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CW Ep. 34: Cara Silletto

Workforce thought leader Cara Silletto, MBA, CSP, explores exactly why staff stay and why they leave. She explains who the real flight risk is on our teams and how to identify common escape routes of why people leave when they do. Moving forward, leaders must prepare to manage a shorter-term workforce and begin to slow the revolving door of turnover.

Contact Cara.

Welcome to Bridge the Gap Contributor Wednesday, I’m Cara Silletto and I am thrilled to be one of the contributors this year with a great lineup of my friends and colleagues helping you provide the best quality care possible. My work focuses solely on reducing unnecessary employee turnover. So for the next six months, I’m going to be working with you on strategies about workforce retention and building a stronger culture within your organization. My company is Now some of you may know me from our previous name of crescendo strategies, but in 2020, we rebranded to focus on helping organizations become magnet employers; where people want to work. And more specifically, we focus on making managers a magnet; someone that people really want to work for, and that encourages them to come back tomorrow.

So let’s talk about retention, but before we talk about why people leave, let’s talk about why people stay. Why is it that people stay at your organization or at any organization? To some extent it’s because of the positive things, right? It’s because they love their team, they love the organization, they love the residents that they serve. That’s huge in our profession, right? A lot of people are drawn in because it’s a calling for them. So why is it then that some people stay, even if they’re not happy doing what they’re doing. You know, we see this more often than what I’d like. And sometimes when I’m especially running workshops around this topic, I will ask this question and we dive deeper and deeper and deeper. You know, of course all the comments start out positive at first and have great culture, great team, things like that. But then when we talk about why would people stay that maybe aren’t happy or don’t love what they do or love the people they work with. Then we get to the real, the real reasons why some people stay. And some of that is because of comfort. Oh, let’s be honest, some people don’t like change, right? Some people just don’t like change and they are really interested in keeping things the way they are. They don’t want to learn a new system, they don’t want to learn a new organization, a new building, a new team, a new boss, all of that stuff. And sometimes that’s what keeps people, sometimes it’s that loathing of change. And just the dread of that situation of having to find a new job or switch to a new job. Have you ever heard someone say the ‘devil you know is better than the devil you don’t’. That phrase is typically said by people that prefer things the way they are. It doesn’t mean that person’s happy. In fact, they’re saying, look, the situation I’m in now; it isn’t great, but it could be worse, and I don’t want to explore that. 

Where it’s funny to me all the generational work that I do, which we’ll explore in a future episode, but the mindset of many of our younger workers today is kind of the opposite of that. Instead of the devil you know is better than the devil you don’t, and I’ll just deal with what I have, I know how to navigate it, and I don’t want change. Instead, the other end of that same spectrum is I’m not happy where I am. This isn’t working for me and the grass has got to be greener somewhere else. Right? So it’s two different ways of looking at a situation where somebody’s not as happy. But one person is not a fan of change and does not think things would be better somewhere else, where the other person with a different mindset is not happy where they are, but absolutely believes there’s gotta be a better option out there that they’re not willing to put up with whatever situation they’re in that they’re unhappy about.

So in some cases, people stay because of that lack of interest in making a change. And sometimes it’s because maybe they’re at the top of their pay. That if they went somewhere else, they would probably have to lower that pay or start over on the hierarchy, for example. So some folks it’s because they’ve kind of capped out on that pay, other folks it’s because they have seniority. I mean, come on. If you’ve been there 10 or 20 years, you know how to pull strings and get things done, right? And if you go somewhere else, you become the new kid on the block. You become the person that doesn’t have all the connections and doesn’t have the seniority. So some folks may stay just because of that reason. Also sometimes we have what we call golden handcuffs that keep people in their position. Now it could be something like that high level pay that they might not be able to match elsewhere.


But sometimes it’s also something like a big cushion of paid time off that they have accrued. So if you’re sitting on three, four, five, six weeks of paid time off that you have gained and earned over that time, if you go somewhere else, it’s gone. You lose all of that. And those folks that many of them really like having that cushion, having that backup option for paid time off. And so that could be another reason, another golden handcuff as to why people stick around. There could also be something like a lack of transferable skills to go do anything else. And more often than not, I find that that’s a perception of not having transferable skills to go elsewhere. Someone doesn’t feel like they could be successful in any other role or profession or organization. So they just stay put because of that lack of confidence, even.

So I’m curious if you have anyone on your team who may fall into one of those buckets of, you know, they probably would leave if they could, or if they didn’t have one of those barriers. Now, the reason that I start with this conversation is because so often we blame the people who jumped ship and say they have no loyalty, right? They just aren’t committed to the job. But I have to ask myself of those people who might have golden handcuffs or might care more about having the seniority on the team. Are they truly loyal to the organization or do they stay because of one of those other reasons? There are so many different things going on in our staff’s heads. And sure, it’s a matter of whether or not we’re going to lose them or keep them. And to some extent, as a leader in the organization, maybe you don’t care. Hey, if the golden handcuffs work, use them. That’s fine, but I want to make sure we are not accusing the newer hires of being less loyal or of not having any commitment. Today the employer/employee relationship must be mutually beneficial my friends, because if our occupancy goes down, we are absolutely going to cut hours. And we know that that’s how we operate. So they’re going to take the hit and we may even have to cut jobs. Then if the employee is not happy or whatever is going on is not a fit for them anymore; the schedule or the team or the boss or whatnot, they’re going to jump ship. So today we must recognize that this relationship between us as employers and the employees that we bring on, it must remain mutually beneficial for us to stay intact; for that relationship to stay intact.

So who is the flight risk then? I would actually argue that it has nothing to do with the generational dynamics and the generational mindset even. It has to do with a person’s roots in the organization. If you think about your staff as trees, all right, how deep are the roots that they have with your company? If they’ve been there a long, long time, then their routes are going to be much deeper, much stronger, and you know how hard it is to transplant a 20 year old Oak, right? I mean, that’s next to impossible to be able to uproot that and successfully transplant that somewhere else. It takes a lot of work, heavy machinery and all that fun stuff. But little saplings it’s much different, right? If they don’t have deep roots, if they haven’t been there very long, it is far easier to replace or transplant something that doesn’t have deep roots. 

So I put our workforce kind of into two different buckets. One would be the deep rooted trees. We’ve got folks at our organization who’ve been there a long time. And I can’t put a number on that as far as how many years they’ve been there, because it depends on how old your organization is and whether you’ve had major leadership changes over the years. You know, some of the organizations I work with, they’ve been around 50 plus years and they’re trees in the organization. Or anybody who’s been there maybe more than 10 years, that those folks are deep rooted and they can sway with the weather, right. They can weather the storm, they’re not going anywhere, even if you want them to. But some of the other organizations that I work with, maybe they’re a much younger organization and they’ve only been around for 10 years.

So in that case, the trees might be the people who’ve been there three or four years or longer, that that’s kind of the old guard or the original leadership team that came in. So I want you to think about where that cutoff would be for you, of who would be the trees. Once people reach this certain tenure threshold, then they’re probably not going anywhere. You know, maybe they do have some of those golden handcuffs of seniority and PTO and pay and things like that. Right. Or, I mean, they could certainly be very loyal to your organization, but they’re probably not going anywhere for one reason or another. Now the other side of the employee base, the other type of employee, that’s not the deep rooted trees. I consider those the revolving door. You know, we hear that term all the time and we see a ton of this 30, 60, 90 day turnover. And so if you were to put your workforce into those two buckets, what percent would be deep rooted trees and what percent would be revolving door positions? 

Now I bring this up because a lot of times we put everybody in the same bucket. For example, in our retention numbers, when we calculate retention, what do we do? We put everyone in the same bucket and we say turnover is X percent. But that includes both the trees and the revolving doors. And the problem with doing that is what’s going to happen in the next five to 10 years my friends, If we think about that ratio of trees to revolving doors, you know, some folks will say, ‘Oh, we’re 50/50 Cara. We’re 60/40, 70/30.’ They get that current ratio. But then we project out five to 10 years from now, how many of your trees are going to retire?

That changes things doesn’t it? So in the next 5 to 10 years do you believe, as most of the organizational leaders I work with believe, do you believe that the percent of revolving door positions is going to rise in the next 5 to 10 years? Now I know that’s painful to hear. I get it that sometimes it’s like, ‘oh no, that’s not what I want to hear right now.’ But here’s the gift in that, it’s not going to blindside us. We can see this transition happening for some of you. It may already be here that you are more than 50% revolving doors. For many of us, we are going to have that increase in shorter term workers. Now I’m not saying short term, that’s like fast food. Those are summer jobs and whatnot. We may have a few positions like that, but we are going to have to deal with having shorter term workers.

If you had positions in the past, for example, that stayed 10 to 15 years. Now most folks I talk to say that those people would maybe stay five to seven years in a position like a department head role or something in management, for example. Where with the CNA roles, we used to have CNAs that of course they would stay a long time, but also some of them they would stay you know, at least a couple of years, maybe three to five. And now we are struggling to keep people 90 days. You know, some people bang their head against a wall saying, Oh, she was only here a year, that was a bad hire. We shouldn’t have hired her, she’s not loyal, she didn’t stay. And yet in a separate conversation, people will tell me that ‘yes Cara, if you had a really good CNA that would stay guaranteed for 12 months, I will take her. Yes, absolutely.’ So where are we? Is it yes I’m grateful that somebody stays a full year or is it, oh,I can’t do it if they only stay a full year, right? Or if they just stay one year, I need them to stay longer. If we shift our mindset around that, we recalibrate our success meter of how long someone needs to be there for us to consider that a successful hire. Yes, it’s going to be shorter than it used to be. But I’ll tell you right now, the organizations that have embraced that they are going to have shorter tenure. They’re the ones who are actually able to extend the tenure of folks. Instead of just 90 days, they’re staying six months, which may not sound like a big difference, but that is twice as long, six months is twice as long as 90 days. Which is a huge help to us and it helps our continuity of care. It will eventually help the quality of care that we give. Right? If we can extend those things. 

Now in this podcast series, I’m going to talk later about how to extend the tenure of each new hire. What kind of carrots, what kind of incentives, how do we treat our people? What are the managers to do to influence people to stay longer? We’re going to get to all kinds of those things in this series from January to June. But right now, I really want you to just think about why do people leave? Why do people stay? What are the real reasons behind that? Now I do about 75% of my work within senior care and senior living. It is an absolute passion of mine to serve you and to help create a place where people want to work at every community across America.

But I also do some of my work outside of healthcare because I love to see what other industries are doing with retention. What kind of best practices are out there? What information can I gather from other leaders in different professions that I can bring to senior living that we could incorporate in order to do things more effectively. So I want to give you an example here of a concrete company that I worked with. 

Now, I promise you this will relate when I explain what happened with this concrete company. They were complaining about losing their concrete ready-mix truck drivers. Now you guys know the ready-mix trucks, those are the ones that spin as they’re going down the road. Well, that job is really dirty. It’s really heavy equipment, it is very laborious in that job. And they have not only crazy schedules, but they have to work around the weather all right. So if it’s raining on Friday, they have to pour the concrete on Saturday instead, even when they weren’t originally scheduled. So they have a very tough role to fill. Now, when we talk to the managers of this concrete organization and said, why do your truck drivers quit? You know, the only two answers that they gave us, the only two, where the truck drivers quit for better pay and better schedules. That was it. That’s what they heard on their exit surveys, that’s the stories that they told me, that was their assumption. And yet when I went to talk to the truck drivers and ask them, why did you leave your last company to come here? Why would you consider leaving this organization to go take a different job? The answers were amazing. They said things like, there are no staff meetings, no communication with us out in the field. We don’t know what’s going on around here. We feel like we’re the last ones to know. 

Is there any chance that some of your staff within your community could feel that way? That even though of course we tell them, we tell them, we tell them, but there’s still a perception sometimes of folks that say I’m always the last to know, or nobody told me, right? So that of course crosses over all different careers and industries. Another one was that they hated the outdated hardware and software. They really hated it when their system would just churn and wait and wait and wait to submit a form that they were trying to submit online, for example. And so, so many organizations don’t realize how frustrating that is for busy staff to have old outdated equipment or software. So that was a real concern of these staff and I’ve also heard it within healthcare as well.

This one is pretty common. The next one is that bosses were degrading and played favorites. We of course see that. And we know that we have to have great bosses and supervisors in order to keep our people. We’ll dive into that in great detail later. But we have to be honest that the supervisors and managers have a ton of influence on whether people stay or go. So that’s something we definitely have to address in these conversations. And then the last one was my favorite. It said, the truck you get as a rookie is a joke. Now I know you guys don’t have trucks that the CNA’s are driving, but I love this example because we could swap out that word truck for other things. And in many cases, we treat the new hires as though they have to pay their dues. They have to earn them they’re stripes, right? We think that they have to work for so long before they get the treatment of the senior folks, right? Now, a lot of organizations I’ve seen have really evolved this and are doing a great job. They no longer have holidays chosen by seniority, for example. And of course that’s more of a rotation or other ways of more equally choosing who works holidays. But there are still times, you know, whether it’s choosing shifts using which unit or when you’re working on which set of residents you get to choose to work with. Some of the perks and benefits of the company. Sometimes I still see the situation where seniority rules and the people who’ve been here the longest get the first say, which means, my friends, that the new hires get the leftovers. 

But who’s hiring today? Who’s hiring in your town, right around your community, who has now hiring signs up? I’m going to guess that it’s almost everybody. That almost everybody; food service, logistics, retail, call centers. You know, all these organizations are hiring, which means that every new hire is a flight risk. If we go back to the trees versus the revolving door position that has nothing to do with that generational difference on the age of the person; every new hire is a flight risk, my friends. So I don’t care whether your next hire is 25 or 45. They are the exact same flight risk. They do not have deep roots in your organization. They do not have golden handcuffs and they have, I have the guts to leave their last company to come to you, which means they have the guts to leave your organization and go on to somewhere else.

We have got to listen to the new hires and figure out what is attractive to them. What does keep them and make sure that we are operating in a much more egalitarianism environment rather than a hierarchy. Now egalitarianism means that we value every person’s capabilities and talents that they are bringing to the organization. It means we have equal value to everyone. Not that they have equal or that they all do the same jobs and things like that, but that we truly value every single person as essential and critical for us to provide quality care, whether they are the DON or the CNA, right. They both are absolutely critical to our success. So we have to pay more attention to those new hires coming in and make sure that we listen to them. So if I go back to this concrete example here, the truck you get as a rookie is a joke. You know, if we say the shift you get, those residents you get, the workload you get. Whatever it is, if we’re putting anything on the new hires that is less than desirable right now, we really have to rethink how we can shake that up, spread that out, spread out the decisions and you know, one man’s junk is another man’s treasure. So sometimes certain shifts certain people love and other people don’t. So, you know, we can really listen to our people and take that into consideration these days. So think about who are the deep rooted trees in your organization, which roles have become that revolving door and how can we keep people longer? One last thing I want you to think about with this is, think about when people leave. Why do people leave when? Because we find that there are totally different reasons for people leaving within the first couple of weeks versus the first few months versus the first few years.

In fact, I create templates and tools and documents for you guys all the time. And I have this hidden page on my website called In the vault, we have a document of why people leave when, and it explains, you know, in that first week for example; that’s very different reasons such as this job is not what I thought it was or maybe somebody is eating their young. We all have seen that happen. So those kinds of reasons typically happen right at the beginning of somebody coming in and it could be detrimental to their success and our success of keeping them. Versus someone who leaves after a few months, typically that it’s going to be more related to the relationship on the team, the relationship with the boss, possibly even that they are looking for opportunities for advancement at that point. Which 20 plus years ago, we would’ve said, well, you’ve only been here six months and you think you should have a mentor or be a mentor or get promoted already. But today things go so quickly that we need to think about that. 

So of course on a future episode, we’re going to talk quite a bit about advancement and opportunities to advance, even when a promotion isn’t available. But I want you to think about, go back and look at exit surveys, look at your employee surveys, the satisfaction surveys, and engagement surveys that you’ve done and really think about why people leave when. And then go to, download that free document of why people leave when and really start to analyze some of those major exit routes, right? When people are escaping, is it in those first 30 days? Is it three to six months? Is it 18 months? That type of thing, because then we can start to close up those doors a little bit more, close up those escape routes, focus on the people in those very sensitive times when they might escape and we can learn to keep them longer.

So I hope you’ve learned a few things to think about and to go analyze. On our next contributor Wednesday episode, I’m going to dive into the cost of turnover, the impact on the business, how to improve the risk management side of things. By getting more staffing stability, not to mention improving continuity of care and quality of care, and really how to make the case for getting more retention resources and a focus from your entire senior leadership team on spending the dollars and the hours upfront in order to reduce turnover later. So that’s what we’re going to dive into on the next episode that I’ll be doing next month. But remember if you’re impatient and you want to learn the strategies immediately, you can always grab a copy of my book, “Staying Power: Why Employees Leave and How to Keep Them Longer” on Amazon. Thanks so much for listening to this week’s BTG Contributor Wednesday, and don’t forget to connect with me and all the other contributors at

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CW Ep. 34: Cara Silletto