Explorer Exploring the relative importance of factors that influence the job retention of social care staff working in intellectual disability services

Background: High staff turnover presents a challenge to the provision of good qual ity community-based support to people with an intellectual disability. While recent research has identified factors that are thought to be important for staff retention, their relative importance to social care staff is unknown. The aim of this study was to address this gap. Methods: 205 social care staff who worked in intellectual disability services com pleted an online questionnaire that asked them to: rank factors that had been previ ously identified as influencing staff retention in order of importance; identify the extent to which their most important factor was met by their organisation (fulfilment score); and rate their recent job-seeking intentions.


Accessible summary
• We wanted to find out what would help care staff to stay in their jobs.
• The most important thing for them was getting on well with the person they supported.
• The next most important thing was their pay.
• These results can be used to find ways to help staff stay in their jobs.
• This is important to make sure that people with a learning disability get good support.

Abstract
Background: High staff turnover presents a challenge to the provision of good quality community-based support to people with an intellectual disability. While recent research has identified factors that are thought to be important for staff retention, their relative importance to social care staff is unknown. The aim of this study was to address this gap.
Methods: 205 social care staff who worked in intellectual disability services completed an online questionnaire that asked them to: rank factors that had been previously identified as influencing staff retention in order of importance; identify the extent to which their most important factor was met by their organisation (fulfilment score); and rate their recent job-seeking intentions.

Findings:
The most important factor overall was the relationship of the staff member with the person they supported. This was also identified as the most important factor by the most participants, followed by pay. All of the factors, with the exception of "benefits" (such as pensions), were rated by at least one person as the most important factor. A significant negative relationship was found between fulfilment score and job-seeking score; that is, the lower the former, the more the person agreed that they had been seeking a new job.

| INTRODUC TI ON
There is an increasing need for a competent and stable social care workforce to meet the policy objectives of providing good quality care to people with an intellectual disability in community settings (NHS England, 2014 Poor retention can have a significant negative impact at all levels of care provision. It can have a negative effect on the consistency and quality of care of people with an intellectual disability (Stevens et al., 2019). It can reflect negative staff experiences, with high turnover rates being found to be associated with high levels of staff stress and burn-out (Leoni et al., 2020). It can also be expensive for the employing organisations, which have to meet the costs of recruiting and training new staff.
As has been noted (NHS England, 2017), the most cost-effective way to ensure that staffing requirements are met is to retain the staff who are already employed. There is, however, only limited evidence-based guidance to help social care providers decide what the best retention strategies are to use. Moriarty et al. (2018) conducted interviews and surveys with stakeholders who represented the wider social care sector and identified a number of factors that were thought to be related to poor recruitment and retention. These were thought to be related to retention, were perceived as important to staff and did actually influence retention. Indeed, the authors note that much of the literature in this area was anecdotal and there was a dearth of robust evaluations of evidence-based interventions to improve retention. Without this information, it is difficult for organisations to know which areas to prioritise when trying to address high turnover rates.
As a first step in addressing this gap, the aim of the present study is to explore which of the areas identified in the literature review conducted by McKenzie et al. (2020) are considered to be the most important by staff working in social care settings with people with an intellectual disability. A second aim is to explore whether there is a significant association between the extent to which the areas that are rated as important by participants are met by their organisations and the extent to which participants have been actively seeking another job. It is hypothesised that there will be a negative relationship between the two; that is, the less the important areas are met by the organisation, the greater the likelihood of the person having been actively looking for another job.

Conclusion:
The results suggest that interventions to improve staff retention should take account of differences in staff views about which work-related factors are most important to them; use multi-component approaches where possible; prioritise staff pay; and help ensure that staff relationships with those they support are positive and fulfilling.

K E Y W O R D S
intellectual disability, social care, staff retention 2 | ME THOD

| Design and ethics
The study used a correlational, observational design. Ethical approval for the study was provided by the first author's university ethics committee. Data are available on request from the corresponding author.

| Participants
A total of 205 participants took part, 139 (67.8%) of whom were female and 66 (32.2%) of whom were male. Participant's ages ranged from 18 to 71 years, with a mean of 39 years (SD = 11.1). The majority of participants reported their ethnic origin as being white British or white other (n = 198, 96.6%), with only 7 people (3.4%) being coded as "other." In terms of qualification, 48 participants (23.5%) had no formal qualification, 113 (55.4%) had a school level qualification, 37 (18.1%) had a vocational qualification, and 6 (2.9%) had a postgraduate qualification. Sixty-eight (33.3%) participants held a managerial role, 105 (51.5%) were support workers or day service workers, and 31 (15.2%) held another type of role, for example senior coordinator.
Participants could take part in the study if they were aged 18 years or older, worked in a relevant role, such as support worker, in a social care setting with people with an intellectual disability and provided informed consent.

| Materials
Participants were asked to complete an online measure which was designed for the purposes of the study. This first section asked them to provide some basic demographic information. Following this, they were asked to indicate the extent to which they agreed that they had been seeking a new job in the previous three months (job-seeking score). This was rated from "completely disagree" = 1, to "completely agree" = 7.
The areas that had been identified in a previous review (McKenzie et al. 2020) as being likely to be important to staff retention were then presented. Participants were asked to rank each one in order of importance to them in their work. The rankings ranged from 1 to 13, with lower numbers indicating that the factor was of greater importance.
Participants were then redirected to a section of the questionnaire according to their top ranked area, for example, those who ranked "pay" as number one, would be presented with statements about pay. Participants were asked to indicate the extent to which they agreed with the statements which were specifically related to the item that they had ranked as being most important to them. As an example, those who chose "communication" would be asked to rate items such as: "Team debriefing should occur after a difficult shift" and "new staff should have increased contact with their line managers." Ratings ranged from "Definitely agree" = 5, to "Definitely disagree" = 1. The statements relating to each area were drawn from a previous review of published and grey literature and relevant websites, in relation to staff retention (see McKenzie et al. 2020). TA B L E 1 Mean ranking for each area, the number of times each area was rated as the most important and the mean rating of the extent to which each area was fulfilled by the participants' organisation Factor Ranking (lower number indicates higher importance) Participants were then asked to rate the extent to which their organisation currently fulfilled the action or recommendation outlined in the statement. Ratings ranged from "Fully fulfilled" = 5 to "Unfulfilled" = 1. In order to take account of the fact that some areas had fewer associated statements than others, the "agree" rating for each item was multiplied by the "fulfilled" rating for each statement. These were summed and divided by the number of statements to give an average score. This reflected the overall extent to which the participants' organisations met their expectations in respect of the area that they rated as being most important in their work (fulfilment score). A higher score indicates greater fulfilment of items that were viewed as important (possible range 1-25).

| Procedure
Participants  Table 1 illustrates the mean ranking for each factor, the number of times each factor was rated as the most important and the mean rating of the extent to which each area was fulfilled by the participants' organisation. Table 2 illustrates the mean scores for "fulfilment" and "job seeking" for the sample. Pearson's correlation was conducted between the two sets of scores. This indicated a significant negative correlation between the two (r = −0.398, p < .001, n = 204).

| D ISCUSS I ON
The first aim of the study was to clarify which of those factors which were identified in the review by McKenzie et al. (2020) were most important to social care staff in their work supporting people with an intellectual disability. This was to help organisations to develop targeted interventions to improve retention that prioritise these most important areas. In respect of this aim, the factors that were rated most important overall were the relationship with the person being supported, followed by communication and morale.
Previous research has highlighted the importance of all three of these factors.
As When considering the factors that were rated by the highest number of participants as being the most important, the relationship with the person being supported was again first. This was followed by pay. The importance of pay to the retention of care staff in general (e.g. Hussein, 2017;Moriarty et al., 2018) and those supporting people with developmental disabilities in particular has been highlighted previously (e.g. Kazemi et al., 2015;Robertson et al., 2005;Stevens et al., 2019). This is perhaps unsurprising, given that social care workers generally receive low pay and pay is often seen as representing the extent to which their organisation values them (Stevens et al., 2019).
The factors that were rated least important by the participants were work-related benefits, such as pension and health care, career progression and role clarity. Despite this, all of the factors, except benefits, were rated by at least some participants as being the most important for them, suggesting that they are worth considering in interventions aimed at improving retention staff rates.
A second aim of the study was to explore whether there was a relationship between the extent to which those areas that were rated as personally important to participants were met by their organisations (fulfilment) and the extent to which participants had been actively seeking another job. It was hypothesised that there would be a negative relationship between the two. This was supported by the results, which found a significant negative correlation; that is, the less the important areas are met by the organisation, the greater the likelihood of the person having been actively looking for another job in the previous two months. While this does not TA B L E 2 The range, mean and standard deviation for "fulfilment" and "job seeking" scores or the sample

Mean (SD)
Fulfilment 4-25 16.6 (5.6) Job seeking 1-7 1.9 (1.8) mean that the person would actually leave their job in the near future, intention to leave was seen as a potential indicator of future turnover.
The results have some potential practical implications for organisations who wish to reduce staff turnover. First, while there was some degree of consensus about the main factors that were most and least important, all but one area (benefits) had at least one person rating it as the most important factor in their work. This suggests the need for organisations to consider more individually tailored approaches to reflect these potential staff differences.
Second, they may wish to consider multi-component approaches that address as many of the areas highlighted as being potentially important for staff retention as possible. If limited resources preclude such an approach, the results of the research suggest prioritising staff pay and ways of ensuring that staff relationships with those they support are positive and fulfilling. The latter may involve using approaches such as Positive Behavioural Support and Active Support to help staff to use methods that explicitly aim to improve the quality of life and personal development of people with an intellectual disability (e.g. Bigby et al., 2020;Gore et al., 2013).
The study did have some limitations, the first of which was referred to previously. While a relationship was found between "fulfilment" and "job seeking," this cannot be assumed to be causal.
Further longitudinal research is needed to address the question of whether low fulfilment can prospectively predict future staff turnover. A second limitation is that the study did not explore the reasons why staff rated certain factors in a particular way. It may be, for example, that certain factors were rated as relatively less important because they were already being addressed well in the person's organisation, so did not have the same prominence as factors that were not addressed as well. A third limitation was that the study asked participants to rank the importance of pre-identified factors relative to each other, rather than the importance of each individual factor to them. The importance of each factor in absolute terms was not, therefore, quantified. A fourth limitation is that, while the sample size was relatively large and included participants of different ages, qualifications and job roles, the majority were white and female. It may be that a sample that included more males and individuals with different ethnic backgrounds may have prioritised different factors as important in their work.
In conclusion, the current study identifies the relative importance of different areas to social care staff in their work with people with an intellectual disability. It also identifies a relationship between the extent to which these areas are fulfilled in their organisation and staff actively seeking alternative work. The results may help organisations to prioritise interventions aimed at retaining social care staff who support people with an intellectual disability.