of their designated interview, as well as
the WebEx link and instructions for use.
Interview instrumentation. According to Kvale (1996), focus groups and personal
interviews are the most common methods of data collection in qualitative research. The
qualitative phase of this research study utilized one-on-one interviews of leaders to collect in-
depth data and understand the “why” behind what was influencing employee retention inside of
XYZ Healthcare. The interviews were semi-structured with an interview guide provided to
guide the discussion. Semi-structured interviews are used when the researcher wants to delve
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deeply into a topic. The guide provided standardized open-ended questions and the order in
which to ask them. The Interviewer had some discretion in the clarifying questions they asked,
but probing questions were provided to ensure they addressed specific topics. While detailed
information was collected in a structured way, the interview was still designed to be
conversational in nature. In-person, in-depth interviews were chosen over focus groups because
of the sensitive nature of the study and the population. Many survey questions had to do with
personal leadership behaviors that some participants may not have been comfortable discussing
in a group setting. Reducing the likelihood that one participant may influence or dominate the
discussion was another driver of why in-person interviews were chosen.
The interview was comprised of 20 open-ended questions, and corresponding follow-up
questions, that were developed based on the anticipated findings of the survey. Because
interview questions were based on results derived from survey results, a bank of potential
interview questions had been established to address specific anomalies within the data that
required further explanation and understanding. While potential questions had been developed,
the actual survey results drove the final interview questions used in the research study.
Interview data collection process. One-on-one interview questions were structured
according to the interview protocol designed by the researcher (see Appendix B). Unlike the
survey, the questions for individual interviews were open-ended to deter participants from giving
yes/no answers and to encourage them to elaborate and provide more detail. In order to capture
accurate information, all interviews were recorded on tape. In order to ensure accuracy, a third
party company was used to transcribe all individual interviews.
Interviews were conducted over a two-week time frame. Each interview lasted
approximately 45 minutes to one hour. Interviews were conducted via the organization’s internal
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online video conferencing technology, WebEx. The use of online interviews capitalizes on the
increasing use of the internet as a communication tool (Moore, McKee, & McLoughlin, 2015).
Advocates of on-line / blended interviews note the following advantages: when distance is no
longer a factor, it allows for a larger and more diverse sample size; geographically distant
individuals and groups are able to share diverse ideas and thoughts; and avoiding costly travel or
transportation (Bosco & Herman, 2010; Lewis, 1995). Utilizing the online video conference tool
also allowed for all interview questions to be verbally asked, while also being displayed on the
screen for the participants to read. The added use of visual communication, through media,
increased the clarity and understanding of the questions while also improving the efficiency of
the interview session, by reducing time lost on repeating the questions.
Data Analysis
Multilevel Design
Multilevel triangulation is an approach that utilizes multiple data methods (quantitative
and qualitative) to address different levels within a system (Creswell, Plano Clark, Gutmann, &
Hanson, 2003). It is commonly used to overcome validity problems in qualitative data and its
primary goal is to gather multiple perspectives in order to gain a more complete and accurate
understanding of the phenomenon. The findings from the survey and interviews were merged
together to create a “big picture” of what leader behaviors were impacting employee retention
inside of XYZ Healthcare. It also allowed the researcher the opportunity to confirm or validate
the research findings (Creswell & Clark, 2011).
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Survey
Once all surveys were collected, the data collected was cleaned and analyzed by the
researcher. Based on analysis, the results were used to develop interview questions that would
aid in a deeper assessment and understanding of the participant perspectives.
Interviews
Once all interviews were completed, they were transcribed using Rev.com. Analysis of
the interviews included coding the transcripts to identify themes. Codes are researcher-generated
words or short phrases that become the critical link between the data and the explanation of
meaning for the data (Saldaña, 2015). The codes were then organized according to the
corresponding knowledge, motivation, and organizational influences they addressed.
Reliability and Validity
Reliability, in quantitative research, is repeatability or the extent to which results of a data
collection instrument in a research study measure the same way each time it is used under the
same conditions with the same, or like, subjects (Creswell, 2014; Joppe, 2000). The use of
reliability and validity are common practices in quantitative research and adds confidence to the
results. According to Merriam and Tisdell (2016), a qualitative study is valid and reliable only to
the extent in which it produces meaningful data and can be reproduced under similar
methodology (Creswell, 2014; Joppe, 2000).
In all empirical research, data has to be evaluated in relation to the research questions
posed. This study aimed to provide insight into the relationship between specific leader behavior
and practices and employee retention. Since leadership behaviors have been shown to affect
employee retention, this study took a look at the assumed knowledge, motivational, and
organization influences that impacted the specific leader behaviors that were influencing
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employee retention within XYZ Healthcare. To measure employee turnover intentions, a survey
instrument was designed aimed at measuring specific components of employee engagement and
retention. The questions revealed the extent to which employee engagement and retention exist
within the organization.
To ensure validity, the survey instrument in this research study was designed to measure
employee satisfaction and turnover intentions. Each category and question was built using
validated research from an exhaustive literature review. This design approach ensured that the
questions explicitly focused on employee satisfaction and turnover intentions and that the results
would reveal the extent to which these phenomena addressed the research question:
• What knowledge, motivation, and organizational influences are potentially inhibiting
leaders within XYZ Healthcare Company from decreasing employee turnover?
Credibility and Trustworthiness of Data
The researcher ensured credibility and trustworthiness though two key strategies. First,
credibility and trustworthiness was validated in this research study through triangulation of the
data. Triangulation design was used in order to obtain different but complementary data on the
same topic and to provide a deeper breadth of understanding to the research problem. Employee
engagement and retention are both complex phenomena and an individual’s experience defined
engagement and retention differently. Simply using the numerical data derived from the survey
questions would not have provided the necessary understanding or validation to gain an
understanding of the responses. Thus, data from the survey was compared to the more in-depth
qualitative data that was gathered during the one-on-one interviews. The correlational research
allowed the researcher to find correlations among variables and directly compare and contrast the
statistical results of the survey with the qualitative findings in the one-on-one interviews (Ali &
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Yusof, 2011). The qualitative data can then be used to validate or expand upon the quantitative
results (Ivankova, Creswell, & Stick, 2006).
Second, the researcher ensured confidentiality of participants and the research that is
collected within this research study. The researcher took explicit measures to communicate to
participants the confidentiality of the study in order to gain trust and encourage participants to
feel safe to share their true opinions and perspectives in both the survey and interviews.
Role of Investigator
As an academic study, an ethical consideration that was important to address was the
researcher’s relationship with the organization that was studied. As an employee of the
organization, it was extremely important to ensure to the participants in the study that the
researcher’s role during this research process was that of a graduate student and the principal
investigator, not an employee. As mentioned above, measures were taken to ensure each
participant’s anonymity. However, it was also important to note that their identities were not
shared with the researcher as well. Therefore, the identities of those who participated could not
be shared with the organization. It was also important to note that if participants inadvertently
shared any identifying characteristics, potentially revealing their own identities during the data
collection process or afterwards, the researcher went through extensive measures to remove the
information.
Ethics
As a qualitative researcher, the aim of a research study is to determine the relationship
between a phenomenon already isolated and defined in prior research and focus on meaning and
understanding in order to answer specific research questions within that phenomenon (Loh,
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2013). In qualitative research, to gain more insight on a phenomenon, the focus is on exploring,
examining, and describing people and their natural environments (Orb et al., 2001).
In order for a researcher to conduct this type of in-depth analysis on the human subject,
the researcher is often immersed in the actual environment of the study and the research study is
frequently conducted in settings that involve people in their everyday environments (Orb et al.,
2001). Therefore, any research that includes people as the subject requires an increased
awareness of the ethical issues that may derive from such interactions (Orb et al., 2001). As a
result, it is imperative that the researcher makes ethical choices when conducting qualitative
research. When looking at ethics in any type of research, Capron (1989) states that the method
should be “guided by the principles of respect for people, beneficence, and justice” (p. 169).
Within this research study, much of the data collection and sampling was conducted
through surveys and interviews of subjects in the environment in which the phenomena exist. As
a result, it was necessary to ensure the autonomy of the participants. According to Capron
(1989), participants must be made aware of their participation in the study and exercise their
autonomy to either accept or refuse to participate in the study.
Additionally, any conversation or question, collected formally or informally, that was
used in the study was made public to the participant. Participants were also made aware of their
rights and that their participation in the study was completely voluntary. They were advised that
at any time, they had the right to withdraw from participating in the study without any penalty.
Participants were reminded that participation was voluntary and that no incentives would be
given. However, as a small token of appreciation, at the end of the study, a Thank You email
was sent to participants, with a gift card of $25.
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In order to advise of autonomy and honor the rights of the participants, informed consent
forms were provided to all participants at the commencement of the study. The informed
consent was clearly written in the participants’ native language and provided essential points of
information, such as the “purpose of the research, a description of what the subject will be asked
to do, any foreseeable risks of harm, and that the study is voluntary and subjects are free to
withdraw at any time”. Participants who were unable to provide consent were not asked to
participate in the study.
The study asked questions to uncover organizational issues that may be deemed as
negative. All one-on-one interviews were recorded and transcribed by the interviewer. Prior to
the start of any recorded session or conversation, participants were verbally asked their
permission to be recorded and had to verbally respond with a yes or no. The researcher did not
record those who responded no. Before use or publication of any content, participants were
given the opportunity to view the transcripts to ensure accuracy. As a result, the employees that
participated in the study needed to feel safe to speak freely without any repercussions. To ensure
a safe environment and maintain the principle of beneficence, pseudonyms were assigned to all
participants and used throughout the study to eliminate the possibility of inadvertently revealing
a participant’s identity.
To ensure the welfare, protection of rights, autonomy, beneficence, safety and all rules
and guidelines regarding the protection of the participants, this study was submitted to the
University of Southern California Institutional Review Board (IRB) for review and approval.
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Limitations and Delimitations
Limitations
The limitations of this study included a lack of ancillary stakeholders and geographical
limitations. The study focused on health care leaders’ impact on employee turnover. Ancillary
internal and external stakeholders in health care such as commercial payers, state representatives,
physicians, and vendors may provide perspectives on challenges in health care but were not
included in this study. Lack of ancillary stakeholder perspectives limited the scope of this study
because their services may influence patient satisfaction and employee turnover. There were
also geographical limitations with the selected population. The sample size represented leaders
from several sites within a single health care organization. This limited the ability to view
perspectives from other organizations. Views and perspectives of the employees focused only on
one employer.
Delimitations
Delimitations help to clarify the focus of a study by indicating the areas that are included
and excluded from the study. For example, a delimitation of this study was to select participants
with at least one direct report. This ensured that interview responses would provide data from
leaders who had influence on employee turnover. It is conceivable that individuals with power
or those in leadership positions without direct reports will still influence employee turnover and
might provide different perspectives. The final delimitation was excluding leaders who have
been in their position for less than three months. Research was dependent upon reliable,
credible, and accurate presentations of data from participants. This exclusion increased the
likelihood that the participants had an understanding of the organization and a familiarization
with its culture and the employee base.
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Summary
Chapter 3 outlined the procedures and methodology used for this study which included
using surveys and interviews. Chapter 4 will present the data that was collected and discuss the
validation process.

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CHAPTER 4
RESULTS AND FINDINGS
The purpose of this mixed methods study was to explore the assumed knowledge,
motivational, and organizational influences that hindered people leaders within XYZ Healthcare
from achieving their goal of reducing employee turnover from 14.5% to 12% by the end of 2018.
The study aimed to assess the assumed knowledge, motivational, and organization influences
that impacted the specific leader behaviors that influenced employee retention. The researcher
examined the problem from the perspective of the leader and the challenges they faced in
engaging and retaining their team employees. As such, the following questions guided this
study:
1. What knowledge, motivation, and organizational influences potentially inhibited
leaders within XYZ Healthcare Company from decreasing employee turnover?
2. What were the knowledge, motivation, and organizational solutions for leaders within
XYZ Healthcare that decreased employee turnover?
The study utilized a mixed methods approach that evaluated the key assumed knowledge,
motivational, and organization influences that impacted the specific leader behaviors that
influenced employee retention at XYZ Healthcare. Quantitative data was collected from leaders
via self-reported questionnaires; while quantitative data was collected via in-person interviews.
Definition of Validation
Chapter 4 includes an overview of the study and specific findings, presenting data
collected that validated or did not validate the assumed causes identified in Chapter 3.
Specifically, this chapter will describe the survey data results, as well as the themes that emerged
from the in-depth interviews. The data presented below is organized by assumed knowledge,
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motivation, and organizational influences. Data from the surveys will be presented, followed by
results from the interview data. Within those influences, we identified whether a gap was
validated or not and lastly results from both instruments are presented. While the organization
would like 100% of its leaders to knowledgeable, and motivated, in analyzing the data,
influences were considered validated if over 80% of the data confirmed the gap and it was
confirmed at that percentage by both instruments. It was considered partially validated if the
influence was confirmed by one instrument, but not by the second data source. The threshold of
80% was chosen as opposed to 51% because most organizations with 51% of its leaders lacking
knowledge and motivation in decreasing employee retention are still not successful.
Each influence was categorized in the following manner: “gap validated,” “no gap,” or
“partially validated.” When an influence was determined to be a “validated gap,” this was an
indication that both instruments had identified that the influence negatively impacted the efforts
to reduce employee turnover and should be addressed in order to move XYZ Healthcare towards
meeting its goals. A designation of “no gap” implied that the data from both instruments did not
indicate a negative impact on the stakeholder goals and no changes needed to be made. If an
influence was deemed “partially validated,” this was an indication that there was conflicting data
between the two instruments and that further study was needed.
Participating Stakeholders
The stakeholder group of focus in this study consisted of individuals with the title of
leader and who had at least one direct report within XYZ Healthcare. For the purposes of this
study, this included individuals with the title of supervisor, manager, director, Associate Vice
President (AVP) and Vice President (VP). Leaders were identified as the key stakeholder group
because the leader-employee relationship tends to have a significant influence on employee
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engagement and retention (Mendes & Stander, 2011). Thus, improving leader behaviors may
increase the likelihood of improving the organization’s employee retention rate, therefore
directly influencing its financial stability, productivity, and patient satisfaction (Kim & Park,
2014).
Due to the nature of the study it was critical to ensure anonymity of respondents to ensure
their honest feedback and perception was provided. However, basic demographic information
was collected during the survey only to ensure the leaders met the basic parameters to participate
in the study. An invitation to participate in the survey portion of the study was sent to 30 leaders
of XYZ Healthcare from three office sites located in Texas, New Mexico, and California. Of the
30 respondents, all of them met the basic criteria of being a current leader within XYZ
Healthcare for a minimum of three months, and had at least one direct report. Of the 30
respondents, 21 responded to the invitation and successfully completed the survey, which
resulted in a 70% response rate.
In order to identify respondents for the interview portion of the study, the survey
instrument included an inclusion question that asked the respondent if they would be interested
in participating in a one-hour interview. Of the 21 respondents that successfully completed the
survey, all 21 respondents selected the response “Yes, I would like to participate” to the
inclusion question. Of the 21 survey takers/respondents that agreed to participate in an
interview, 17 respondents responded to the invitation to participate and successfully completed
the interview portion of the study.
In order to maintain respondents’ anonymity for the interview, each of the 17
interviewees were referred to as P, for Participant, plus a corresponding interview number was
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assigned (i.e., P1). This allowed for differentiation of quotes that were pulled from the
interviews for the corresponding influence.
Results
Knowledge Results
The first section of the study reviewed assumed knowledge influences that impacted the
leaders’ ability to retain employees. Knowledge was broken down into the three knowledge
types: (1) declarative; (2) procedural; and (3) metacognitive. Leaders needed to understand the
terms and concepts of employee retention and functional turnover; how to engage in activities
that promoted functional turnover, have a self-awareness of their understanding and thinking of
employee retention and the role they played in it. A combination of data from survey questions
and interviews was used to validate the knowledge gap of leaders that existed within XYZ
Healthcare. Nine total knowledge influences were identified in Chapter 2. To analyze if the nine
influences were validated or not, declarative, procedural, and metacognitive knowledge was
measured using eight survey questions and 11 interview questions. Of the nine assumed
knowledge influences, evidence revealed that no gap existed in seven of the nine influences,
while a gap was found for two of the assumed influences.
Declarative knowledge. Two assumed influences were identified under declarative
knowledge. Data on the two declarative knowledge influences identified in the literature review
was collected and analyzed. The results are outlined below.
Leaders need to know their role as a leader and how their role influences employee
turnover. Gap not validated. According to Ansari et al. (2007), literature revealed that an
employee’s direct leader is a key factor in their intention to voluntarily stay with or leave an
organization. As a result, leaders need to understand their role as a leader and how their role
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directly influences their employees’ turnover intentions. A combination of data from survey
questions and interviews was used to analyze the declarative knowledge, influence and both
confirmed that leaders had a good knowledge base of how their role as a leader influenced
employee turnover.
Survey results. Survey question number 10 (SQ10) asked a true/false question to
measure the leaders’ understanding of their impact on their employees. All of the respondents
answered, A. True.

Table 11
Survey Question #10 Results
Declarative Survey Question(s) Item Results
As a leader, I have a direct impact on my
employees’ level of engagement intent to leave?
a. True
b. False
Survey Q10 100% selected a. True

Interview results. Interview question 1 (IQ1) asked respondents, “Thinking of your
employees, in general, what do you think they need from you as a leader to positively influence
their retention?” All 17 respondents were clear in their identification of the ways in which their
employees needed them. Themes that emerged around what employees needed from their
leaders included: growth and development opportunities, communication, support, and a positive
relationship. All of these needs appeared in the literature review in Chapter 2. Based on the
provided feedback it was clear that the leaders had a good understanding of what their employees
needed from them.
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Leaders demonstrated their knowledge in these areas based on specific examples that
were provided. For example, P3 stated:
They need me to know those things and frame ways to utilize them within the
organization. So if I am trying to retain them, then my opportunity is to find ways to
develop them professionally, to give them opportunities to grow and be stretched, all that
good stuff.
Leaders need to know what growth and development opportunities are and how
providing growth and development opportunities contribute to functional employee turnover.
Gap not validated. The literature revealed that an important aspect of an employee’s turnover
intentions is their perception of the promotion, career advancement, and development
opportunities available to them (Hausknecht et al., 2009). Leaders need to have a good
understanding of what growth and development opportunities are and how they contribute
positively to turnover.
This influence was assessed from one survey question and two interview questions posed
to respondents. Survey question 4 (SQ4) and interview question 2 (IQ2) provided opportunities
for the respondents to demonstrate their knowledge of what growth and development
opportunities looked like, what specific growth and development opportunities existed within the
organization. To further validate the influence, leaders were also asked how they have
specifically been able to provide growth and development opportunities to their employees in
order to reduce turnover.
Survey results. The purpose of survey question 4 (SQ4) was to measure the respondents’
knowledge of growth and development opportunities. Five options were provided and 100% of
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the survey respondents responded “f: All of the above,” which showed the respondents had a
clear understanding of growth and development opportunities.

Table 12
Survey Question #4 Results
Declarative Survey Question(s) Item Results
Which of the following are growth and development
opportunities? (Declarative)
a. Training and development
b. Mentor program
c. Succession planning
d. Coaching and feedback
e. Goal Setting
f. All of the above
Survey Q4 100% selected f. All of
the above

Interview results. To identify how leaders were able to provide growth and development
opportunities to their employees in order to reduce turnover, IQ2 asked, “In your current role as a
leader, describe to me how you have specifically been able to help an employee develop their
career.” One hundred percent of the respondents were able to clearly articulate how they have
been able to provide growth and development opportunities to their employees. The theme that
emerged across all respondents was that growth and development conversations were an
important activity. P12 stated:
For me it’s a conversation. Just talking to my employees, and finding out what their
goals are, and coaching them on goals that I see a professional gap in but not calling it
that. Encouraging the employee, for example, “You could really use some management
training to get to your next level in your career. Let’s look for some iLearns, or let me
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see if I can get you an intern this quarter so that you can manage an employee and have
experience with approving time cards and all these other things.”
P17 stated:
I would say definitely the first step in developing my employee’s career is finding out
where they want to go, really understanding their whole skillset because they bring an
entire skillset that you might not even know about from previous employment. Then
matching it up or working with them to match it up with their dream job, so to speak.
Then really helping them fill in those puzzle pieces to do a real specific swat analysis on
their skills, and giving those pieces to the employee without necessarily telling them,
“This is a swat analysis on your skillset.”
Procedural knowledge. Five assumed influences were identified under procedural
knowledge. Data on the five procedural knowledge influences identified in the literature review
was collected and analyzed. The results are outlined below.
Leaders need to know how to define and identify critical/core employees in order to
retain them. Gap not validated. According to the literature, it is critical for leaders to be able to
identify individuals in critical positions, as well as distinguish top performers from average and
low performers. Critical/core employees are defined as employees who are top performers,
demonstrate high potential, or are in critical jobs. If the goal is to retain top performers and
critical employees, leaders must first define who these individuals are (Scott et al., 2012). To
assess this influence, one interview question was asked.
Interview results. To assess if leaders were able to define critical/core employees, they
were asked, “How do you define a critical / core employee?” One hundred percent of the
respondents were able to identify at least one aspect of the definition of a core employee in their
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response. P3 stated, “I would define a critical employee as one that we would have a difficult
time replacing or one that has proprietary knowledge or skills.” P14 further expanded on the
definition and stated:
I would say an employee who is always asking, “What can I learn, or how can I build my
skills?” or who is consistently performing, they grab something and learn it 100%. Then
ask for more. I would say a very engaged or hungry employee where they know what
they’re doing for their job and their role, and have such a positive attitude about it.
Lastly, P15 responded and outlined that:
Critical or core employee, I think, is definitely somebody whose position is vital to the
success of an area, someone that has perhaps key knowledge or skills such as abilities to
do reports, program experience, things that may be unique to that area that only them or
one or limited other people would know or have. Some come in through educational
skills and abilities; others by also, I’ll even throw this in here, the quality or level of their
work. I think we can consider somebody a key employee because they’re a high
contributor. With the work that they do, we know that they can be counted on to get the
job done and get it well where there may be others that aren’t as strong in those areas.
Leaders need to know how to provide effective goals to employees. Partially validated.
According to the literature, goal clarity is important to employees and their turnover intentions,
as it guides them in a specific direction, and assists them in understanding the most effective
channel to direct their efforts (Ghosh et al., 2013). The study set out to assess this by trying to
understand how well leaders knew how to provide their employees with effective goals. Survey
question 6 (SQ6) and interview question (IQ3) were used.
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Survey results. SQ6 asked respondents, “Which of the following are components of Goal
Setting?” The question offered five options, which included “All of the above” and “None of the
above” options. Sixty-seven percent of the respondents chose the correct answer of “All of the
above,” while 19% chose Cascading Goals and 14% chose SMART Goals. No one chose option
C. “Goal Alignment” or E. “None of the above.”

Figure 4. Data from survey question #6

Interview results. IQ3 asked respondents, “Please describe the activity of cascading a
goal and its importance.” The goal of IQ3 was to identify the procedural knowledge leaders had
regarding goal setting. All but two of the respondents were able to clearly articulate the activity
of cascading a goal, as well as provide an example from their department. P6 pinpointed an
3, 14%
4, 19%
0, 0% 14, 67%
0, 0%
Survey Question # 6
Which of the followng are components of Goal Setting?
A. SMART Goals B. Cascading Goals C. Goal Alignment
D. All of the Above E. None of the Above
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activity of cascading goals and stated, “Communicating goals from one level of the organization
to the next.” P5 demonstrated a clear understanding of cascading goal and stated:
For me it’s to understand the direction, the strategic direction, of the department as a
whole, and how they fit into the business plan for the organization, and our goals for
profitability and growth. That’s the big goal. Then we break it down to how does this
particular department fit into that? Then we break it down to how does the director and
their staff fit in? Then how does that individual fill in that piece? Because while the goal
comes from the top cascading down, the results are from the front line staff cascading
upwards. If the front line staff do not achieve their goals, then eventually the
organization will not achieve their goals.
The survey data showed a gap in knowledge, but the interview responses showed a clear
understanding of goals, the gap was only partially validated.
Leaders need to know how to build effective relationships with their employees. Gap
not validated. Many researchers have reinforced the correlation between interpersonal
relationships and employee turnover by finding that constituent attachment at work, with a direct
leader or coworkers, is a primary force that embeds employees in an organization, thus
promoting employee retention (Maertz & Campion, 2004; Maertz & Griffeth, 2004).
Specifically, leaders need to know how to build effective relationships with their employees. In
order to assess the knowledge level of leaders to build effective relationships with their
employees, two True/False survey questions and one open-ended interview question were asked.
Survey results. One hundred percent of the respondents responded “True” to both survey
questions, thus validating their procedural knowledge of building relationships with their
employees.
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Table 13
Survey Questions #7 and #9 Results
Procedural Survey Question(s) Item Results
An employee’s trust in their leader is an important part of
employee engagement and employee retention. (Procedural)
a. True
b. False
Survey
Q7
100% selected
a. True
Effective, open and honest communication are vital to building
trust and mutual respect with my employees. (Procedural)
a. True
b. False
Survey
Q9
100% selected
a. True

Interview results. To validate the survey questions, the corresponding interview question
was asked, “As a leader, what do you specifically do to ensure you are building a positive,
trusting relationship with your employees?” This question allowed leaders to display their
knowledge by providing specific examples of how they build relationships with their employees.
All leaders were able to clearly communicate effective ways to build relationships with their
staff. Themes that emerged from this interview question included respect, fairness, open
communication, feedback, and how they provided support. P10 provided the following example:
I speak to them with respect. I have open communication. I ask for their honest feedback.
Nine times out of ten, their feedback is really good feedback. I implement their feedback,
showing and demonstrating that I am a leader not only of my words but of my actions.
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P15 stated:
I try to be fair and consistent and supportive. For me, it’s important I seek feedback from
them on what they need from me. What’s going well, what’s not going well? I also
provide them with as much autonomy as possible.
Leaders need to know how to provide effective coaching and feedback. Gap validated.
According to a 2000 Gallup study, employees who are satisfied with the frequency, level, and
quality of the performance feedback they receive, are found to be more engaged and committed
to the organization, and therefore more likely to be retained (Saks, 2017). We wanted to
understand the role coaching and feedback played in retention. There are numerous coaching
models identified in the literature. XYZ Healthcare has a specific coaching and feedback
process, with an accompanying coaching form, that leaders are trained to implement and
expected to use with all of their direct report, at minimum, on a quarterly basis.
In order to gauge the procedural knowledge of leaders regarding how they provided
effective coaching and feedback, this study utilized the components from the organization’s
internal coaching process. We assessed the knowledge of leaders on how they provided effective
coaching and feedback, survey question 8 (SQ8) and interview question 10 (IQ10) were utilized.
Survey results. To measure the understanding of the procedural knowledge of leaders,
survey question 8 asked leaders to identify the components that an “effective coaching and
feedback session included.” Respondents were asked to check all that applied. Check All That
Apply (CATA) questions are a type of multiple choice question in which respondents are asked
to select all the terms from a list that they consider applicable to describe a set of items, without
any constraint on the number of terms that can be selected.
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Six possible options were provided: (a) A relationship of trust; (b) Preparation;
(c) Specific behavioral examples; (d) A completed coaching form; (e) Coaching form from
previous discussion; (f) Data to support performance. All of the responses were components that
were pulled from the organization’s internal coaching process, however, the “All of the above”
option was not provided. This tested the knowledge and personal use of each component in the
coaching process. To eliminate a gap, 80% (16 respondents) of the 21 respondents needed to
correctly identify 100% of the six items as a component of coaching and feedback. Of the six
components, four were selected over 80%. One hundred percent of the respondents selected (a)
A relationship of trust and (b) Preparation. Slightly over 85% of the respondents selected
(c) Specific behavioral examples. Only 15, or 71.43% of the respondents selected (d) A
completed coaching form, and only 16 (76.19%) selected (e) Coaching form from previous
discussion. Lastly, 90% of respondents selected (f) Data to support performance. Based on the
aforementioned validation standards, the gap was validated because less than 80% of the
respondents correctly identified 100% of the items as components of the coaching and feedback
process.

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Figure 5. Data from survey question #8

Interview results. To validate the survey question and better understand the knowledge
levels of leaders regarding the components for coaching and feedback, respondents were asked to
“Describe the components necessary to have an effective constructive coaching and feedback
discussion with an employee when they are not meeting performance expectations.” While the
respondents identified aspects of coaching and feedback, none of the 21 respondents identified
the six official components from the organization’s internal coaching process, which further
validated the gap. P1 stated: “I try to tell them what is going well. I state the positive, and then
tell them what they could do to be a little bit more effective.” P2 stated:
a. A
relationship
of trust
b.
Preparation
c. Specific
behavioral
examples
d. A
completed
coaching
form
e. Coaching
form from
previous
disucssion
f. Data to
support
performance
# of Responses 21 21 18 15 16 19
21 21
18
15
16
19
Survey Question #8
Effective coaching and feedback include the following. Check all
that apply:
# of Responses
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What I try to do is I make sure that I’m not going to have any interruptions. My phone
and email and all that kind of stuff is generally not open and then I just like to start with
them and ask them how are you doing? Do you have any questions or concerns? Do you
have any ideas? I like to encourage my people to think outside the box frequently. Then
I always ask them do you have the tools you need to do your job? Do you have any
feedback for me if there’s something that I could be doing different? Basically I look for
constructive criticism that goes both ways. Maybe perhaps I need to tell the employee
having to coach you on this certain circumstance I would try to provide real life
examples. But then I always ask for feedback too about me just to keep the conversation
open and they have a certain level of trust knowing that they can talk to me openly and
honestly.
P14 agreed and stated:
The biggest part is actually knowing what the goals are and being on the same page with
them [my employees], but also, I think it’s being consistent. Goals, being on the same
page, and consistency are probably the biggest keys there. If you’re not consistent with
how you do coaching and feedback, you kind of leave people all over the place. You
can’t do it one way one time and then change it up the next.
P6 echoed these sentiments and stated:
Definitely having it scheduled is number one. Having an appropriate time scheduled,
doing my homework before the coaching session, and encouraging the employee to do
the same. Some prep time prior, having the quarterly coaching pre-filled out before we
meet, and go through it together on screen so both myself and the employee can see what
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I am typing as I am typing. If I need to make edits, I think that’s really important because
it makes the meeting efficient.
Leaders need to know how to help their employees plan and develop their long-term
career objectives. Gap not validated. Providing training and development to employees has
been identified as a key retention for top performing and core employees. According to research,
employee learning has a strong effect on retention (Echols, 2007; Gershwin, 1996; Rodriguez,
2008). Because employee learning plays such a critical role in retention, leaders need to have the
necessary skills and knowledge to use training and development as a tool to meet the learning
needs of their employees.
Survey results. To measure the assumed influence, a survey question asked leaders,
“Career development conversations should focus on which of the following?” As shown in
Table 14, the data showed that 100% of the respondents responded, (c) Activities to increase the
knowledge and skills of the employee, to the survey question, thus validated their procedural
knowledge of how to help their employees plan and develop their long term career objectives.

Table 14
Survey Question #5 Results
Procedural Survey Question(s) Item Results
Career development should focus on which of the
following:
a. The employee getting a promotion
b. Promises of a raise / bonus/ increase in pay
c. Activities to increase the knowledge and
skills of the employee
d. None of the above
Survey Q5 100% selected c.
Activities to increase the
knowledge and skills of
the employee.

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Interview results. IQ9 assessed if leaders knew what growth and development
opportunities were available within the organization and available to offer to their employees.
The interview responses to the question, “Identify 2-3 specific growth and development activities
that are available to employees on your team within the organization” revealed common themes
of employee training, tuition reimbursement, and goal setting as growth and development
opportunities. All responses were deemed correct, as they all identified the current growth and
development activities within XYZ Healthcare, previously validated by the Human Resources
department. Goal setting, mentoring, and internal training and development was a theme that
consistently appeared during the interview. P8 stated:
So on my team I connect people with a mentor. So there’s that. Also goal setting is a
part of our department culture and within the organization people are given the
opportunities for professional development through education stipends and some funds
for conferences and that sort of professional development activities. So those are a few.
P12 further reinforced a solid knowledge of goals by stating, “Well, quarterly development,
WebEx trainings or in-person trainings on a variety of topics around functioning in the
workplace with others, communication, time management, working remotely with others.”
Metacognitive knowledge. One assumed influence was identified under metacognitive
knowledge. Data on the one declarative knowledge influence identified in the literature review
was collected and analyzed. The results are outlined below.
Leaders need to reflect on how their current leadership behaviors impact employee
retention. Gap not validated. Metacognition requires critical thinking and inquiry, which is then
predicated upon one’s awareness and ability to take responsibility and control in order to
construct meaning and confirm the meaning (Akyol & Garrison, 2011). According to Krathwohl
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(2002), leaders need to reflect and have a certain level of self-awareness as it relates to their
current leadership behaviors and how these behaviors impact employee retention. In order for
leaders to do this, they need to seek feedback from peers and employees regarding their
leadership behaviors and reflect upon the feedback as it relates to their effectiveness in reducing
employee turnover.
Survey results. To assess if leaders reflected on how their current leadership behaviors
influenced employee turnover, survey question 11 (SQ11) asked leaders to select True or False
to the statement, “My employees and other team members would say that I regularly ask them
for feedback on my performance.” One hundred percent of the respondents selected (a) True,
which indicated there was no gap in metacognition.

Table 15
Survey Question #11 Results
Metacognitive Survey Question(s) Item Results
My employees and other team members would say that I
regularly ask them for feedback on my performance.
a. True
b. False
Survey Q11 100% selected
a. True

Interview results. To further validate the survey data, and identify how leaders reflected
on their leadership behaviors, an interview question asked respondents to, “Give me an example
of a time when you received feedback from one your employees about your behavior/
performance and what you did with that feedback.” All 17 leaders provided specific instances of
when they received feedback from their employees regarding their behavior/performance and
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how they reflected on the feedback and made changes to improve their leadership effectiveness.
P1 shared feedback received as a new employee and outlined:
When I was first started, it was really stressful, I think for all of us, because I was also a
relatively new employee and was not used to working in the culture and this big of a
corporation. When I asked my team for feedback, the feedback that I got was that it
appeared that I didn’t really know where we were going and they didn’t understand what
was going on. They told me that I seemed really stressed out all the time and in a big
hurry and that’s putting some stress on them.
P7 recalled:
I took some time to really think about that and how I wanted to change, well it wasn’t a
perception because they were right. I was feeling extremely stressed out. That was when
we decided that we would basically have weekly or every other week updates where we
could all talk about everything that was going on within the organization and how we
were going to try to build our team. It worked really well. Then the other thing was I
just asked them, “Hey if you feel like I’m totally stressed out or I’m not providing
enough instruction or feedback to you I just want you to be honest enough to tell me
because sometimes I’m not going to recognize that I’m being too intense.”
P16 shared an experience in which:
One of my employees told me that I needed to be more assertive when working with our
regulators because it made their job harder. I took that feedback and I thought about it,
and I did my own work on it. The next time I came up with a request from a regulator
that I truly felt was something that I did need to push back on as a leader of the
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organization, I did. It was very open, and respectfully, and it went very well. I would
say that their feedback was honestly taken to heart, and it was really good feedback.
Motivation Results
The goal of this motivation gap analysis was to explore the motivational influences that
drove leaders’ choices and efforts to alter certain leadership behaviors when they attempted to
increase employee retention. Motivation is an important component when trying to drive
organizational change because motivation influences the type of task a person chooses to engage
in, their initiation to take on the task, the level of intensity and vigor exerted to the task, the
performance level given to the task, and the level of drive persistence given, despite any obstacle
or adversity they may face (Bandura, 1977).
The aim of this section is to assess assumed motivational influences important for leaders
to be effective in improving dysfunctional voluntary turnover. Three motivational influences
were identified in the literature based on Expectancy Value Theory and Self-efficacy Theory.
Data was collected through the same survey and interview tools used to assess the preceding
knowledge influences. The survey and interview questions were designed to explore the
motivational influences that drove leaders’ choices and efforts to alter certain leadership
behaviors in an effort to increase employee retention.
There were a total of three survey questions and three interview questions used that
assessed motivational influences. Each question sought to determine if the motivational barriers
identified in the literature were present in the organizational setting. Of the three assumed
motivation influences, evidence revealed that no gap existed in two of the three influences;
however a gap was found for one of the assumed influences.
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Valance. Two assumed influences were identified under valance. Data on the two
valance motivation influences identified in the literature review was collected and analyzed. The
results are outlined below.
Leaders need to see the value in reducing employee turnover. Gap not validated. The
literature identified the importance of leaders understanding the impact of employee turnover and
seeing the value in reducing it.
Survey results. To assess this influence, survey question 12 (SQ12) asked leaders an
Agree/Disagree question, “Retaining top performers and employees with critical skills is
important to the organization in order to maintain a competitive advantage.” One hundred
percent of the respondents selected (a) Yes, I agree, which indicated leaders see the value in
reducing employee turnover, and did not validate the gap.

Table 16
Survey Question #12 Results
Valance Survey Question(s) Item Results
Retaining top performers and employees with critical skills is
important to the organization in order to maintain a competitive
advantage.
a. True
b. False
Survey
Q12
100% selected
a. True

Interview results. To validate the data from the survey, an interview simply restated the
survey question and asked why the leaders found value in retaining top performers. The question
was phrased as follows, “Retaining top performers and employees with critical skills is important
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to the organization in order to maintain a competitive advantage. Why is that of value to you and
the organization?” One-hundred percent of the leaders were able to accurately state specific
reasons why retaining top performers and employees with critical skills were important to them
and the organization in order to maintain a competitive advantage. Statements from respondents
reflected a strong desire to retain talent, skills, knowledge. P10 stated:
Those are typically the type of individuals that you want to entrust the organization with
is the ones who is committed, and have the skill set, at least you identify they have the
skill set to grow with the organization.
P2 outlined:
Yes, I agree with that because competitive advantage is based on the positioning of an
organization to compete and win, and you can’t do that unless you have top performers
that are excelling beyond your competition. So if you don’t have those people with the
skills and abilities to compete and win, then you’ll lose your competitive edge there.
P17 shared:
Yes. I think the organization understands the value that top performers, key people are
definitely the ones that obviously get more of our work done and are more effective in
what we do, although I will say I think we could still do better with it.
A follow up question to further identify the value leaders saw in retaining top talent
asked respondents, “How have you personally experienced not being able to retain top
employees and how has that impacted your department?” Of the 17 respondents interviewed,
eight of the respondents stated that they had not personally experienced employee turnover.
However, for those that had experienced employee turnover, they referenced the impact it had on
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their team’s overall performance and effectiveness. P11 was a respondent that experienced
employee turnover and stated:
I’ve experienced it when we are not given the resources or capacity to compensate people
for being top performers and so despite best efforts at development or mentorship or all
of those fringe benefits, they still need to make that decision to go elsewhere. Then that
impacts the morale of the team because when people feel like, or have seen somebody
that was doing a really great job still not being compensated for what they’re worth, they
start to feel like “then it’s hopeless for me as well.” Then they start looking. Even if they
do choose to stay, they’re going to be demotivated to do good work.
P7 shared the negative impact to the organization or department:
By not being able to keep the top performer typically who’s going to be a key performer,
somebody that also has a lot of responsibility, may have a lot of unique knowledge, it
creates large gaps within departments or within the organization that with somebody new,
that area may need to be filled by even two or three people, not just one that is a
replacement because not just that they’re so well in the flow but there’s just so much
uniqueness with what a top performer is able to do and the impact that they make within
their department and the organization.
Leaders need to see the value in adopting and implementing specific leadership
behaviors in an effort to increase employee retention. Gap not validated. The literature stated
that people are motivated to perform an activity when they feel they will achieve the thing(s)
they want from doing so (Lin, 2007). Therefore, it is one’s belief that increased effort will lead
to increased performance (Watson & Hewett, 2006). In the case of leadership, leaders need to
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believe that they have the ability to change their leadership behaviors and that their efforts would
positively influence employee retention.
Survey results. To assess this influence, survey question 13 (SQ13) asked leaders an
Agree/Disagree question: “There is value is providing employees clear goals, coaching and
feedback, growth and development, and advancement opportunities.” One hundred percent of
the respondents selected (a) Yes, I agree, thus indicating leaders saw the value in reducing
employee turnover, and did not validate the gap.

Table 17
Survey Question #13 Results
Valance Survey Question(s) Item Results
There is value is providing employees clear goals, coaching
and feedback, growth and development, and advancement
opportunities.
a. Yes, I agree.
b. No, I disagree.
Survey
Q13
100% selected
a. Yes, I agree.

Interview results. Survey question 13 (SQ13) looked to validate the survey response by
looking deeper into what leaders believed the value was in adopting and implementing specific
behaviors to reduce employee turnover. SQ13 asked, “What do you think the value is in
providing your employees clear goals, coaching and feedback, growth and development, and
advancement opportunities?” One hundred percent of the respondents expressed value in
providing their employees clear goals, coaching and feedback, growth and development, and
advancement opportunities. P4 stated:
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If the employee feels that you are invested in their career and you truly are invested in
their career, you are retaining that employee not only for your department but for the
entire organization because the employee is an asset to the entire organization. That will
make the entire organization successful.
P11 stated, “There’s huge value in these things because if you can’t retain your talent then you’re
going to cease to be effective in your business objectives.”
Self-efficacy. One assumed influence was identified under self-efficacy. Data on the
self-efficacy influence identified in the literature review was collected and analyzed. The results
are outlined below.
Leaders need to believe they are capable of successfully adopting and implementing
specific leadership behaviors in an effort to increase employee retention. Gap validated.
Greater self-efficacy is shown to strengthen an individual’s belief that effort will result in
successful completion of the action. Therefore, leaders need to believe that they have the
necessary capabilities to successfully adopt and implement specific leadership behaviors in an
effort to increase employee retention. To assess this influence, both a survey and interview were
deployed.
Survey results. Survey Question 14 (SQ14) asked respondents a scale question which
stated, “On a scale of 1 to 5, 1 being the lowest, 5 being the highest, how confident are you in
your ability to do the following: (a) Accurately identify your critical employees / top performers;
(b) Establish effective goals for your employees; (c) Consistently provide effective coaching and
feedback to your employees; (d) Build trust among your employees; (e) Provide your employees
career development opportunities.” This question measured the confidence level of respondents
in five specific leadership behaviors identified in the literature.
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The data revealed that leaders were confident in their ability to (a) Accurately identify
your critical employees / top performers; and (d) Build trust among employees. However, a gap
was identified in the leaders’ confidence in the remaining three areas of (b) Establishing effective
goals for employees; (c) Consistently providing effective coaching and feedback to employees;
and; (e) Providing employees career development opportunities.

Figure 6. Data from survey question #14

Identifying
Top
Performers
Establishing
Goals
Providing
Coaching &
Feedback
Building Trust Career
Development
1 (No Confidence) 0 0 0 0 0
2 (Very little Confidence) 0 10 0 0 6
3 Average Confidence) 2 7 8 0 9
4 (Confident) 4 3 9 2 3
5 (Very Confident) 15 1 4 19 3
15
1
4
19
3
4
3
9
2
3
2
7
8
9
0
10
6
Surv e y Q ue st ion # 14
On a sc ale of 1 t o 5, 1 be ing t he lowe st , 5 be ing t he hig he st , t e ll
me how c onfide nt y ou are in y our abilit y t o do t he following :
5 (Very Confident) 4 (Confident) 3 Average Confidence) 2 (Very little Confidence) 1 (No Confidence)
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Figure 7. Data from survey question #15

Interview results. To dig deeper and validate the data from the survey, during the
interview, respondents were asked the survey question and asked to elaborate on “why” they
chose that rating. The question asked, “On a scale of 1 to 5, 1 being the lowest, 5 being the
highest, tell me how confident you are in your ability to do the following and please state why
you chose that rating: (a) Accurately identify your critical employees / top performers; (b)
Establish effective goals for your employees; (c) Consistently provide effective coaching and
feedback to your employees (d) Build trust among your employees; (e) Provide your employees
career development opportunities.”
2, 10%
19, 90%
Survey Question # 15
As a leader, I am confident that I have what I need to effectively establish
and comminicate clear expectations and goals for 100% of the employees
on my team for this year.
a. Yes, I agree b.No, I disagree
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Based on respondents’ responses to the five statements, leaders showed they had high
confidence in their ability for the following questions: (a) Accurately identify your critical
employees/top performers; (d) Build trust among your employees; and (e) Provide your
employees career development opportunities. However, leaders expressed low confidence in
their ability to: (b) Establish effective goals for your employees; (c) Consistently provide
effective coaching and feedback to your employees; and (e) Provide your employees career
development opportunities.
Several themes emerged based on the above questions, including a lack of confidence in
the leader’s ability to be effective when dealing with topics that were impacted by the
organization. Change was a common theme that emerged when leaders spoke about goal setting.
However, when leaders felt the topic was 100% within their control, they assessed their
confidence as high. The following statements are from the three areas where leaders expressed
low confidence.
When asked about confidence regarding: (b) Establish effective goals for your
employees, P1 rated in the middle and stated:
I would say a three. The change in the organization has led to some role confusion and
it’s hard for me to help them establish goals when I’m not really sure even what their job
description is in a new environment.
In response to (c) Consistently provide effective coaching and feedback, P8 also fell in the
middle and stated, “I would probably say a three and part of what’s happening right now is I just
don’t have the time. I’m trying to get there but I’m not there yet.” With respect to (e) Provide
your employees career development opportunities, P15 was on the low end and stated:
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I would say a two right now at because there is just not a lot of opportunities within the
company that I feel that I can offer my employees. I do what I can, but there comes a
time when you really don’t have anything else to offer them.
Organizational Results
As with knowledge and motivational influences, organizational influences were assessed
with the same survey and interview tools. Five organizational influences were identified within
the literature. Each of the survey and interview questions discussed in this section determined
the organizational influences that were presented in the literature around employee retention.
There were a total of 10 survey questions and seven interview questions used that assessed
organizational influences. Of the five assumed knowledge influences, the evidence revealed that
a gap existed for all five of the assumed influences.
Cultural models. Two assumed influences were identified under cultural models. Data
on the two cultural model influences identified in the literature review was collected and
analyzed. The results are outlined below.
Human resource strategies within the organization are aligned with and support the
goal of decreasing voluntary dysfunctional turnover. Gap validated. The literature revealed
that the combination of varying HR strategies selected by an organization, based on its
organizational culture values, resulted in the development of specific “psychological climates
and norms that fostered varying levels of employee commitment and retention” (Deery & Shaw,
1999, p. 388). From this analysis, it is showed that Human Resources practices within an
organization are closely aligned with and can either support, or hinder the goal of decreasing
employee turnover. To assess this influence, one survey question and one interview question
were presented to respondents.
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Survey results. To assess the perceptions of how Human Resources strategies within the
organization supported the goal of decreasing employee turnover, leaders were asked a Yes / No
Agreement Statement, “Our current Human Resource practices, including: selection & hiring,
onboarding, internal advancement & promotion, training & development, and reward systems are
effective practices in reducing employee turnover.” This question was guided by literature and
gauged specific Human Resources activities that influenced employee turnover rates.
Of the 21 respondents surveyed, 20 selected (b) No, I do not agree, while only one agreed
with the statement. With 95% of the respondents not agreeing with the statement, the gap was
validated.

Figure 8. Data from survey question #16

1, 5%
20, 95%
Survey Question # 16
Our current human resource practices, including: selection & hiring,
onboarding, internal advancement & promotion, training & development,
and reward systems are effective practices in reducing employee turnover.
a. Yes, I agree b.No, I disagree
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Interview results. To further validate the data collected in the survey, interview
respondents were asked, “Describe how effective you feel the current human Resource practices,
including selection and hiring policies, internal advancement and training promotion and
employee development, and reward systems are in reducing employee turnover.” Of the 17
interviewees, 100% of them described the HR practice as being ineffective and able to support
the reduction of employee turnover. Leaders outlined that they strongly believed that the current
HR practices were ineffective in reducing employee turnover. Themes that emerged included,
unfair selection and hiring practices, confusing and inadequate onboarding process, little internal
advancement and promotion opportunities, and an ambiguous and unfair reward system within
the organization. However, many of the leaders believed there was sufficient training and
development opportunities through iLearns.
P13 outlined there were areas in need of improvement and stated, “Job, skills, and
functional training for employees is lacking. The selection practices are not effective due to
inadequate job description and what is identified for candidate skills. Internal advancement, ha,
there isn’t much opportunity.” P15 echoed the need for improvement and stated:
To be quite honest, if this is an honest interview, I have had very poor luck with having
anybody help me with selection and hiring. I think the onboarding process has actually
been improved from when I first started. As far as internal advancement and promotion
that is pretty much nonexistent. Obviously we’re in a special situation right now, but
there’s not a lot of opportunity for advancement and development. As far as training and
development, actually I would say that I think we do have some pretty good training and
development opportunities through iLearn. There’s not a reward system, unless I am the
reward system for my team.
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The organization culture is seen as balanced, valuing on both people and performance.
Gap validated. As was identified in the literature review, some organizations have cultures that
emphasize values of shared goals, teamwork, security, and interdependence; while other
organizations have cultures that emphasize individual performance and reward employees for
accomplishing specific work objectives that impact the bottom-line, regardless of method of
accomplishment (Kerr & Slocum, 1987). This would possibly lead to a disjointed view in what
leader and employees can potentially view as being valued within an organization. Conversely,
the second assumed organizational influence stated the organizational culture should be seen as
balanced, valuing both people and performance. To assess the perception leaders have
responsibility of being able to balance between valuing both people and performance of the
organization. Three survey questions and two interview questions were asked to validate this
influence.
Survey results. Three survey questions were designed to measure the assumed influence.
The first survey question asked aimed to identify if the organization’s focus on assessing if the
organization placed a value on people by asking respondents, “Do you see the organization
investing resources to ensure employees are engaged and satisfied?” Available responses were,
(a) Yes, I do; (b) No, I do not. As Figure 9 shows, 67% (14) of the respondents indicated (b)
Yes, I do, which demonstrated they saw the organization was investing resources to ensure
employees were engaged and satisfied. Only 33% stated that they did not.

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Figure 9. Data from survey question #17

The second survey question aimed to identify if the organization focused on performance,
by identifying the level of accountability that was placed on employees to perform. The question
stated, “The organization is committed to holding employees accountable for high performance,”
and asked for a Yes/No agreement statement. Of the respondents, 86% responded “No, I
disagree.”

14, 67%
7, 33%
Survey Question # 17
Do you see the organization investing resources to ensure employees are
engaged and satisfied?
a. Yes, I do b.No, I do not
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Figure 10. Data from survey question #19

The third and final survey question for this influence was used to validate the previous
two, and simply asked respondents what was their perception of what the organization valued
most. The question asked, “Based on how the organization spends its time, resources, focus, and
energy, what do you think they value the most? (a) People; (b) Performance; (c) There is a good
balance of both.” According to the data, 57% stated the organization focused on performance,
while 33% identified people. Only 10% felt that there was a good balance focused on both
people and performance.

3, 14%
18, 86%
Survey Question # 19
The organization is committed to holding employees accountable for high
performance.
a. Yes, I agree b.No, I disagree
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Figure 11. Data from survey question #18

Interview results. The interview questions were designed to validate the data from the
survey. The first interview question corresponded with survey question #17, and asked, “In what
ways, if at all, do you see the organization is investing resources to ensure employees are
engaged and satisfied?” Ironically, unlike the survey data, which indicated a clear belief that the
organization was investing resources to ensure employees were engaged and satisfied, many of
the interview respondents could not easily state what ways the organization was doing so. One
theme emerged: leaders saw training as a way the organization was investing resources. Of the
nine respondents who could identify investments were being made, all referenced training and
development as the primary way in which they saw the organization investing resources into
people.
7, 33%
12, 57%
2, 10%
Survey Question # 18
Based on how the organization spends its time, resources, focus, and
energy, what do you think they value the most.
a. People
b.Performance
c. There is a good balance
of both
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P9 stated, “They are trying to shape our culture, reshape our culture, and developing their
iLearn systems. They are trying.”
To validate survey question 19, respondents were asked, “In what ways, if at all, do you
see the organization holding employees accountable for high performance?” The survey was
validated as 90% of the interview respondents indicated that they did not see the organization
holding employees accountable for high performance. The themes identified in the interviews
included a lack of pay for performance and no accountability systems in place. P2 stated:
I don’t think we’re committed to holding anyone accountable, high performance or not.
So to me, that equates . . . it really equals out to our current situation at the company. So
if that was something that we practiced, then we would see the fruit of that. But it’s
definitely . . . It’s something that we really don’t do. At every level.
P13 added, “We need at least a Pay for Performance program so people are finally held
accountable in some way.”
Cultural settings. Three assumed influences were identified under cultural settings.
Data on the three cultural setting influences identified in the literature review was collected and
analyzed. The results are outlined below.
The organization is perceived as being supportive. Gap validated. As was identified in
the literature review, organizational support is the assurance that the necessary assistance and
resources will be available from the organization when they are needed to carry out one’s job
effectively (Kottke & Sharafinski, 1988). Therefore, in order for leaders to be successful in
reducing employee turnover, they need to feel confident that the organization is supportive and
provides them the necessary tools and resources to be successful. To assess the perception of
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how supportive leaders believed the organization was, three survey questions and two interview
questions were asked.
Survey results. Three Yes/No agreement statement survey questions were designed to
measure that assumed influence. The first survey question aimed to identify if the organization
was perceived as being supportive. Respondents were asked to respond to the statement, “The
organization provides me and my team the necessary resources, tool, and systems needed to do
our jobs effectively.” Available responses were, (a) Yes, I agree; (b) No, I disagree. As Figure
12 shows, 86% (19) of the respondents indicated (b) No, I disagree, which demonstrated they do
not feel the organization provided them the necessary resources, tools, and systems they needed
to do their jobs. Only 14% stated that they agreed with the statement.

Figure 12. Data from survey question #21
3, 14%
19, 86%
Survey Question # 21
The organization provides me and my team the necessary resources, tool,
and systems needed to do our jobs effectively.
a. Yes, I agree b.No, I disagree
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Another characteristic of organizational support is providing an employee clarity through
processes, procedures, goals, and role clarity. The second survey question used to assess this
influence asked for a response to the statement, “Effective workflows, processes, and procedures
are established and documented in a way that allows my employees to do their job effectively.”
Available responses were, (a) Yes, I agree; (b) No, I disagree. As Figure 13 shows, 90% (19) of
the respondents indicated (b) No, I disagree, which further indicated they do not feel they had the
necessary tools and resources needed to be effective. Only 10% (2) of the respondents selected
(a), Yes, I agree.

Figure 13. Data from survey question #22

2, 10%
19, 90%
Survey Question # 22
Effective workflows, processes, and procedures are established and
documented in a way that allows my employees to do their job effectively.
a. Yes, I agree b.No, I disagree
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The third and final survey question used to assess this influence asked, “As a leader, I
feel supported by the organization.” Available responses were, (a) Yes, I agree; (b) No, I
disagree. As Figure 14 shows, 67% (14) of the respondents indicated (b) No, I disagree, which
demonstrated they did not see the organization as being supportive. This question further
authenticated the data from the first two survey questions. Only 33% stated that they agreed
with the statement.

Figure 14. Data from survey question #20

7, 33%
14, 67%
Survey Question # 20
As a leader, I feel supported by the organization.
a. Yes, I agree b.No, I disagree
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Interview results. To validate the survey data results, interview respondents were asked,
“Do you feel effective workflows, processes, and procedures are established and documented in
a way that allows your employees to do their job effectively? Why? Or Why not?”
P7 stated, “No. While there are some workflows, processes and procedures established
and documented, there are many that are not, and there are several that conflict with each other.”
P9 added, “There are not workflows and processes and the ones that do exist are old and do not
work, but I do know that’s something that’s a high priority for myself.” P15 also expressed
disagreement and stated:
I would have to say no which is why we are failing sometimes in my department because
there are no, there’s nothing written about how to do certain things at all. There’s no
SOPs, Standing Operation Procedure, there’s not any for my department.
The second interview question posed to validate the survey data asked, “As a leader, do
you feel the organization provides you and your team the necessary resources, tool, and systems
needed to do your jobs effectively? Why? Or Why not?” P1 stated:
We do not have the tools and systems needed to do the job effectively and efficiently.
Specifically, we need better technology. Systems that are able to capture the information
that is needed to report as part of what we do so that it’s not a manual system or that it’s
able to address the systems that have conflicting information. A tool to more efficiently
manage policies and QRGs. Access to other departments’ information at both the health
plan level and the corporate level that are needed to resource to do our job.
P15 reiterated the sentiment by stating, “The systems are ineffective. Our technology is behind
than our competitors in this industry, but some tools are very effective that they’ve provided us.
Overall, I’m going to say no, I disagree, and that is why.”
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The organization provides advancement and growth opportunities. Gap validated. In
order to retain core employees, organizations need to provide them career growth opportunities.
According to Weng et al. (2010), employees who perceive that their current organization
provides them opportunities to attain their career goals, or develop new/better job skills, have
higher levels of commitment and are less likely to leave that organization. Therefore, in order
for leaders to effectively reduce employee turnover, the organization must provide, not only
leaders career development and growth opportunities, but the organization must also make
advancement and growth opportunities readily available as a resource to leaders to offer their
employees. To assess the perception leaders had of the growth and development opportunities
available, one survey question and one interview question were asked.
Survey results. One survey question was designed to measure the assumed influence.
The survey question aimed to identify if the organization provided sufficient advancement and
growth opportunities. The question asked respondents, “There are sufficient advancement and
growth opportunities that exist within the organization that enable me to support my employees
in their professional development and growth.” Available responses were, (a) Yes, I agree; (b)
No, I disagree. As Figure 15 shows, 86% (19) of the respondents indicated (b) Yes, I do, which
demonstrated the leaders’ perception that there were not sufficient advancement and growth
opportunities that enabled them to support their employees’ professional development. Only
14% stated that they did.

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Figure 15. Data from survey question #23

Interview results. To validate the survey data, respondents were asked, “To what degree
do you feel employee development and growth opportunities are readily available in the
organization?” Two themes that emerged that were consistent across the responses: development
and growth opportunities were not readily available which made it hard for them to provide
opportunities to employees and retain them. The other theme was there were not enough
positions for advancement to motivate employees. Both themes validated the survey data. P14
stated:
The advancement opportunities for me has always been a challenge because obviously
the organization does not have lots for positions for them to advance into. That to me is
always a challenge because sometimes there are not those positions at our company. It’s
3, 14%
19, 86%
Survey Question # 23
There are sufficient advancement and growth opportunities that exist
within the organization that enable me to support my employees in their
professional development and growth.
a. Yes, I agree b.No, I disagree
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still trying to keep your top performer plugged in and still learning even if there may not
be an advancement opportunity for them in the near future.
The organizational culture is seen as transparent, fair, and just. Gap validated. Park
and Kim (2009) found that organizational culture is directly associated with job satisfaction and
employee turnover intentions. Joo and Park (2010) further contended that a transparent
organization that is seen as fair and just can better retain key performers. The final assumed
organizational influence stated that the organizational culture is seen as transparent, fair, and just.
To assess the perception leaders have of the how transparent, fair, and just the organization is,
two survey questions and one interview question were asked. Both the survey and interview data
validated the gap.
Survey results. Two survey questions were designed to measure the assumed influence.
The first survey question, was a Yes/No Agreement statement that aimed to identify leaders’
perceptions of fairness and transparency and asked, “Practices within the organization, such as
hiring, promotions, and reward systems are fair and transparent.” Available responses were, (a)
Yes, I agree; (b) No, I disagree. As Figure 16 shows, 95% (20) of the respondents indicated (b)
No, I disagree, which demonstrates their disagreement with the statement that practices within
the organization, such as hiring, promotions, and reward systems were fair and transparent. Only
5% of the respondents stated that they did agree with the statement, which validated the gap.

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Figure 16. Data from survey question #24

The second survey question was a True/False statement that asked respondents, “The
organization creates a culture where I can communicate effectively, openly, and honestly with
my team.” Available responses were, (a) True; (b) False. Figure 17 shows that 67% (14) of the
respondents indicated (a) True. Contrary to the previous survey question that measured fairness
and justice within the organization, leaders perceived that the organization created a culture
where they could communicate effectively, openly, and honestly with their team. Only 33% of
the respondents stated that they found this statement to be false.

1, 5%
20, 95%
Survey Question # 24
Practices within the organization, such as hiring, promotions, and reward
systems are fair and transparent.
a. Yes, I agree b.No, I disagree
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Figure 17. Data from survey question #25

Interview results. To further validate the survey data, an interview question was designed
to identify the perceptions leaders had of justice within the organization. The literature identified
that employees distinguish three forms of justice: (1) distributive justice (fairness of the
outcomes that the employee receives); (2) procedural justice (fairness of the procedures used to
determine those outcome allocation decisions); and (3) interactional justice (fairness of
communications or interpersonal treatment that accompanied an organization’s formal
procedures). To measure these distinctive areas of justice, respondents were asked a multilevel
question phrased, “Please describe your perceptions of the following: (a) Transparency of
communication and changes; (b) Fairness in decision making; (c) Fairness in promotions and
raises; (d) Justice when dealing with discipline.”
14, 67%
7, 33%
Survey Question # 25
The organization creates a culture where I can communicate effectively,
openly, and honestly with my team?
a. True b. False
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In regards to (a) Transparency of communication and changes, leaders were consistent
that there was a lack of transparency of communication and changes, however four of the
respondents did report that they were optimistic that communication was improving.
P5 expressed, “There’s a lack of transparency of communication and changes.” P7
replied, “Transparency of communication and changes, I would say, ‘foggy.’ That is a very
cloudy subject for me. So . . . Yeah, sometimes it’s there, and sometimes it’s not.” P5 validated
and stated, “I would say that my perception is that communication could definitely be improved
from senior leadership down to front line staff in the health plan, and tremendously from
corporate office to the local healthplans.” P11 stated:
People are trying to be transparent. So they’re trying to move towards more transparency,
but there still seems to be a lot of decisions that are made in secret or there’s not a lot of
clarity given around why things are happening in a certain way.
When asked about fairness in decision making, there was less optimism expressed in
responses. A majority of the leaders expressed a lack of experiencing fairness in decision
making, which was more profound at the corporate level, versus at the healthplan level. P1
stated, “There’s inconsistent fairness in decision-making.” P4 contended:
I think, from my experience with this company, we’ve kinda . . . corporate has kinda ran
the gauntlet. So, I think whatever they choose to create as law, will be. So there’s not
much fairness when it comes to the health plans versus our corporate partners.
P10 expressed, “I would say that there wasn’t a lot of fairness when it came to decisions,
promotions, or raises. There was favoritism and other factors that were at play.” Finally, P17
stated:
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There is a lot of favoritism and nepotism in this organization. However, because so many
people have complained, or because of the new leadership, I now see a bit of a pendulum
swing in the other direction in trying to be very fair across the board and maybe that’s
just resulting in things being a little more stringent overall, which isn’t always the
answer.
When fairness was assessed in promotions and raises, leaders expressed a confusion and
frustration in how individuals were chosen for promotion and how raises were given. A theme
that emerged was a sense of favoritism and inconsistency. Regarding raises, leaders identified a
feeling of little control over how raises are allocated and frustration with the “peanut butter”
approach they are forced to utilize. P5 stated:
As far as fairness in promotions and raises, I think that’s a joke because we’re given one
amount. Like last year was 2%. You get 2%, there you go. Figure out how you’re going
to promote and give somebody a raise with that. It’s very difficult.
P13 echoed this sentiment, by stating, “That’s more of a, you know, popularity vote. And if
you’re on the right side of that, then you’re doing well.” Lastly, P17 contended, “Fairness in
promotions and raises, I feel that my perception is that there’s not. My perception is that starting
salaries vary wildly from leader to leader, and from front line staff to front line staff.”
Lastly, when assessing the perception leaders had of how well the organization is at fairly
reprimanding and disciplining employees, a common theme expressed was frustration with the
current disciplinary process and the leader’s difficulty or inability to work with Human
Resources to discipline their employees. P3 stated, “There is a complete lack of justice when
dealing with discipline. There’s probably little to no accountability here when it comes to that.”
P8 confirmed and claimed:
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Justice in dealing with discipline, this one I would say I have a mixed perception. I think
in some cases I see things handled really well and in others, there are some red flags as
far as disciplinary actions that didn’t seem warranted to me. Again, it’s the favoritism. If
they like you, they can choose to go light on you. If they don’t anything can be a fire-
able offense.
P16 voiced a similar frustration and stated:
No! I’ve seen people get away with murder and not get as much as a write up. It’s
because when we go to HR, they make it so hard to fire someone, sometimes it’s just not
worth it. They tell you to do steps 1-2-3, you do them, and then they tell you to do
something more. By then, months have passed and the employee is still not performing.
Summary
This chapter presented a combination of data from surveys and interviews in order to
validate gaps in the areas of knowledge, motivation, and organizational influences identified
through the literature review. The data identified that leaders had a good understanding of their
role as a leader and how they personally influence employee turnover. While a majority of the
leaders identified a shortage of growth and development opportunities within the organization,
they were very aware of the available opportunities at their disposal and they showed a clear
understanding of how to use these to assist their employees develop their long-term career
objectives. Two procedural knowledge gaps were identified around their understanding of how
to provide effective goals and coaching and feedback.
Leaders within XYZ Healthcare showed value in reducing employee turnover and
adopting and implementing specific leadership behaviors in an effort to increase employee
retention. One motivational gap was identified around self-efficacy. Interview results identified
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high self-confidence in areas where leaders felt they had total control. This included their ability
to identify critical employees and build trust among friends. However, both the survey and
interview data revealed leaders were not confident in their ability to establish effective goals,
provide effective coaching and feedback, or provide career development opportunities.
Interestingly, leaders expressed low confidence in these activities where leaders felt they were
out of their personal control, thus lowering their confidence. Many of them noted low
confidence due to organizational influences such as a lack of resources, information and support
from the organization.
Interestingly, all five organization gaps were validated. Leaders did not feel HR
strategies within the organization aligned with or supported the goal to decrease voluntary
turnover. The interview revealed many leaders believed HR practices such as hiring and
promotions were fair, thus increasing employee turnover. While leaders believed the
organization was supportive, they conversely identified that they did not feel the organization
provided them effective workflows, processes, or procedures. Lastly, leaders were consistent in
their belief that the organizational culture is not transparent, fair, or just. This was validated in
the interview, with many leaders expressing challenges in areas such as fairness in decision
making; fairness in promotions and raises; and justice with discipline. It is interesting to note
that both the survey and interview data around organizational influences indicated that leaders
within XYZ believed the organization was ineffective in providing the necessary support,
resources, systems, or tools to improve employee turnover.
Chapter 5 will elaborate on the challenges identified and present recommended solutions
for the causes of the validated gaps.

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Table 18
Summary of Validation
Assumed Knowledge Influences Validated?
Leaders need to know their role as a leader and how their role influences employee
turnover. (D)
Not Validated
Leaders need to know what growth and development opportunities are and how providing
growth and development opportunities contribute to functional employee turnover. (D)
Not Validated
Leaders need to know how to define the concepts of Employee Retention and Employee
Engagement. (P)
Not Validated
Leaders need to know how to define and identify core employees in order to retain them.
(P)
Not Validated
Leaders need to know how to provide effective goals to employees. (P) Validated
Leaders need to know how to build effective relationships with their employees. (P) Not Validated
Leaders need to know how to provide effective coaching and feedback. (P) Validated
Leaders need to know how to help their employees plan and develop their long-term career
objectives. (P)
Not Validated
Leaders need to reflect on how their current leadership behaviors impact employee
retention. (M)
Not Validated
Assumed Motivation Influences Validated?
Leaders need to see the value in reducing employee turnover. (V) Not Validated
Leaders need to see the value in adopting and implementing specific leadership behaviors
in an effort to increase employee retention. (V)
Not Validated
Leaders need to believe they are capable of successfully adopting and implementing
specific leadership behaviors in an effort to increase employee retention. (SE)
Validated
Assumed Organizational Influences Validated?
Human resource strategies within the organization are aligned with and support the goal of
decreasing voluntary dysfunctional turnover. (CM)
Validated
The organization culture is seen as balanced, valuing on both people and performance.
(CM)
Validated
The organization is perceived as being supportive. (CS) Validated
The organization provides advancement and growth opportunities. (CS) Validated
The organizational culture is seen as transparent, fair, and just. (CS) Validated

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CHAPTER 5
SOLUTIONS, IMPLEMENTATION, AND EVALUATION
In Chapter 4, the results and findings from data collection were published in detail. An
interview that combined both qualitative and quantitative questions was used to answer Research
Question 1, “What knowledge, motivation, and organizational influences are potentially
inhibiting leaders within XYZ Healthcare Company from decreasing employee turnover?” Eight
of the influences were found to have gaps that could be inhibiting leaders within XYZ
Healthcare Company from decreasing employee turnover.
This chapter will answer Research Question 2, “What are the knowledge, motivation, and
organizational solutions for leaders within XYZ Healthcare that will decrease employee
turnover?” The recommendations discussed in this chapter are based on the Clark and Estes
(2008) Gap Analysis of knowledge, motivation, and organizational influences there were
identified in the literature review as impacting leader behavior. Each of these influences was
evaluated during the data collection process using surveys and interviews (Merriam & Tisdell,
2016). A majority of the gaps were validated and recommendations for closing those gaps are
detailed below.
The recommendations in this chapter are presented through the knowledge, motivation,
and organizational influence framework. The first section offers recommendations utilizing
resources such as classroom and on-the-job-training, mentoring, and job aids. The second
section provides subsequent implementation and evaluation recommendations using the New
World Kirkpatrick Model as the framework (Kirkpatrick & Kirkpatrick, 2016). The
recommendations, implementation, and evaluation plans outlined here work as an integrated
system and were designed to work in unison in order to support leader knowledge acquisition,
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motivation, and organizational alignment (Clark & Estes, 2008). The final section of this chapter
will discuss the limitations of this study, and recommendations for future research.
Recommendations for Practice to Address KMO Influences
Eight influences were validated during the data collection process. Two knowledge gaps
around XYZ leaders’ knowledge of providing effective goals and knowledge of coaching and
feedback. Gaps in both declarative and procedural knowledge were validated. One self-efficacy
motivation influence gap was validated and all five organizational influence gaps were validated.
Knowledge Recommendations
The four knowledge types identified by Krathwohl (2002) of factual, conceptual,
procedural, and metacognitive knowledge were analyzed in relation to how certain leader
behaviors influence employee turnover. Two procedural knowledge gaps were validated and
prioritized as having a positive impact on the stakeholder goal of decreasing employee turnover.
Procedural knowledge is an understanding of how to do something or how to get a task
accomplished (Krathwohl, 2002). Recommendations for the two identified knowledge
influences are represented in Table 19. The recommendations are based on principles that
directly impact procedural knowledge influences. To close the identified knowledge gaps,
corresponding support, such as knowledge specific information, job aids, training and education,
is also suggested based on literature by Clark and Estes (2008).
Providing information is telling someone something that they need to know in order to do
their job. This is the simplest and most basic form of learning support. Job aids are slightly
more complex and provide learners support for how to perform specific day-to-day activities.
Not all learning that takes place through training is retained by the learner. Job aids are
important, as they provide a supplemental resource outside of the learning environment. Job aids
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can take the form of flow-charts, checklists, worksheets, how-to and processes or formulas to
follow to accomplish a task. Training is a more formal process of learning than simply providing
information and using job tools. It often consists of a formal presentation coupled with
opportunities for skills practice and performance feedback. The most complex form of support is
learning, which involves the acquisition of knowledge, reflection, self-awareness, situational
awareness, and theories and strategies that can be applied over time and used in new and
complex ways (Clark & Estes, 2008).
Learning, specifically leadership development interventions, have recently gained more
attention in the healthcare industry because healthcare organizations are facing a variety of
outcome-based demands on their time and resources, including ever-changing federal mandates,
increased competition, and more stringent national accreditation and quality standards. With
healthcare seeing the need for strong leaders, now more than ever, to drive business outcomes,
they are investing more money and resources into developmental learning programs to improve
leader skills and capabilities (Leatt & Porter, 2003).
Table 19 provides a list of the knowledge influences that were first identified through the
literature review and then validated as having a gap through data collection and analysis. The
table provides the knowledge influence, knowledge type, principle related to each need and a
context specific recommendation for satisfying the need. A discussion of the context specific
recommendation based on learning theory and results from this inquiry follow the table.

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Table 19
Summary of Knowledge Influences and Recommendations
Knowledge Influence:
Cause, Need, or Asset*
Validated
Yes or No
Priority
Yes or
No
Principle and
Citation
Theoretical
Evidence and
Citation
Context-Specific
Recommendation
Leaders need to know
their role as a leader
and how their role
influences employee
turnover. (D)
No No
Leaders need to know
what growth and
development
opportunities are and
how providing growth
and development
opportunists
contributes to
functional employee
turnover. (D)
No No
Leaders need to know
how to define and
identify core
employees in order to
retain them. (P)
No No
Leaders need to know
how to provide
effective goals to their
employees. (P)
Yes Yes Leaders need to
see and hear
worked
examples of
good SMART /
Cascaded Goals.
This is
reinforced by
Ghosh et al.
(2013),
Kirschner,
Sweller, and
Clark (2006),
Van Gerven,
Paas, Van
Merriënboer, and
Schmidt (2002),
who state
learning needs to
provide worked
examples.
Atkinson,
Renkl, and
Merrill (2003)
studied the
concept of
worked
examples, or
worked-out
examples and
noted that it is a
very effective
method of
learning during
the initial stages
of cognitive
skill
acquisition.
Job Aid. Provide
leaders with
several worked
examples of
actual SMART/
Cascaded goals
with details of
every aspect of
the SMART
framework.

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Table 19, continued
Knowledge Influence:
Cause, Need, or Asset*
Validated
Yes or No
Priority
Yes or
No
Principle and
Citation
Theoretical
Evidence and
Citation
Context-Specific
Recommendation
Leaders need to know
how to build effective
relationships with their
employees. (P)
No No
Leaders need to know
how to provide
effective coaching and
feedback. (P)
Yes Yes Leaders need to
have the
opportunity to
practice setting
real coaching
and feedback in
a safe learning
environment.
This is
reinforced by
Merrill (2002),
Nadolski,
Kirschner, van
Merriënboer, &
Hummel (2001),
and Reigeluth
(1999).
When
introducing
complex tasks,
the general
assumption is
that providing
real-life
experiences and
opportunities to
engage in the
task, through
authentic
learning
improves the
learners’ ability
to integrate the
knowledge,
skills, and
attitudes
necessary to
effectively
perform the
task (Lombardi,
2007).
Training Activity.
It is
recommended
that training for
coaching and
feedback will
include actives
such case studies
and role-playing
that will allow the
leader to engage
in a real world
scenario to
provide coaching
to an employee.
Leaders need to know
how to help their
employees plan and
develop their long term
career objectives. (P)
No No
Leaders need to reflect
on how their current
leadership behaviors
impact employee
retention. (M)
No No

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Procedural knowledge solutions, or description of needs or assets. Surveys and
interviews found that leaders had a lack of knowledge around knowing how to provide effective
goals effective coaching and feedback to their employees. One example of this lack of
procedural knowledge was revealed during the interview process when leaders were asked to
identify the components of effective goal setting. SMART Goals, Goal Alignment, and
Cascading were given as multiple-choice options. While the majority of leaders selected “All”
as their response, several leaders only selected SMART goals. Secondly, leaders were asked to
describe the activity of cascading a goal and its importance. Several of the leaders stated that
they had never had to cascade a goal and did not know how to do it. As stated in the literature
review, goal clarity is important to employees as it guides them in a specific direction, and assists
them in understanding the most effective channel to direct their efforts (Ghosh et al., 2013). The
disconnect between the leaders’ understanding of developing effective goals demonstrates that
the employees are not getting the clarity and guidance needed to be effective in their position.
Goal setting. Leaders need to know how to provide effective goals for employees.
Since goal setting is a procedure with multiple steps leading to an end result, leaders need to see
examples of effective goals developed step-by-step in the SMART/ Cascaded format. This is
reinforced by several studies (Ghosh et al., 2013; Kirschner et al., 2006; Van Gerven et al.,
2002), which state that learners need to be provided with “worked examples” to aid in the
development and transfer of new skills. Worked examples are instructional strategies that
provide samples of a completed activity and show how each step should be completed. A well-
done worked example allows a learner to get into the brain of the expert to understand the
thought processes involved in the getting to the finished product.
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The aforementioned research would suggest that providing learners with a variety of
detailed job-aids of worked-out examples of SMART goals would be beneficial in supporting
their learning. The recommendation then for leaders is to provide them with several worked
examples of actual SMART/ Cascaded goals with details of every aspect of the SMART/
Cascaded framework. The goals will be realistic and vary in scope and difficulty. These worked
examples will be provided as a tool during the on-line and classroom trainings to aid them in
their understanding of the SMART/ Cascaded concept. These worked examples will also be
included in the participant guide as references.
Atkinson et al. (2003) studied the concept of worked examples, or worked-out examples
and noted that it is a very effective method of learning during the initial stages of cognitive skill
acquisition. One instructional design principle suggests that effective examples have highly
integrated components that employ multiple modalities in presentation and emphasize conceptual
structure by labeling or segmenting (Atkinson, Derry, Renkl, & Wortham, 2000). At the lesson
level, effective instruction employs multiple examples for each conceptual problem type, varies
example formats within problem type, and employs surface features to signal deep structure
(Atkinson et al., 2000). Also, examples should be presented in close proximity to matched
practice problems. Moreover, learners can be encouraged through direct training or by the
structure of the worked example to actively self-explain examples (Atkinson et al., 2000).
Coaching and feedback. Leaders need to know how to provide effective coaching and
feedback. Leaders need to see and hear examples of a good coaching and feedback conversation,
as well as have the opportunity to practice providing coaching and feedback conversations in a
safe learning environment. This is reinforced by Merrill (2002), Nadolski et al. (2001), and
Reigeluth (1999), who state learning needs to provide authentic learning. Authentic leaning
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typically focuses on learning real-world, complex tasks through the use of case studies, role-
playing activities, problem-based activities, and simulations. Authentic learning aims at the
integration of knowledge, skills, and attitudes; the coordination of qualitatively different
constituent skills; and the transfer of what is learned in the classroom to daily life or work
settings. Recent instructional theories stress authentic learning tasks as the driving force for
learning (Merrill, 2002; Reigeluth, 1999; Van Merriënboer, Kirschner, & Kester, 2003).
Therefore, it is recommended that training for coaching and feedback include activities
such case studies and role-playing that will allow the leader to engage in a real world scenario to
provide coaching to an employee.
Lombardi (2007) noted when introducing complex tasks, such as providing coaching and
feedback to an employee, the general assumption is that providing learners with real-life
experiences and opportunities to engage in the task, through authentic learning improves the
learners’ ability to integrate the knowledge, skills, and attitudes necessary to effectively perform
the task. Authentic learning goes beyond content and cultivates “portable skills” such as
judgment, patience, flexibility, and critical thinking (Lombardi, 2007). Providing real-life
examples and opportunities to engage in complex activities in a safe learning environment gives
the learner the opportunity to learn to coordinate integral skills that make up complex task
performance; and will eventually enable them to transfer what is learned to their daily life or
work settings (Van Merriënboer et al., 2003).

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Motivation Recommendations
Introduction. Two perspectives on motivation were evaluated in this study, expectancy
value theory and self-efficacy theory. Three gaps in self-efficacy were validated through data
collection and analysis. There was one basic question associated with self-efficacy: “Am I
confident in my ability to perform a task?” (Bandura, 1986). The gaps that were validated
through interviews were around the leader’s confidence in their ability to provide effective goals,
effective coaching and feedback, and career development opportunities. Table 20 represents a
complete list of validated motivational influences based on the most frequently mentioned
motivation influences for achieving the stakeholder’s goal during informal interviews and
supported by the literature review and the review of motivation theory. Table 20 also shows the
recommendations for these influences based on theoretical principles. A discussion of the
context-specific recommendations based on learning theory and results from the research follows
the table.

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Table 20
Summary of Motivation Influences and Recommendations
Motivation
Influence: Cause,
Need, or Asset*
Validated
Yes or
No
Priority
Yes,
No Principle and Citation
Context-Specific
Recommendation
Leaders need to
understand the
value in reducing
employee turnover.
(Expectancy)
No No
Leaders need to
value adopting and
implementing
specific leadership
behaviors in an
effort to increase
employee retention.
(Expectancy)
No No
Leaders need to be
confident that they
are capable of
successfully
adopting and
implementing
specific leadership
behaviors in an
effort to increase
employee retention.
(Self-Efficacy)
Yes Y There are three
components that
constitute a leader’s
developmental
experiences: (a)
developmental
experiences (feedback,
challenge, and
support) and (b)
learning orientation
(Machida &
Schaubroeck, 2011;
McCauley & Van
Velsor, 2004).
Provide leaders rich
development
experiences such as
leadership coaching
and feedback,
modeling, mentoring,
and peer support
groups (McCauley &
Van Velsor, 2004).

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Self-efficacy. Self-efficacy has been formally defined as the conviction that one can
successfully execute the behavior required to produce desired outcomes (Bandura, 1977). Self-
efficacy influences the initiation, intensity, and persistence of a behavior. Individuals high in
self-efficacy try more challenging tasks, exert more effort toward accomplishing them, and are
more tenacious in their efforts as they encounter obstacles (Bandura, 1977, 1986, 1997; Gist &
Mitchell, 1992). Not surprisingly, these behavioral characteristics are positively related to
performance in the workplace (Stajkovic & Luthans, 1998).
Leadership Self-Efficacy (LSE) is a leader’s confidence in his or her ability to effectively
carry out the behaviors that comprise the leadership role (Chemers, Watson, & May, 2000;
Murphy & Ensher, 1999; Paglis & Green, 2002). Leadership self-efficacy has been related to
successful performance in the leadership role. In a study involving ROTC cadets in leadership
training, Chemers et al. (2000) reported that those with higher LSE scores received stronger
leadership ratings. Anderson, Krajewski, Goffin, and Jackson (2008), using the comprehensive,
multidimensional LSE measure described previously, found through canonical analysis that LSE
dimensions were positively related to several facets of leadership effectiveness. For this study,
the specific leadership behaviors of focus were (a) accurately identifying critical employees/top
performers; (b) establishing effective goals for employees; (c) providing effective coaching and
feedback to employees; (d) building trust among their employees, and (e) providing career
development opportunities for their employees.
Leaders need to be confident that they are capable of successfully adopting and
implementing specific leadership behaviors in an effort to increase employee retention (Self-
Efficacy). Data from interviews reveled that not all leaders were confident in their abilities in
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three distinct leadership behaviors: confidence in their ability to provide effective goals, effective
coaching and feedback, and career development opportunities.
Traditionally, personal ability factors, such as previous mastery experience, is viewed as
one of the most important influences on self-efficacy because it provides the most authentic
evidence of whether one can actually master the task (Bandura, 1997). However, as identified in
the Paglis and Green (2002) study, surprisingly, many of the reasons identified in this study for
low self-efficacy in all three areas were less attributed to confidence in personal abilities or
mastery experience, but rather organizational factors such as organizational, support, recourses,
time, tools, information, and consistent processes. As such, recommendations will focus less on
increasing self-efficacy through procedural skill acquisition, but rather on creating an
environment that provides the support and resources leaders need to feel confident in their ability
to learn and implement tasks successfully.
While research on LSE and organizational factors is rather scant, there is evidence that
has emerged that validates that certain organizational factors do influence a leader’s self-
efficacy. Paglis and Green (2002) examined several organizational-level and work unit
characteristics as potential influences on managers’ LSE. One factor that received substantial
support was the degree of job autonomy managers had. Ng, Ang, and Chan (2008) also found
job autonomy to be a significant LSE correlate. It stands to reason that managers with greater
control over tasks such as managing budgets, selecting staff members, and organizing work flow
between units would feel more positively about their ability to effectively lead their work units.
Two other organizational-level characteristics receiving support as LSE antecedents in the Paglis
and Green (2002) study were the availability of resources (e.g., funds, staff, equipment) and the
extent to which the culture was open to change (e.g., encourages risk-taking over maintaining the
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status quo). Paglis and Green (2002) also noted that superiors’ modeling and coaching were both
significantly correlated with a manager’s leadership attempt. For instance, managers who
evaluated their superiors as effective at activities like driving change engaged more in those
leadership behaviors themselves.
To address the three gaps in self-efficacy, it is recommended to provide leaders rich
development experiences such as leadership coaching and feedback, modeling, mentoring, and
peer support groups. This approach is validated according to McCauley and Van Velsor (2004),
who identified three components that constitute a leader’s developmental experiences, thus
increasing leadership self-efficacy: assessment, challenges, and support. Developmental
experiences that are rich in these three components serve to motivate leaders to learn, and they
provide leaders with the resources for learning, while also increasing their self-efficacy.
The first component, assessment, involves the feedback that a leader receives from
multiple sources (themselves, supervisors, peers, etc.). The importance of feedback is
documented in research (e.g., DeRue & Wellman, 2009; Enoch, 1997). Assessment also clarifies
the changes needed to close these gaps. Therefore it is recommended that leaders consistently
receive assessment, in the form of relevant and timely feedback, from their leaders as it pertains
to their ability to provide effective goals, effective coaching and feedback, and career
development opportunities. According to Bandura (1997) and Vealey, Garner-Holman, Hayashi,
and Giacobbi (1998), verbal persuasion, appraisal, feedback, or positive encouragement from
others are some of the main sources of self-efficacy for individuals. Accurate and individually
tailored feedback can increase the self-efficacy of leaders who have low leader self-efficacy or
who may be experiencing downward efficacy spirals.
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Challenges that force an individual to expand outside his or her comfort zone are
necessary components to leader development (McCauley, Ruderman, Ohlott, & Morrow, 1994).
McCauley and Van Velsor (2004) noted that when providing leaders with challenging
experiences that correspond with their developmental levels, this should give leaders the success
experiences necessary to learn and increase leader self-efficacy. Bandura (1997) argued that
challenging work assignments and achievement experiences of any kind (failure or success) are
the most salient source of self-efficacy. Therefore, it is recommended that leaders be assigned at
least one challenging work assignment on an annual basis by their leader. Characteristics of
challenge experiences include unfamiliar responsibilities, creating change, facing high levels of
responsibility, working across boundaries where one has no direct authority, and managing
diversity (McCauley et al., 1994). Challenging experiences highlight leaders’ need to master the
challenges, provide an impetus for them to experiment with different strategies to overcome
challenges, and expose them to different perspectives. Several studies have documented the
positive influence of challenging work assignments on leader development (e.g., DeRue &
Wellman, 2009; Dragoni, Tesluk, Russell, & Oh, 2009).
In addition to feedback and challenging work assignments, support that leaders receive
from supervisors, peers, significant others, and followers is also crucial to leader development.
Therefore we recommend establishing a leadership-mentoring program that is designed to
specifically support leaders in their development and confidence in their ability to provide
effective goals, effective coaching and feedback, and career development opportunities to their
employees. Research by McCauley and Van Velsor (2004) validates this recommendation and
states that mentoring relationships “provide both career-enhancing effects and psychological
support to leaders” (p. 294). One reason support is believed to be essential for leader
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development is because development requires experimentation with new strategies, and people
are more likely to try new practices when they are supported in doing so by other people. In
addition to verbal persuasion, vicarious experiences through the process of modeling are also
considered as a significant source of self-efficacy beliefs (Bandura, 1997).
Support, in the form of supportive relationships and mentoring relationship from credible
individuals, can be a strong source of self-efficacy when leaders experience failure. Challenges
that leaders experience could make them question their skills and this often creates lower self-
efficacy. However, development requires failure, and support from others encourages one not to
become demoralized by failure but rather to recognize it as a part of development that others
have experienced and from which they learned meaningful lessons. Thus, the provision of
support may offset the possibility that challenging work assignments could backfire and lead to
demoralization and lowered self-efficacy.
Support in the form of peer support groups may also foster a leader’s self-efficacy in
his/her ability to learn. Talking to other leaders about their developmental experiences can
confirm and clarify the lessons learned (McCauley & Van Velsor, 2004). This can aid in
increasing or maintaining a leader’s efficacy to learn leadership skills in the face of highly
challenging situations and tasks. Verbal persuasion is identified as one of the four main sources
of self-efficacy identified by Bandura (1997). One form is encouragement from trusted and
respected sources, which was noted by Hannah and colleagues to be a primary contributor to
leaders learning self-efficacy (Hannah, Avolio, Luthans, & Harms, 2008; Hannah & Lester,
2009).
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Organization Recommendations
Introduction. There were a total of five organizational influences that were evaluated in
this study; (a) Human Resource (HR) strategies, (b) organizational culture, (c) Perceived
Organizational Support (POS), (d) advancement and growth opportunities, and (e) transparency.
All five of the organizational influences were validated through the interview and survey
process. Table 21 shows the complete list of organization influences that were validated based
during the interviews and recommendations supported by the literature review and the review of
organization and culture theory. Clark and Estes (2008) suggest that organization and
stakeholder goals are often not achieved due to a lack of resources, most often time and money,
and stakeholder goals that are not aligned with the organization’s mission and goals. Gallimore
and Goldenberg (2001) propose two constructs about culture — cultural models or the
observable beliefs and values shared by individuals in groups, and cultural settings, or the
settings and activities in which performance occurs. Thus, both resources and processes and
cultural models and settings must align throughout the organization’s structure to achieve the
mission and goals.
While all five organizational influences were validated, not all are considered a priority.
While leaders validated that Human Resource strategies within the organization are not aligned
with, nor support the goal of decreasing voluntary dysfunctional turnover, many challenges were
identified during the interview process, and more information is needed in order to provide clear
recommendations to the organization. Table 21 also shows the recommendations for the
validated influences and supporting recommendations based on theoretical principles.

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Table 21
Summary of Organization Influences and Recommendations
Organization
Influence: Cause,
Need, or Asset*
Validated
Yes or
No
Priority
Yes,
No Principle and Citation
Context-Specific
Recommendation
Human resource
strategies within
the organization
are not aligned
with, nor support
the goal of
decreasing
voluntary
dysfunctional
turnover (CM).
Yes No Organizational performance and
employee retention increases when
human resource strategies are aligned
with the organization’s goals (Kerr &
Slocum, 1987).
Not a priority.
The organization
culture is seen as
unbalanced,
valuing
performance over
people (CM).
Yes No When there is an emphasis on people
(teamwork, relationships), versus
individual performance, these cultural
values have a tendency to “foster a
culture of loyalty and long-term
commitment to the organization among
all employees, regardless of job
performance” (Sheridan, 1992, p. 1039).
Not a priority.
The organization
is not perceived
as being
supportive (CS).
Yes Yes Perceived Organizational Support
(POS), should provide employees
organizational values, visions
statements, and missions that encourage
an employee to feel an obligation to care
about the organization and the
motivation to reach its goals.
Second, the culture should fulfill an
employee’s socio-emotional needs by
encouraging organizational membership
and providing an environment that is
caring, accepting, and respectful.
Third, POS involves creating a feeling
of safety for an employee through job
security (Allen et al., 1999).
The fourth characteristic of POS is
providing an employee clarity through
processes, procedures, goals, and role
clarity.
Work with
leaders and
Human Resource
to ensure they are
practicing fair
hiring and
promotion
practices, and
encourage
consistent and
timely team
meetings to
promote open
communication
and to share
pertinent
information in a
timely manner.

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Table 21, continued
Organization
Influence: Cause,
Need, or Asset*
Validated
Yes or
No
Priority
Yes,
No Principle and Citation
Context-Specific
Recommendation
The organization
does not provide
advancement and
career growth
opportunities (CS).
Yes Yes Employees who perceive that their
current organization provides
them opportunities to attain their
career goals, or develop
new/better job skills, have higher
levels of commitment and are less
likely to leave that organization
(Weng et al., 2010).
Career growth as consisting of
four distinct dimensions: career
goal progress, professional
development availability,
promotion speed, and
compensation growth. Survey
data showed that all four
dimensions of career growth were
positively related to increased
employee commitment, thus
drastically decreasing an
employee’s turnover intentions
(Weng et al., 2010).
Provide leaders
training to develop
an understanding of
how to provide
advancement and
career growth
opportunities
through stretch
goals, projects,
shadowing and
coaching and
feedback sessions.
The organizational
culture is not seen as
transparent, fair, and
just (CS).
Yes Yes Organizational performance
increases and key performers are
better retained when individuals
see it as transparent, with fair
hiring and promotion policies (Joo
& Park, 2010).

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With employee retention being so strongly influenced by a leader’s ability to effectively
communicate with their employees, in order to decrease the 14% employee turnover rate, leaders
within XYZ Healthcare will need to increase their knowledge and skills in effective
communication practices. Fortunately, research has shown that leader communication is a skill
that can be learned (Mayfield & Mayfield, 2002). According to the literature, leader
communication skills can be improved as a result of training and development initiatives and the
improvement of a leader’s communication skills positively affects the performance and retention
of direct reports (Goleman, 1998; Scandura & Graen, 1984). This section will review three
possible solutions to increase the knowledge and skills of leaders in effective communication
practices.
The successful implementation of any organizational strategy is dependent upon the
successful analysis of available options. Given the important role that one’s supervisors have on
their employees’ turnover decision, providing leaders with effective training and development,
while incorporating accountability systems can lead to a reduction of employee turnover. To
effectively address deficiencies in leader communication within an organization, McCauley,
Moxley, and Van Velsor (1998) suggested a full range of strategic leadership development
interventions, including: mentoring, stretch job assignments, structured feedback systems,
development of intentional on-the-job experiences, and developmental relationships, and formal
training programs.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The framework that guided this implementation and evaluation plan is the New World
Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), based on the original Kirkpatrick Four
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Level Model of Evaluation (Kirkpatrick & Kirkpatrick, 2006). The original four levels of
evaluation developed by Kirkpatrick (reaction, learning, behavior, and results), have been a
staple and industry standard for evaluating learning activities in the training and development
field since its publication in 1994. However, Kirkpatrick’s son identified that the old model left
many training professionals stuck focusing on Level 1, Reaction, and Level 2, Learning. Most
training focused on evaluating training for the purpose of improving the program. Hence,
evaluation questions related to how much a participant enjoyed the program and sometimes
measured knowledge increase. With the increasing cost of training, stakeholders are looking for
training effectiveness in terms of knowledge or skill transferred to the actual work environment
and that the knowledge and skills are resulting in the desired business outcomes. The revised
four levels of the New World Kirkpatrick Model provide clarity to the original 4 levels and offer
tangible resources to accomplish all four levels.
The new model suggests that learning professionals “begin with the end in mind.” This
means that evaluation actually begins with the desired results and then determines what
behaviors are needed to accomplish them. Once the behaviors have been identified, the trainer
must then determine what attitudes, knowledge, and skills are necessary to bring about the
desired behaviors. The final step is then to design a learning activity that allows the learner to
not only learn, but to enjoy and react favorably to the program (Kirkpatrick & Kirkpatrick,
2006).
Not only does the new model function in reverse order, it also offers several new
additions to each of the four levels. The original Level 1, Reaction, measured participant
satisfaction with the program. The New World Model adds engagement, the degree to which
participants are involved and contributing to the learning, as well as relevance, to measure the
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degree to which participants will have the opportunity to use or apply the learning experience in
the actual work environment (Kirkpatrick & Kirkpatrick, 2016).
The original Level 2, Learning, measured the degree to which the participant acquired the
intended knowledge, skills, and attitude. The New World additions for Level 2 include
confidence and commitment. Level 2 now measures how much a participant believes they can
transfer and implement the newly acquired skills and knowledge on the job and how committed
they are to implement the new knowledge or skills (Kirkpatrick & Kirkpatrick, 2016).
The original Level 3 measured the degree to which participants apply what they have
learned in the classroom, when they are back on the job. The New World model adds critical
behaviors and “required drivers.” Critical behaviors identify the key behaviors believed to bring
about the desired change. Required drivers provide an added level of accountability and support
through processes and systems that reinforce, monitor, encourage, and reward positive
performance of identified critical behaviors of leaders on the job (Kirkpatrick & Kirkpatrick,
2016).
Lastly, the original Level 4 measured the degree to which targeted outcomes occur as a
result of the training. The New World Level 4 adds “leading indicators” which suggest
incorporating short-term observations and measurements that suggest that critical behaviors are
on track in order to create a positive impact on the desired results (Kirkpatrick & Kirkpatrick,
2016).
Designing the implementation and evaluation plan in this manner forces connections
between the immediate solutions and the larger goal and solicits proximal “buy in” to ensure
success (Kirkpatrick & Kirkpatrick, 2016). Figure 18 provides a visual presentation of the
Kirkpatrick New World Model.
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Figure 18. Kirkpatrick New World Model

Figure 19 illustrates a variety of evaluation methods that can be used for more than one
level. This allows for the development of hybrid evaluation tools, which are recommended to
maximize program evaluation resources and show relationships among the levels.

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Figure 19. Evaluation methods

Organizational Purpose, Need and Expectations
XYZ’s mission is to provide quality healthcare to people receiving government
assistance. XYZ Healthcare is responsible for the reduction of healthcare costs, increasing
quality of care, improving patient outcomes, access to care, and positively managing the
financial performance of State Medicaid / Medicare programs. Adversely, high employee
turnover has a negative impact on employee engagement and morale which directly impacts
patient satisfaction and safety, and quality measures, and ultimately the organization’s bottom
line. This project examined the knowledge and skills, motivational, and organizational barriers
that prevented leaders within XYZ Healthcare from reducing employee turnover. The proposed
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solution, a comprehensive training program and related on-the-job supports should produce the
desired outcome — a change in leader behavior that positively impacts employee turnover.
Level 4: Results and Leading Indicators
Leading indicators incorporate providing internal and external benchmarks in the form of
short-term observations and measurements that suggest that critical behaviors are on track in
order to create a positive impact on the desired results (Kirkpatrick & Kirkpatrick, 2016). They
keep the initiative on track, reassure stakeholders by providing interim updates, motivate
participants, and assist in the collection of important data for forming important links between
the activity and outcomes. Table 22 shows the proposed Level 4: Results and Leading Indicators
in the form of outcomes, metrics, and methods for both external and internal outcomes for XYZ
Healthcare. If the internal outcomes are met as expected, as a result of the training and
organizational support for improving leader behavior in an effort to increase employee retention,
then the external outcomes should also be realized.

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Table 22
Outcomes, Metrics, and Methods for External and Internal Outcomes
Desired Outcome Metric(s) Method(s)
External Outcomes
1. Increase member
satisfaction
Annual member
satisfaction surveys
(STARS)
Solicit data from annual
member satisfaction surveys
(STARS report)
2. Increase organizational
reputation / brand value
Market share / stock value Compare stock value from
previous year and compare
to current year
3. Improve access, continuity
of care, and patient quality of
care
STARS data Review STARS data from
previous year and compare
to current year
4. Increase proposal wins /
competitive advantage/
improve reputation with States
Percent of proposals
awarded
Compare the number of
proposals awarded to that of
pervious year
Internal Outcomes
5. Decreased dysfunctional
voluntary employee turnover
Employee turnover rates Compare annual turnover
rates
6. Decreased administrative
costs and increase profits
Operational budget costs Aggregate data (Level 3.1)
from departmental budgets
7. Increased organizational
performance and operational
efficiency
Operational performance
metrics through
department goal
Compare annual survey
results
8. Increased employee
engagement/satisfaction
Annual employee survey /
feedback
Compare annual survey
results

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Level 3: Behavior
Critical behaviors. The original Level 3 measured the degree to which participants
apply what they have learned in the classroom, when they are back on the job. The New World
model adds critical behaviors which identify the few key behaviors believed to bring about the
biggest impact on desired change. These behaviors need to be specific, observable, and
measurable in nature. The stakeholder group of focus for this study are the leaders within XYZ
Healthcare and how their behaviors influence employee retention. The first critical behavior
identified is their need to know how to develop effective goals for their employees. The second
critical behavior is that they must know how to provide effective coaching and feedback to their
employees. The next critical behaviors focus on increasing the confidence of leaders in the areas
of goal development, coaching and feedback, and providing career development opportunities to
their employees. The specific metrics, methods, and timing for each of these outcome behaviors
appear in Table 23.

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Table 23
Critical Behaviors, Metrics, Methods, and Timing for Leaders
Critical Behavior Metric(s) Method(s) Timing
1. Leaders need to
know how to develop
effective goals for their
employees
The number of
effectively
written SMART
goals in HR
Connect System
1. The HR Director in each region will
randomly select and review 15
department goals in the HR Connect
System and score against rubric and
provide feedback to department leader
(Interview)
1. Annually
2. Leaders need to
know how to provide
effective coaching and
feedback to their
employees
The number of
effective
coaching
sessions
2a. The HR Director in each region
will randomly select and review 15
department goals in the HR Connect
System to review for accurate and
documentation completion of
coaching form (Interview)
2a. Annually
2b. The Learning and Development
team will review employee feedback
on the level of effectiveness of
coaching and feedback sessions
through the annual organizational
satisfaction survey (Data Analysis)
2b. Annually
3. Leaders need to be
confident in their
ability to develop
effective goals for their
employees
Follow-up
interview
percentage
3. The Learning and Development will
conduct follow-up interviews with 15-
20 randomly selected leaders to
measure their confidence in their
ability to develop effective goals for
their employees
3. Immediately
before next
goal setting
season —
Annually
4. Leaders need to be
confident in their
ability to provide
effective coaching and
feedback to their
employees
Follow-up
interview
percentage
4. The Learning and Development will
conduct follow-up interviews with 15-
20 randomly selected leaders to
measure their confidence in their
ability to provide effective coaching
and feedback to their employees
4. Annually
5. Leaders need to be
confident in their
ability to provide
career development
opportunities to their
employees
Follow-up
interview
percentage
5. The Learning and Development will
conduct follow-up interviews with 15-
20 randomly selected leaders to
measure their confidence in their
ability provide career development
opportunities to their employees
5. Annually

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Required drivers. New and tenured leaders require the support of their direct leaders
and the organization to reinforce what they learn in the training and to encourage them to apply
what they have learned in order to change behaviors that positively influence employee retention.
Rewards should be established for achievement of performance goals to enhance the
organizational support of leaders. Required drivers are a newly added component in
Kirkpatrick’s New World Model that provide that support and encouragement (Kirkpatrick &
Kirkpatrick, 2016). Required drivers provide an added level of accountability and support
through processes and systems that reinforce, monitor, encourage, and reward positive
performance of identified critical behaviors of leaders on the job (Kirkpatrick & Kirkpatrick,
2016).
Leaders at XYZ Healthcare do not currently have the knowledge and confidence to
develop effective goals, provide effective feedback, and develop career development
opportunities for their employees. The required drivers identified in Table 24 will offer the
necessary organizational support and accountability systems needed by leaders to ensure the
successful implementation of the recommended solutions and close the gaps identified. A series
of required drivers such as refresher trainings, job aids, recognition, coaching, and on-the-job
training will be developed to support leaders in the development the key competencies needed to
effectively close the current gaps and reduce employee turnover. Table 24 details the required
driver package and timing recommended to support the critical behaviors of leaders at XYZ
Healthcare.

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Table 24
Required Drivers to Support Leaders ’ Critical Behaviors
Method(s) Timing
Critical Behaviors
Supported
1, 2, 3 Etc.
Reinforcing

Follow-up/refresher e-learning training modules available for existing and
new leaders at every level within the organization
Ongoing 1, 2, 3, 4, 5
Job Aids on Intranet, including checklists, process maps, and worked
examples for application
Ongoing 1, 2, 3, 4, 5
Senior leaders audit/observe critical behaviors of leaders and provide
coaching and feedback to leaders
Quarterly 1, 2, 3, 4, 5
Senior leaders need to show support of the initiative though regular and on-
going communication
Quarterly 1, 2, 3, 4, 5
Senior leaders will promote practice through modeling in one-on-one
coaching sessions with leaders
Ongoing 1, 2, 3, 4, 5
Resources and tools need to be made easily and readily available to leaders Ongoing 1, 2, 3, 4, 5
Encouraging / Supporting

Develop templates / rubrics / clear expectation and standards Ongoing 1, 2, 3, 4, 5
On-line supplemental training offered to leaders Ongoing 1, 2, 3, 4, 5
Senior leaders will check in with leaders and ask if support is needed Ongoing 1, 2, 3, 4, 5
Senior leaders will offer support / assistance in managing time, priorities Ongoing 1, 2, 3, 4, 5
Senior leaders will provide the necessary resources and tools Ongoing 1, 2, 3, 4, 5
Rewarding

Public recognition/acknowledgement, such as a mention at All-Hands
meetings when metrics improve
Ongoing 1, 2, 3, 4, 5
Monitoring / Accountability

Include measures on Leader Performance Appraisals Annual 1, 2, 3, 4, 5
Incorporate questions into annual employee satisfaction survey to gather
data on critical behaviors
Annual 1, 2, 3, 4, 5
Senior leaders will check in with leaders to discuss progress Ongoing 1, 2, 3, 4, 5

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Organizational support. Learning is a process and most learning takes place outside of
the classroom and on the job. To support the leaders’ critical behaviors, Kirkpatrick’s revised
New World Model encourages creating a monitoring system for both the organization and the
leader to ensure accountability (Kirkpatrick & Kirkpatrick, 2016). Two monitoring strategies are
recommended for the program. The first recommended monitoring process is incorporating a
quarterly work review for leaders to review coaching documents and goals sheets. Leaders can
either support one another through peer review, or leaders can meet with their leader or a
member of Human Resource (HR) to review these documents. This creates a monitoring system,
while also opening up the lines of communication and creating a culture of safe learning and
development.
The second monitoring system recommended is the use of the Human Capital Dashboard.
The Exit Interview data should be reviewed by the HR team on a monthly basis and reported to
leaders for review. This monitoring system will provide each stakeholder group with an
indication of the total number of employees who have voluntarily left the organization and the
reason why. This data will also assist leaders in monitoring their own performance and will
allow their leaders to also monitor performance and provide feedback.

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Figure 20. Human capital dashboard

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Level 2: Learning
Learning goals. Following the completion of the recommended solutions, stakeholders
will be able to:
1. Understand the specific leadership behaviors that positively influence employee
retention. (D)
2. Describe how these specific leadership behaviors positively influence employee
retention. (D)
3. Recognize and assess these specific leadership behaviors in themselves. (D)
4. Understand the process of goal setting and apply the knowledge and skills to develop
effective goals for their employees. (P)
5. Demonstrate the essential skills necessary to provide effective coaching and feedback
to their employees. (P)
6. Indicate confidence that they can effectively provide effective goals to their
employees. (Confidence)
7. Indicate confidence that they can effectively provide effective coaching and feedback.
(Confidence)
8. Indicate confidence that they can effectively provide advancement and career growth
opportunities to their employees. (Confidence)
Program. The successful implementation of any organizational strategy is dependent
upon the successful analysis of available options. Given the important role that supervisors have
on their employees’ turnover decisions, providing leaders with effective training and
development, while incorporating accountability systems can lead to a reduction of employee
turnover. To effectively address deficiencies in leader communication within an organization,
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McCauley et al. (1998) suggested a full range of leadership development interventions, including
mentoring, stretch job assignments, feedback systems, on-the-job experiences, and
developmental relationships, and formal training programs.
The learning goals listed in the previous section will be achieved with a leadership
development training program that explores in-depth leadership behaviors, activities, and
competencies necessary to positively influence employee retention. This will be achieved
through a blended-learning program that will include a combination of four one-hour face-to-
face classroom workshops every quarter, four asynchronous e-learning modules, and an on-the-
job training (OJT) program known as the Internal Leadership Coaching (ILC). The learners,
leaders within XY Healthcare, will study a broad range of topics pertaining to skills and
competencies for retaining employees through effective coaching and feedback, goal setting, and
career development.
The four one-hour face-to-face classroom workshops will consist of facilitator led lecture,
group discussion and exercises, case studies, role playing, brainstorming and demonstrations.
Table 25 outlines the four one-hour face-to-face classroom workshops.

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Table 25
Training Plan Recommendations
Classroom Session Length Objective
Session 1: Intro to
Employee Turnover
1 hour • Overview of Employee Turnover
• The leaders role in influencing and managing
employee turnover
Session 2: Coaching
and Feedback
1 hour • Understanding Coaching and Feedback
• Improving Skills in Coaching and Feedback
Conversations
• Having Effective Coaching and Feedback
Conversations
Session 3: Goal
Setting
1 hour • Understanding Goal Setting
• Improving Skills in Goal Setting
• Having Effective Coaching and Feedback
Conversations
Session 4: Career
Development
1 hour • Understanding Career Development
• Improving Skills in Career Development
• Having Effective Career Development Conversations

The supplemental, asynchronous, e-learning training sessions include ten nine-minute
modules that are estimated to take a total of 1.5 hours. These sessions can be completed at the
pace of the leader, however one module is launched each month for ten months and must be
completed within 30 days.
The Internal Leadership Coaching (ILC) program is designed as a mentoring / On-the-Job
Training (OJT) program that is led by a supervisor and/or a specified peer-mentor to a less
tenured or less experienced leader within the actual work environment. The program will require
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leaders to meet with their peer-partners once a month for one hour for a total of 12 hours
annually.
The ILC consists of planned instruction that is delivered by the mentor at the work site,
and is designed to reinforce skills learned in classroom or on-line training that helps leaders
perform their jobs efficiently and effectively. With structure and planning, the supervisor and/or
peer-mentor impart(s) proper procedures and best practices to the trainee.
Components of learning. Demonstrating declarative knowledge is often necessary as a
precursor to applying the knowledge to solve problems. Thus, it is important to evaluate
learning for both declarative and procedural knowledge being taught. It is also important that
learners value the training as a prerequisite to using their newly learned knowledge and skills on
the job. However, they must also be confident that they can succeed in applying their knowledge
and skills and be committed to using them on the job. As such, Table 26 lists the evaluation
methods and timing for these components of learning.

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Table 26
Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge — “I know it.”

Knowledge checks using multiple-choice
questions
In the asynchronous portions of the
course before workshops through
online training pre-work
Knowledge checks through discussions, “pair,
think, share” and other individual/group activities
Periodically during the in-person
workshop and documented via
observation notes
Facilitator will incorporate storytelling to embed
relevant facts and meaningful techniques
During the workshops
Demonstration in groups and individually through
role-play / case studies activities of using the job
aids to successfully demonstrate the skills
During the workshops
Allow participants to share past experiences in
skill and identify the “ups,” “downs,” and
“feelings” of the experience
During the workshops
Procedural Skills — “I can do it right now”

During the asynchronous portions of the course
using scenarios with multiple-choice items
In the asynchronous portions of the
course at the end of each
module/lesson/unit
Quality of the feedback from peers during group
activities
During the workshops
Provide job aids with conversation flow charts to
outline coaching conversation
During the workshops
Retrospective pre- and post-test assessment survey
asking participants about their level of proficiency
before and after the training
At the end of the workshop

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Table 26, continued
Method(s) or Activity(ies) Timing
Attitude — “I believe this is worthwhile”

Instructor’s observation of participants’ statements and actions
demonstrating that they see the benefit of what they are being
asked to do on the job
During the workshop
Discussions of the value of what they are being asked to do on
the job
During the workshop
Retrospective pre- and post-test assessment item After the course
Confidence — “I think I can do it on the job”

Survey items using scaled items Following each
module/lesson/unit in the
asynchronous portions of the
course
Discussions following practice and feedback During the workshop
Retrospective pre- and post-test assessment item After the course
Commitment — “I will do it on the job”

Discussions with their direct leader to discuss the importance of
the training and expectations of how the content will be used
after the training
Before the workshop
Create an individual action plan During the workshop
Discussions with their direct leader to discuss the training and
expectations of how the content will be used on the job
After the course

Level 1: Reaction
Level 1 Reaction in training is the degree to which participants find the training program
favorable, engaging, and relevant to their jobs (Kirkpatrick & Kirkpatrick, 2016). Table 27 lists
the methods that will be used to determine how the participants react to the learning event(s).

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Table 27
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement

Data analytics in the learning management
system
Ongoing during asynchronous portion of
the course
Instructor/facilitator observation During the workshop
Brief pulse-check with participants after each
module
During the workshop
Survey training participants (online survey) Immediately following the course
Interviews / focus groups sample of
participants
Immediately following the course
Relevance

Brief pulse-check with participants after each
module
During the workshop
Discuss importance of content through group
discussion
During the workshop
On the job observations Two weeks after the course
Survey training participants (online survey) Immediately following the course
Interviews / focus groups sample of
participants
Immediately following the course
Customer Satisfaction

Brief pulse-check with participants after each
module
During the workshop
Survey training participants (online survey) Immediately following the course
Interviews / focus groups sample of
participants
Immediately following the course

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Evaluation Tools
During the program. During the asynchronous e-learning portion of the course, the
learning management system (LMS) learning analytics tool will record participant activity and
collect data about the start, duration, and completion of modules by the participants. This data
will indicate the engagement with the course material. The LMS reporting tool is shown in
Figure 21.

Figure 21. LMS reporting tools

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For Level 1 evaluation during the in-person classroom workshops, the instructor will
conduct periodic brief pulse-checks by asking the participants about the relevance of the content
to their work and the organization, delivery, and learning environment. Level 2 will include
checks for understanding through the use of questioning, role plays, discussions, and case studies
drawn from the content.
Immediately following the program implementation. Immediately following the
asynchronous e-learning portion of the course, to measure Level 1 and 2, the LMS tool will also
administer brief a survey to each participant requesting them to indicate the relevance of the
material to their job performance and their overall satisfaction with the content and delivery of
the online course.
Immediately following the in-person classroom workshops, surveys will be sent to
participants to measure: satisfaction with the learning environment; the relevance of the material
to their job; the delivery of the content; their overall satisfaction with the content; their
perception of their ability to apply what they have learned on the job; and their confidence and
commitment to applying what they learned to their work.
Delayed for a period after the program implementation. Approximately six weeks
after the implementation of the training, Human Resourses will administer a survey containing
open and scaled items using the Blended Evaluation approach to measure, from the participant’s
perspective, satisfaction and relevance of the training (Level 1), knowledge has increased,
confidence and value of applying their training (Level 2), application of the training to the day-
to-day function of leaders (Level 3), and the extent to which their knowledge, behaviors, and
performance of the leaders has impacted employee satisfaction and turnover (Level 4).
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Human Resources will also reconvene a sample group of training participants to conduct
a focus groups to review key concepts and ask questions regarding the satisfaction, knowledge
gained, relevance and applicability of the content.
Data Analysis and Reporting
A program-specific dashboard, a graphic depiction of key metrics covering summative
Level 1 and 2, required drivers, critical behaviors, leading indicators and Level 4 Results, will be
developed to monitor and communicate progress towards the stakeholder/organizational goals.
The dashboard will serve as a key tool for making informed decisions regarding the training
program. Targets will be set for each metric and training leaders will be responsible for updating
the dashboards on a monthly basis. The dashboard will be posted on the organization’s intranet
site for all stakeholders to access and view. Examples of dashboards are provided in Figure 22.

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Figure 22. Training evaluation dashboards

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Table 28
Dashboard Metrics
Metric Actual Target Status
Level 1 Overall Program Satisfaction Scores 92% 90%

Level 2 Knowledge Scores for Coaching and Feedback 87% 85%

Level 2 Knowledge Scores for Goal Setting 84% 85%

Level 2 Knowledge Scores for Providing Career Development 90% 85%

Level 2 Commitment Scores for Coaching and Feedback 90% 90%

Level 2 Commitment Scores for Goal Setting 87% 90%

Level 2 Commitment Scores for Providing Career Development 94% 90%

Level 2 Confidence Scores for Coaching and Feedback 91% 90%

Level 2 Confidence Scores for Goal Setting 79% 90%

Level 2 Confidence Scores for Providing Career Development 91% 90%

Level 3: % of Accurate Coaching and Feedback Forms 74% 85%

Level 3: % of Accurate Goals Sheets 61% 85%

Level 4: Employee Satisfaction Scores 65% 80%

Level 4: Rate of Voluntary Employee Turnover 12% 8%

Table 29
Dashboard Key
Green: Above Target Up from last month
Yellow: Meeting Target Same as last month
Red: Below Target Down from last month

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Summary
The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) was utilized as the
framework for designing, implementing, and evaluating the recommendations for XYZ
Healthcare to assist them in achieving their stakeholder goal of changing leader behavior in order
to reduce employee turnover. Planning, training, reinforcement, and evaluation up to this point
should create significant value to the agency if they are conducted effectively.
Through the use of Kirkpatrick’s’ New World framework, it is expected that the
organization will be better prepared to implement an initiative with an increased probability of
success. By beginning with the end in mind and starting with Level 4 to identify the desired
outcomes, the organization will be able to design and develop a program that is strategic and
purposeful. This should result in clear learning objectives and outcomes, committed stakeholder
groups, usability and relevance of content, quality instruction, and engaged participants.
Participants should experience a change in attitude, as well as an increase in knowledge,
competence, commitment and confidence. Finally, as a result, the organization should benefit
from achievement of organizational goals and outcomes. Figure 23 illustrates the expected
outcomes for using the framework and the advantages of integrating implementation and
evaluation.

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Figure 23. Expected outcomes

Limitations and Delimitations
Limitations
The limitations of this study included a lack of ancillary stakeholders and geographical
limitations. The study focused on health care leaders’ impact on employee turnover.
Specifically, the study focused on the knowledge, motivation and organizational factors
influencing employee turnover within a large Managed Care Organization (MCO). Including
ancillary internal and external stakeholders in healthcare, such as employees, commercial payers,
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state representatives, physicians, and vendors may provide perspectives on turnover challenges
in healthcare but was not included in this study. Lack of ancillary stakeholder perspectives
limited the scope of this study because their interactions may influence employee turnover.
There were also geographical limitations with the selected population. The sample size in this
study represented leaders from three geographical locations within a single health care
organization. This limited the ability to view perspectives from leaders from other
organizational locations, as well as an inability to understand turnover from a variety of
healthcare organizations of different sizes, locations, and types.
Delimitations
Delimitations help to clarify the focus of a study by indicating the areas that are included
and excluded from the study. For example, a delimitation of this study was to select participants
with at least one direct report. This ensured that interview responses would provide data from
leaders who had influence on employee turnover. It is conceivable that individuals with power
or those in leadership positions without direct reports will still influence employee turnover and
might provide different perspectives. The final delimitation was excluding leaders who have
been in their position for less than three months. Research was dependent upon reliable,
credible, and accurate presentation of data from participants. This exclusion increased the
likelihood that the participants had an understanding of the organization and a familiarization
with its culture and the employee base.
Recommendations for Future Research
There is a significant need for further research to be conducted in the United States on a
larger scale, on strategies that organizations can use to reduce employee turnover in the
healthcare industry. Recommendations for further research include focusing on a variety of
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healthcare organizations of different sizes, locations, and settings, such as hospitals. To keep this
project manageable in size and scope, this research study focused on reducing employee turnover
within one healthcare organization. However, reducing employee turnover of skilled workers
within the healthcare industry as a whole, is an enormous problem of practice. The specific
focus of this study was understanding more about the knowledge, motivation and organization
factors within one large Managed Care Organization (MCO) in the United States that affect
leadership’s ability to impact employee retention. While the gaps identified were validated
through the data, with such a narrow focus, there is a need for future research to better
understand how knowledge, motivation and organization factors may impact other organizations
within the healthcare industry. Another recommendation is a study be conducted to better
understand the relationship between turnover factors such as Leader Member Exchange (LMX),
employee engagement, job security, work environment, leadership style, and the turnover
intentions of healthcare workers.
A major limitation of the study was the absence of secondary stakeholders in the
participant tools. The turnover influences identified in this study merit investigation from the
viewpoints of other stakeholders, such as employees. Further research from the employee
perspective is necessary to better understand the correlations between leader behavior and
employee turnover in healthcare organizations. For example, being able to incorporate an
employee survey in the study would have increased validation of the data and provided a deeper
understanding of employee turnover.
Additionally, researchers should conduct further studies to explore reasons for employee
turnover intentions not identified or covered in this study, which should help to address the
limitations identified in this study. Conducting future studies about the job satisfaction
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commitment levels from the perspective of the leader could help organizational leaders with the
tools needed to reduce costs associated with high turnover of critical employees and increase the
retention rate of key talent.
Furthermore, since this study focused on one organization located in Texas, New Mexico,
and California, I recommend further research on turnover intentions in other geographic
locations using a larger study population. Examining larger and smaller organizations could add
richer data to the study.
Conclusion
The purpose of this project was to evaluate the degree to which XYZ Healthcare is
achieving its goal of reducing employee turnover from 14.5% to 12% by the end of 2018. The
analysis focused on knowledge, motivation, and organizational influences of leaders within XYZ
Healthcare related to achieving this organizational goal. While a complete evaluation project
would focus on all XYZ Healthcare stakeholders, for practical purposes the stakeholders focused
on in this analysis were leaders.
The Kirkpatrick and Kirkpatrick New World Model (2016) was utilized as the framework
for designing, implementing, and evaluating the recommendations for XYZ Healthcare to assist
them in achieving their stakeholder goal of changing leader behavior in order to reduce employee
turnover. Planning, training, reinforcement, and evaluation up to this point should create
significant value to the agency if they are conducted effectively.
The main takeaway from this research study is that employee retention in the healthcare
industry is complex and the solutions needed to fix this problem are equally complex. While
many leaders had a good understanding of employee turnover, as this study described, they
expressed a lack of confidence in the organization. For example, while it is possible to increase
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the confidence of leaders through improved organizational support and resources, without a real
desire from all stakeholders and an internal cultural change throughout the organization,
employee turnover will continue.
The fundamental principles on employee turnover presented in this study suggest that
organizations have to provide employees opportunities for growth and advancement; they need
to be seen as fair, transparent, and just; have the necessary tools and resources needed for
employees to do their jobs; and they must provide clear organizational goals. In addition,
organizations must see the value in employee retention and be willing to invest the necessary
time and money in the training and development of their leaders. To simply provide the goals
and development opportunities is not enough. Leaders must be have the knowledge, skills and
confidence to execute.
It is evident, based on the research presented above, that this organization still has
significant work to do to retain core employees. It is also clear that there is a need for leaders
who are better equipped to effectively lead. It is important that the organization invests time into
understanding their specific retention challenges by conducting a gap analysis of what they do
well versus what they need to improve upon. While this research is one small step in the right
direction to decrease employee turnover, in order to fully prepare leaders to positively influence
employee retention, their organizations must be willing to take a realistic view of their culture
and be willing to change.

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APPENDIX A
SURVEY QUESTIONS
1. Are you an employee at XYZ Healthcare?
a. Yes
b. No

2. Are you currently a leader within XYZ Healthcare with more than 1 direct report?
a. Yes
b. No

3. Have you been in your current leadership position within XYZ Healthcare for more than
3 months?
a. Yes
b. No

4. Which of the following are growth and development activities?
a. Training and development
b. Mentor program
c. Succession planning
d. Coaching and feedback
e. Goal Setting
f. All of the above

5. Career Development conversations should focus on which of the following:
a. The employee getting a promotion
b. Promises of a raise / bonus/ increase in pay
c. Activities to increase the knowledge and skills of the employee
d. None of the above

6. Which of the following are components of Goal Setting:
a. S.M.A.R.T. Goals
b. Cascading Goals
c. Goal Alignment
d. All of the above
e. None of the above

7. An employee’s trust in their leader is an important part of employee engagement and
employee retention.
a. True
b. False

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8. An effective coaching and feedback session includes the following. Check all that apply:
(Procedural)
a. A relationship of trust
b. Preparation
c. Specific behavioral examples
d. A completed coaching form
e. Coaching form from previous discussion
f. Data to support performance

9. Effective, open and honest communication are vital to building trust and mutual respect
with my employees.
a. True
b. False

10. As a leader, I have a direct impact on my employees’ level of engagement and their intent
to leave the organization.
a. True
b. False

11. My employees and other team members would say that I regularly ask them for feedback
on my performance.
a. True
b. False

12. Retaining top performers and employees with critical skills is important to the
organization in order to maintain a competitive advantage.
a. Yes, I agree
b. No, I disagree

13. There is value is providing employees clear goals, coaching and feedback, growth and
development, and advancement opportunities.
a. Yes, I agree
b. No, I disagree

14. On a scale of 1 to 5, 1 being the lowest, 5 being the highest, how confident are you in
your ability to do the following:
a. Accurately identify your critical employees / top performers
b. Establish effective goals for your employees
c. Consistently provide effective coaching and feedback to your employees
d. Build trust among your employees
e. Provide your employees career development opportunities

1: No confidence, 2: Very little confidence, 3: Neutral, 4: Confident, 5: Very confident

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15. As a leader, I am confident that I have what I need to effectively establish and
communicate clear expectations and goals for 100% of the employees on my team for
this year.
a. Yes, I agree
b. No, I disagree

16. Our current Human Resource practices, including: selection & hiring, onboarding,
internal advancement & promotion, training & development, and reward systems are
effective practices in reducing employee turnover.
a. Yes, I agree
b. No, I disagree

17. Do you see the organization investing resources to ensure employees are engaged and
satisfied?
a. Yes, I do
b. No, I do not

18. Based on how the organization spends its time, resources, focus, and energy, what do you
think they value the most?
a. People
b. Performance
c. There is good balance of both

19. The organization is committed to holding employees accountable for high performance.
a. Yes, I agree
b. No, I disagree

20. As a leader, I feel supported by the organization.
a. Yes, I agree
b. No, I disagree

21. The organization provides me and my team the necessary resources, tool, and systems
needed to do our jobs effectively.
a. Yes, I agree
b. No, I disagree

22. Effective workflows, processes, and procedures are established and documented in a way
that allows my employees to do their job effectively.
a. Yes, I agree
b. No, I disagree

23. There are sufficient advancement and growth opportunities that exist within the
organization that enable me to support my employees in their professional development
and growth.
a. Yes, I agree
b. No, I disagree
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24. Practices within the organization, such as hiring, promotions, and reward systems are fair
and transparent.
a. Yes, I agree
b. No, I disagree

25. The organization creates a culture where I can communicate effectively, openly, and
honestly with my team.
a. True
b. False

Inclusion Question: Are you interested in participating in a 1-hour Interview to further discuss
the topics included in this survey?
a. Yes
b. No

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APPENDIX B
INTERVIEW PROTOCOL
The survey includes an inclusion question that asks the respondent if they would be interested in
participating in an interview. Participants will be chosen from those who answered “Yes, I
would like to participate” on the survey. These leaders will be contacted via email until a
minimum of 15 respond back and agree to participate. At that time, the leaders will be sent an
email with detailed instructions an outlook calendar invitations with possible dates and times.

The interviews will be semi-structured with an interview guide provided to guide the discussion.
Semi-structured interviews are used when the researcher wants to delve deeply into a topic. The
guide provides standardized open-ended questions and the order in which to ask them. The
Interviewer has some discretion in the clarifying questions they ask, but probing questions are
provides to ensure they address specific topics. While detailed information is collected in a
structured way, the interview is still designed to be conversational in nature. In-person, in-depth
interviews were chosen over focus groups because of the sensitive nature of the study and the
population. Many survey questions had to do with personal leadership behaviors that some
participants may not be comfortable discussing in a group setting. Reducing the likelihood that
one participant may influence or dominate the discussion was another drive of why in-person
interviews were chosen.

Interview questions will be open-ended and always begin with a ‘frame of reference” statement.
Specifically, in order for the researcher to gain more insight on a specific survey question, the
moderator script will include the data collected about that question to provide the participants a
frame of reference and clarity on what the researcher is looking for in their answer. For example,
if the question on the Survey regarding understating the organizations goals was identified as
“High for Strongly Disagree”, the moderator will begin the statement by saying, “The survey
results for the question pertaining to organizations goals were identified as “High for Strongly
Disagree” by 73% of respondents. The moderator will them read the question exactly as it is
listed on the survey. They will then proceed with the respective interview question for that
survey item.

Interviews will be conducted over a 2 week time frame beginning the week of _______and
ending on _______. Each interview is expected to last approximately forty-five minutes to 1
hour. Interviews will be conducted through the use of XYZ Healthcare’s WebEx system, and
will include both local and remote leaders.

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Moderator Interview Script
Welcome and thank you for participating in the interview! My name is _________ and I will be
interviewing today. The interview is takes approximately 45 minutes to one hour. You identified
that you would like to participate in a one-on-one interview and have voluntarily decided to
participate in this interview to assist in the analysis of leader behaviors on XYZ’s employee
turnover. I appreciate your willingness to participate in this interview.

I will be audio recording this interview. Please be assured that any comments you share will
remain confidential. My objective is to identify leaders’ awareness, attitudes, and perceptions in
regards to their behaviors in relation to employee turnover.

There will be a total of 20 questions with each question allowing for no more than 2-3 minutes of
discussion. I will facilitate us moving to the next question as we approach the 2 minute time
frame. I will not participate in the discussion, but I will ask follow-up questions and be able to
provide clarification on any question if needed.

I want you to feel comfortable and invite you to share your opinions freely. Please help yourself
to the refreshments that have been provided. In addition, if you have a cell phone please turn it
off or put it in silent mode.

To aid in capturing the information shared, the interview will be recorded and hand written notes
will be taken. If you do not want to be taped, you will not be able to participate in the interview
part of the study.

ASK: Do you agree to participate in the interview portion of the study? Please respond Yes or
No. (Wait for a response, if “yes”, proceed to next question. If “no”, end the interview.)

ASK: Do you agree to be audio recoded? Please respond Yes or No. (Wait for a response, if
“yes”, start audio recorder. If “no”, end the interview.)

Administer Informed Consent Form
ASK: Please take this time to thoroughly review the Informed Consent form and sign. Allow
time for participant to review Informed Consent form and sign.

ASK: I will start the recorder now and ask you the same permission questions and then we will
begin the interview.

Start Audio Recorder
ASK: Do you agree to participate in the interview portion of the study? Please respond Yes or
No. (Wait for a response, if “yes”, proceed to next question. If “no”, end the interview.)

ASK: Do you agree to be audio recoded? Please respond Yes or No. (Wait for a response, if
“yes”, start interview. If “no”, end the interview.)
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STATE: You can choose not to respond to any question, for any reason. As with the survey, at
any point during the interview you may also choose not to answer any question. Again, your
participation in the survey and interview is voluntary and you may choose to end the survey or
the interview at any time with no further explanation.

Begin Interview
Interview Questions
1. Are you currently in a leadership position at XYZ Healthcare?
2. Are you currently a leader within XYZ Healthcare with more than 1 direct report?
3. Are you able to meet for at least 1 hour?
4. Thinking of your employees, in general, what do you think they need from you as a
leader to positively influence their retention?

5. In your current role as a leader, describe to me how you have specifically been able to
help an employee develop their career?

6. How do you define a “critical/ key employee”?
7. Please describe the activity of cascading a goal and its importance.
a. If possible, briefly provide an example from your department.
8. As a leader, what do you specifically do to ensure you are building a positive, trusting
relationship with your employees?

9. Describe the components necessary to have an effective constructive coaching and
feedback discussion with an employee when they are not meeting performance
expectations.

10. Identify 2-3 specific growth and development activities that are available to employees
on your team within the organization?

11. Give me an example of a time when you received feedback from one your employees
about your behavior/performance and what you did with that feedback.

12. Retaining top performers and employees with critical skills is important to the
organization in order to maintain a competitive advantage. Why is that of value to you
and the organization?”

13. How have you personally experienced not being able to retain top employees and how
has that impacted your department?”
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14. What do you think the value is in providing your employees clear goals, coaching and
feedback, growth and development, and advancement opportunities?

15. On a scale of 1 to 5, 1 being the lowest, 5 being the highest, tell me how confident you
are in your ability to do the following and please state why you chose that rating:
a. Accurately identify your critical employees / top performers;
b. Establish effective goals for your employees;
c. Consistently provide effective coaching and feedback to your employees
d. Build trust among your employees;
e. Provide your employees career development opportunities.
16. Describe how effective you feel the current human Resource practices, including
selection and hiring policies, internal advancement and training promotion and employee
development, and reward systems are in reducing employee turnover.

17. In what ways, if at all, do you see the organization is investing resources to ensure
employees are engaged and satisfied?

18. Do you feel effective workflows, processes, and procedures are established and
documented in a way that allows your employees to do their job effectively? Why? Or
Why not?”

19. To what degree do you feel employee development and growth opportunities are readily
available in the organization?

20. Please describe your perceptions of the following:
a. Transparency of communication and changes
b. Fairness in decision making
c. Fairness in promotions and raises
d. Justice when dealing with discipline”

INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

245
APPENDIX C
INFORMED CONSENT / INFORMATION SHEET
University of Southern California
Rossier School of Education
3470 Trousdale Parkway
Los Angeles, CA 90069

INFORMATION/FACT SHEET FOR EXEMPT NON-MEDICAL RESEARCH

Leaders ’ Role in Reducing Voluntary Dysfunctional Employee Turnover
You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. Please ask questions about anything that is unclear to you.\

PURPOSE OF THE STUDY
The purpose of this study is to better understand how your role as a leader influences the
dysfunctional turnover of employees within the organization.

PARTICIPANT INVOLVEMENT
You can participate by being taking part in the survey, providing your experiences through an
interview, or both. Participants who choose to participate in the survey will be emailed a link.
The survey should take about 30 minutes to complete. During the survey, you are not obligated
to answer any question you do not want to answer. In addition to the survey, you have the option
to take part in an individual interview with a researcher that will last approximately one hour.
Pre-determined, guiding questions will be asked, but the interview will be conversational in
nature. Follow-up questions may be asked to gather additional insight and clarity. To aid in
capturing the information shared, interviews will be recorded and hand written notes will be
taken, with the interviewee’s permission. You can choose not to respond to any question, for
any reason. As with the survey, at any point during the interview you may also choose not to
answer any question. Again, your participation in the survey and interview is voluntary and you
may choose to end the survey or the interview at any time with no further explanation. If you do
not want to be taped, you will not be able to participate in the interview part of the study.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will receive a $25 Visa gift card for your time. You do not need to respond to all questions
in the survey or the interview to receive this gift card.

ALTERNATIVES TO PARTICIPATION
Participation in this study is voluntary. Your alternative is to not participate. Your relationship
with your employer will not be affected whether you participate or not in this study. Your
participation is confidential and your employer will not be notified of who participates in the
study and who does not.

INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

246
CONFIDENTIALITY
You will not be asked to identify yourself in any way during the survey, nor will any identifying
information be kept with interview responses. Identifying information such as name, title, and
department are not pertinent to the study and will not be collected.

Upon request, you have a right to review and edit all interview notes, transcripts, and audio
recordings that you participated in. Only the professional transcriber and the researcher will have
access to the survey data, interview notes, transcripts, and audio recordings. While in use, to the
survey data, interview notes, transcripts, and audio recordings will be stored on a password
protected computer in a secure office by a member of the research team. After the survey
responses have been analyzed and the audio recordings are transcribed, they will be destroyed
and not kept as records.

The members of the research team and the University of Southern California’s Human Subjects
Protection Program (HSPP) may access the data. The HSPP reviews and monitors research
studies to protect the rights and welfare of research subjects.

INVESTIGATOR CONTACT INFORMATION
If you have any questions or concerns about the study, please contact the following individuals:

Principal Investigator
Summer L. Allen
Email: summeral@usc.edu
Phone: (214) 226-9417

Faculty Advisor
Dr. Melora Sundt
Email: Sundt@rossier.usc.edu
Phone: (310) 403-6671.

IRB CONTACT INFORMATION
University Park Institutional Review Board (UPIRB), 3720 South Flower Street #301, Los
Angeles, CA 90089-0702, (213) 821-5272 or upirb@usc.edu
INFLUENCES ON EMPLOYEE TURNOVER: A GAP ANALYSIS

247
APPENDIX D
RECRUITMENT EMAIL
Date

Dear XYZ Healthcare Leader,

In fulfillment of the requirements of the degree of Doctor of Education, Organizational Change
and Leadership, I am working with Corporate Leadership to conduct an internal study
concerning employee turnover within XYZ Healthcare. While employee turnover is inevitable,
data has shown high turnover in critical and hard to fill roles. To address this challenge, the
organization launched a project to reduce voluntary turnover of critical employees and top
performers. Your role as a leader is critical to the success of the project, and we would like you
to assist us in understanding your perceptions and needs by participating in the study.
Participants in this study are all randomly selected for the invitation to participate.

This email is to invite you to voluntarily participate in the study by: (a) anonymously completing
an online survey, which should take you no more than 30 minutes and (b) participating in a one
hour virtual interview with the researcher, (via WebEx). Your participation in the survey and
interview is completely voluntary and all of your responses will be kept confidential and you
have the option to terminate your voluntary participation at any time.

If you are interested in participating in the study, please click on the link below and complete the
3 question Participation Request form.

Participation Request Form Link: INSERT HERE
Once you complete the Participation Request Form, you will sent a follow up email with
information regarding the survey. If you are willing to participate in this study or have and
questions, please contact me at summeral@usc.edu or 214-226-9417.

Your contribution is greatly appreciated.

Sincerely,

Summer L. Allen

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Asset Metadata

Creator Allen, Summer L. (author)

Core Title The moderating role of knowledge, motivation, and organizational influences on employee turnover: A gap analysis

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 07/24/2018

Defense Date 01/23/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag employee engagement,employee turnover,healthcare,Kirkpatrick new world model,KMO model,leadership, GAP analysis,OAI-PMH Harvest

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Sundt, Melora (committee chair), Datta, Monique (committee member), Hanson, Kathy (committee member)

Creator Email drsummerallen@gmail.com,summeral@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-24072

Unique identifier UC11671821

Identifier etd-AllenSumme-6449.pdf (filename),usctheses-c89-24072 (legacy record id)

Legacy Identifier etd-AllenSumme-6449.pdf

Dmrecord 24072

Document Type Dissertation

Format application/pdf (imt)

Rights Allen, Summer L.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA