In Summary
- Retention challenges are rarely solved through workforce planning alone. Strong workplace cultures play a critical role in keeping people engaged and committed.
- When employees feel empowered to speak up, organisations can strengthen trust, improve engagement and address issues before they impact teams and services.
- From candidate experience to onboarding, recruitment shapes culture from day one and can influence whether talented people choose to stay.
Retention is often discussed as a workplace planning challenge. In reality, it’s as much as culture change.
When people talk about retention challenges in the NHS, the conversation often focuses on staffing shortages, budget pressures and increasing demand. While those challenges are real, a conversation with healthcare people leader Janine Larosa reinforced something equally important, retention is fundamentally about culture.
In simple terms, culture is what people experience every day at their place of work. It's how colleagues interact, how leaders respond to feedback and whether employees feel safe, supported and able to contribute.
Learn to read the cultural room
One of the comments from our conversation that stayed with me was Janine's observation that people often leave managers more than they leave organisations. It's a simple statement, but it highlights how much influence day to day leadership has on someone's experience at work.
When employees feel listened to, respected, trusted and supported, they're far more likely to remain engaged and committed. Equally, when individuals feel unable to speak up, fearful of making mistakes or don't feel valued, those pressures can quickly build over time and ultimately affect retention.
In healthcare environments, where teams are working under immense pressure and making important decisions every day, creating psychological safety is essential.
Janine spoke about walking into organisations and immediately sensing whether the environment feels open and collaborative, or whether there's an undercurrent of fear and hesitation. Teams become quieter. People stop contributing ideas. Individuals become reluctant to challenge decisions or raise concerns, data often reflects this too.
For me, this reinforced an important point, retention problems rarely appear overnight and are the knock-on result of cultural issues that have been developing over time without intervention.
Why employee voice matters
Another theme that came through strongly was employee voice. We discussed practical ways organisations can create genuine opportunities for people to contribute and be heard, particularly those who may not usually have direct access to senior leadership.
One example Janine shared was the introduction of a shadow executive group. Employees from different parts of the organisation were given visibility of board discussions and the opportunity to provide feedback that directly informed executive decision making.
What I found particularly powerful was the message this sends across an organisation.
When employees can see that leaders are listening and acting on feedback, it helps build trust. It reinforces the idea that everyone's perspective has value, regardless of grade, role or department.
Culture begins before someone joins
As someone working in resourcing, this was the part of the conversation that resonated most strongly with me. We often think about culture as something that happens after a person starts a role. In reality, it begins much earlier.
It starts with recruitment campaigns. Right at the start. Every interaction contributes to a candidate's impression of what it might be like to work within an organisation and the quality of recruitment itself has a direct impact on how someone feels valued prior to joining. Every hiring decision is an opportunity to think carefully about the values, behaviours and experiences needed to strengthen a team and ensuring that these are felt by new joiners from their very first engagement with the business.
That's why I believe recruitment and retention should never be viewed as separate conversations and that the candidate experience you create today directly influences the culture you're building for tomorrow.
Looking ahead
There are no quick fixes when it comes to retention however, our conversation reinforced that organisations don't need to tackle everything all at once.
Small, consistent actions can make a meaningful difference as well as listening more closely to employees, supporting managers to have better conversations and creating safe opportunities to speak up, whilst ensuring recruitment and onboarding processes reflect the culture you aspire to create.
For me, the biggest lesson from the discussion was simple… If we want people to stay, we need to think about the experience we're creating long before their first day.
These are just a few of my reflections from what was a fascinating discussion with Janine Larosa. If you'd like to hear more of Janine's experiences and practical advice on culture, leadership and retention in healthcare, you can listen to the full podcast here.