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Nursing excellence program improves staff retention and quality, and reduces costs

Addressing the root causes of nurse attrition and absenteeism increases staff satisfaction, improves patient outcomes and saves money.


A large and complex health system with a variety of inpatient and outpatient facilities had a 20-30% rate of turnover among its nursing staff. This was extremely costly in terms of recruiting and training new nurses and at the same time, negatively affecting the quality of patient care.

The system's senior leadership team asked McKinsey to help develop a program that would address the core issues driving nurse attrition and would improve clinical quality across the system.


Working closely with the client, we evaluated information from surveys, interviews and focus groups. Two themes emerged. First, the nursing staff lacked autonomy and were not being invited to share their thoughts on how to provide patient care. Second, the nurses lacked transparency into how their work made a difference for patients or the health system.

Armed with these insights, the team developed a nursing excellence program. They visited the client’s best facilities for nursing care, as well as several hospitals internationally renowned for nursing excellence. They also scoured the clinical literature to identify cutting-edge initiatives with a proven ability to reduce attrition and improve care quality. Program elements included:

Shared governance

At all levels of the organization, the nurses were given new opportunities to provide substantive input into patient care decisions and to drive innovations in care delivery.

Performance transparency

The nurses were also given meaningful information about their work and its impact. A new performance management system was developed to track nursing-sensitive outcomes, such as patient satisfaction and clinical quality measures. These metrics gave the nursing staff better insight into how their actions were affecting the quality of care. Metrics tracking absenteeism and retention were also shared openly with the nursing staff. The data allowed nurses to serve as change agents in the transformation and allowed leaders at all levels to monitor the program’s success.

Together with the client, we developed a phased implementation plan that included a pilot study, a period of refinement and scale-up preparation, and then five waves of facility-level rollout. The rollout plan included a training and communications program to engage support from key stakeholders throughout the organization.


Over 18 months, McKinsey supported client leaders and managers as they tailored, piloted, and implemented the program in approximately 60 hospitals.

The effort resulted in significant cost savings:

  • Increased nurse satisfaction and improved retention and absenteeism rates yielded annual multi-million dollar savings in most hospitals, primarily due to reduced recruiting and training costs.
  • Better retention and a performance mindset also yielded improvements in nurse-sensitive clinical measures, such as fewer medication errors, patient falls, and patient pressure ulcers. Some units doubled their performance scores on pain management rates.

In addition, the health system now has a foundation for capturing future waves of improvement. Managers who helped with the transformation program are now trained change agents armed with the capabilities needed to sustain the current program and drive future change programs.