Understanding turnover in healthcare and welfare sectors of high-income countries: an umbrella review.

BACKGROUND

This umbrella review aims to systematically synthesize the current evidence on the factors associated with personnel turnover in the healthcare and welfare sectors, the methodologies used to measure turnover, and the effectiveness of interventions designed to reduce turnover.

METHODS

Following PRISMA-P guidelines, we analyzed data from January 2013 to July 2023 across multiple databases, including PubMed, Web of Science, CINAHL, Cochrane Database of Systematic Reviews, and Embase. Two reviewers independently screened titles and abstracts for predefined eligibility criteria. They also collaboratively examined 10% of the full texts to ensure compliance with these criteria. Study quality was evaluated using AMSTAR 2, and a Corrected Covered Area analysis was conducted.

RESULTS

The analysis included 37 studies with a total of 511 primary studies. Turnover factors were grouped into three categories: socio-demographics and health status, work environment characteristics, and personal attitude and functioning, highlighting a wide range of factors that influence both turnover intention and actual turnover. Various measurement methodologies were identified, with a notable lack of standardization. Interventions targeting work-related factors showed mixed effectiveness, underscoring the importance of context-specific strategies.

CONCLUSIONS

The findings show the complexity and context-specific nature of turnover in healthcare and welfare sectors, requiring targeted, context-specific interventions to address the diverse factors involved. Standardization of measurement methodologies is necessary for comparing turnover rates and the effectiveness of interventions. Future research should focus on filling existing gaps, particularly in non-hospital settings, and on developing and evaluating multifaceted interventions.