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• Volume 13, Issue 5
• Turnover intention among healthcare workers in Ethiopia: a systematic review and meta-analysis
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• http://orcid.org/0000-0003-0960-3759 Amanuel Yosef Gebrekidan 1 ,
• Eskindir Yilma Enaro 1 ,
• http://orcid.org/0000-0002-6347-8648 Gedion Azeze 2 ,
• Getachew Asmare Adella 1 ,
• Gizachew Ambaw Kassie 1 ,
• Kirubel Eshetu Haile 3 ,
• http://orcid.org/0000-0001-5226-1200 Yordanos Sisay Asgedom 1
• 1 School of Public Health, College of Health Sciences and Medicine , Wolaita Sodo University , Sodo , Ethiopia
• 2 Department of Midwifery, College of Medicine and Health Sciences , Hawassa University , Hawassa , Ethiopia
• 3 School of Nursing, College of Health Sciences and Medicine , Wolaita Sodo University , Sodo , Ethiopia
• Correspondence to Mr. Amanuel Yosef Gebrekidan; amanuelyosef77{at}gmail.com

Objective To determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia.

Design A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Data sources Electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar were searched to identify studies published in the English language before 31 December, 2021.

Eligibility criteria Studies were included with following criteria: (1) studies conducted or published until 31 December 2021; (2) observational studies; (3) Studies conducted on healthcare workers; (4) reporting turnover intention; (v) studies conducted in Ethiopia and (vi) tudies published in the English language were included.

Data extraction and synthesis Three independent reviewers screened all the papers for eligibility criteria. Data were extracted by two independent investigators using a standardised data extraction format. Random effects model meta-analysis using STATA V.14.0 statistical software was conducted to estimate the pooled prevalence of turnover intention with 95% CI. Funnel plot and Forest plot were used to check publication bias and heterogeneity between studies, respectively. Leave-one-out sensitivity analysis was done.

Primary outcome Prevalence of turnover intention.

Result A total of 29 cross-sectional studies with 9422 participants met the inclusion criteria. The estimated pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93; p value <0.001, I 2 =93.5%).

Conclusion The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia. The Government and policy makers should come up with different mechanisms including a wide variety of healthcare workers retention strategies in order to reduce turnover intention of healthcare workers and retain them.

• HEALTH SERVICES ADMINISTRATION & MANAGEMENT
• Human resource management
• Organisation of health services

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Additional data will be made available on request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2022-067266

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Strengths and limitations of this study

This systematic review and meta-analysis included the different types of health professionals, making it easier for comparison and understanding of the overall situation.

As a limitation, this systematic review and meta-analysis includes cross-sectional studies reporting proportion of turnover intention only. Studies reporting turnover intention using different measurements are not included.

This systematic review and meta-analysis also has not assessed for associated factors of turnover intention.

Even though a wide range of search strategies were included to find relevant research articles, some grey literatures might have been missed.

Introduction

Job-related turnover intention, also known as intention to leave, can be defined as an employee’s intention to voluntarily change jobs or companies. 1

Human resources for health are a critical pillar and a major building block of any health system, and the ability of a country to meet its health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organising and delivering health services. 2

Shortage of healthcare workers, job-related turn over and turnover intention are imposing a challenge in achieving health and health-related goals. 2 3

Despite the fact that healthcare workers affect how all other resources in health are used, many countries, however, lack the human resources needed to deliver essential health interventions for a number of reasons including migration of health workers within and across countries being one. 2 3

Healthcare workers turnover is considered a major cause of healthcare workers shortage, representing problems for healthcare system,which has healthcare workers as one of the building blocks in terms of both quality and cost of care for patients, as a result, loss of healthcare workers by carrier change, out migration, turn over, retirement or death can cause inadequate number and skill mix in a health system. 3 4

Turnover intention is the strongest practical predictor variable of actual turnover, thus it should be taken seriously because it will influence the overall care performance and can lower down efficiency. 4 5

A WHO and Global health workforce alliance 2013 report indicates that 100 countries around the globe fall below 34.5 skilled health professionals per 10 000 population. In addition, 83 countries (44.6%) do not currently meet the 2006 World Health Report threshold of 22.8 skilled health professionals per 10 000 population. 6

Different studies conducted across the globe showed varied prevalence of turnover intention among different categories of healthcare workers. Global prevalence of turnover intention rate among general practitioners was found to be 0.47 while a systematic review conducted on pharmacists turnover intention revealed that turnover was found to be 13%–61.2%. 7 8

Systematic review and meta analyses conducted in China about the turnover intention of primary healthcare workers and a systematic review conducted about nurses’ turnover intention in sub-Saharan Africa showed a pooled turnover intention prevalence of 30.4% and 50.47% respectively. 9 10

Compared with other countries, availability of front line healthcare workers and supportive staff is relatively poor in Ethiopia with the overall health professionals to population density being 1.63 per 1000. 2 11 Ethiopia still has low healthcare workers to population ratio. In addition to this problem, retaining those healthcare workers is a major problem with evidences showing that quarter of doctors (as measured over the first 50 years of medical education in Ethiopia) leaving the country or profession. 2

Even though enhancing staff motivation and retention is one of the strategic objectives of the human resource for health strategic plan of Ethiopia, Ethiopia has not reached the proposed 2.3 healthcare workers to 1000 population ratio. 11 Many recent studies in Ethiopia show that there is a high turnover intention in Ethiopia, indicating a turnover intention of 39% in four developing regions of Ethiopia up to 83% in Sidama region. 12 13

Despite the fact that there are many studies conducted on turnover intention among healthcare workers in Ethiopia, the findings show discrepant results. The lowest finding on turn over intention being 39% and the highest was 83%. 12 13 We, therefore, conducted a systematic review and meta-analysis to determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia by extracting relevant data from the available scientific studies.

Research question: what is the pooled prevalence of turnover intention among healthcare workers in Ethiopia?

Study design and reporting

A systematic review and meta-analysis of observational studies was conducted on turnover intention among Ethiopian healthcare workers. All studies on turnover intention among Ethiopian healthcare workers published up to 31 December 2021 were retrieved using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 14 ( online supplemental file 1 ).

Supplemental material

Search strategy.

We conducted a systematic and comprehensive search in the electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar to identify all the relevant observational studies on Turnover intention among healthcare workers in Ethiopia up to 31 December 2021. EndeNote referencing manager V.20 was used for downloading, organising and citing articles. To find additional potentially applicable studies, a manual search was conducted using reference lists of retrieved articles. Studies were confined to English language publications. The search was carried out using the following key words: ‘prevalence’, ‘turnover intention’, ‘intention to leave’, ‘attrition’, ‘healthcare workers’, ‘health professionals’ and ‘Ethiopia’. The search terms were used separately and in combination using ‘OR’ or ‘AND’ ( online supplemental file 2 ).

Studies that assessed the prevalence of turnover intention among healthcare workers in Ethiopia were considered relevant. Our imposed search limits restricted studies to those that were observational in nature, published in the English language and involving human subjects. The PubMed search engine with Medical Subject Headings and Boolean operators were used to search the Medline database.

Eligibility criteria

Studies were included if they fulfill the following criteria: (1) study period: studies conducted or published until 31 December 2021, (2) study type: observational studies (cross-sectional), (3) population: studies conducted on healthcare workers, (4) outcome; turnover intention (proportion), (5) place of study: studies conducted in Ethiopia and (6) studies published in the English language. Review articles, case series, case reports and letters to editors were excluded.

Study selection and extraction

Retrieved studies were imported into EndNote (V.20, for Windows, Thomson Reuters, Philadelphia, Pennsylvania) and duplicated studies were removed using the EndNote software(106) and manually. Three independent reviewers (AYG, GAA and KEH) screened all the papers for eligibility criteria: first, abstract and title were screened and then, full text were screened. Data were extracted by two independent investigators (EYE and YSA) using a standardised data extraction format prepared in Microsoft Excel. The two independent investigators were blinded to any study data before the extraction process. Variables included: first author’s name, year of publication, region, study design, total sample size, prevalence of turnover intention and quality rating ( figure 1 ) ( table 1 ).

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PRISMA flow diagram of the selection process of studies on turnover intention among healthcare workers in Ethiopia. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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Characteristics of the 29 studies included in the systematic review and meta-analysis of turnover intention among healthcare workers in Ethiopia

According to the PICO statement: Population: Healthcare workers in Ethiopia; Intervention: Studies exploring turnover intention; Comparison: Studies reporting turnover intention in healthcare workers outside Ethiopia; Outcome: Proportion of turnover intention.

Quality assessment

After the full-text review, three authors (AYG, GAK and YSA) assessed the article’s quality by using Newcastle-Ottawa Quality Assessment Scale (adapted for cross sectional studies). 15 Any disagreements were resolved by discussion and consensus. We used the following items as criteria for an appraisal: (1) representativeness of the sample (maximum score=1), (2) sample size (maximum score=1), (3) non-respondents (maximum score=1), (4) ascertainment of the exposure (risk factor) (maximum score=2), (5) the subjects in different outcome groups are comparable, based on the study design (maximum score=2), (6) assessment of the outcome (maximum core=2), (7) statistical test (maximum score=1). Articles with a score of ≥5 of the quality assessment checklist criteria showed a study with low risk and those studies were included in the systematic review and meta-analysis. No study was dismissed after the quality rating ( table 2 ).

Methodological quality assessment of included studies using the Newcastle-Ottawa quality assessment scale

Statistical analysis

The data were analysed using STATA V.14.0 software (StataCorp, College Station, Texas). I 2 statistical test was computed to check heterogeneity across studies. I 2 values of 0%, 25%, 50% and 75% were assumed to represent no, low, medium and high heterogeneity, respectively. Since significant heterogeneity was detected between studies, a meta-analysis using a random effects model was conducted to estimate pooled prevalence with 95% CI. A Forest plot was used to present results of the meta-analysis. Egger’s test was used to check for the presence of publication bias and any potential publication bias was specified by visual inspection of the funnel plot. We also conducted a leave-one-out sensitivity analysis to identify the main studies that exert the most crucial impact on between-study heterogeneity. The analysis was done to evaluate the effect of each study on the pooled estimate of turnover intention among healthcare workers by excluding each study step-by-step.

Patient and public involvement

There was no involvement of patients and public.

A total of 2109 articles were retrieved that had been published before 31 December 2021 using the electronic databases. Of 107 articles were deleted due to duplication. Of the remaining 2002 articles, 1679 were removed by title and abstract and additional 91 articles were not retrieved, while 232 were read in full and assessed for eligibility. Finally, 29 studies with a total of 9422 healthcare workers met the eligibility criteria and were entered into the meta-analysis process ( figure 1 ).

Characteristics of included studies

Among the 29 included studies, 9 were from Amhara, 16–24 8 were from Oromia, 25–32 3 were from Addis Ababa, 33–35 2 studies each from Tigray, 36 37 Sidama, 13 38 multiregional 12 39 and Nationwide 40 41 and one study was from Gambella. 42 The study from Sidama region 13 documented the highest prevalence (83.7%) of turnover intention among health professionals, while the lowest prevalence (39%) was documented from a study conducted by including the three regions of Afar, Gambela and Benishangul Gumz. 12 Twelve studies included a mixed variety of health professionals in general, 13 17–19 25 27 28 30 32 34 35 42 while 10 other studies included nurse professionals only. 20 22 23 26 31 33 36–38 40 Two studies included health extension workers 16 29 and five studies each included physicians, 39 health information technology professionals, 24 anaesthetists, 41 medical laboratory professionals 21 and midwives, 12 respectively. Table 1 summarises the characteristics of the included studies.

Pooled prevalence of turnover intention among healthcare workers in Ethiopia

The pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93). The forest plot below shows a statistically significant heterogeneity (I 2 =93.5%; p<0.001) ( figure 2 ). Therefore, we estimated the pooled prevalence by using random effects models. In addition, due to the significant high magnitude of the heterogeneity, subgroup analysis was conducted to identify the sources of heterogeneity across the studies.

Forest plot for pooled prevalence of turnover intention among healthcare workers in Ethiopia.

Sub group analysis

In this meta-analysis, subgroup analysis was conducted based on study area (regions) and study population to identify possible source of heterogeneity. Regarding the pooled prevalence by region, the highest pooled prevalence of turnover intention was reported in Sidama regional state 66.93% (95% CI 33.9 to 99.95), and the lowest turnover intention was documented in studies involving multiregional study areas 47.5% (95% CI 42.45 to 52.55) ( table 3 ).

Subgroup analysis for the pooled prevalence of turnover intention among healthcare workers in Ethiopia

In addition to subgroup analysis based on study area (region), the subgroup analysis by study population also indicated that the pooled prevalence of turn over intention was high among medical laboratory professionals 65.5% (60.42% to 70.58%) followed by health information technology professionals 64.8 (56.33 to 73.28). The lowest turn over intention was documented in Midwives 39.0 (29.76 to 48.24) ( table 3 ).

Meta-regression

Meta-regression was performed by considering continuous variables to identify associated factors with the pooled prevalence of turnover intention among healthcare workers. Sample size and years of publication were considered in the meta-regression. However, the meta-regression indicated that there was no significant association between pooled prevalence of turnover intention among healthcare workers with years of publication and sample size ( table 4 ).

Meta-regression to identify source of heterogeneity for the pooled prevalence of turnover intention among healthcare workers in Ethiopia

Publication bias

Graphical distribution of the Funnel plot shows no evidence of asymmetry ( figure 3 ). The result of the Egger’s test was also statistically non-significant with coefficient=−0.029, 95% CI (0 to 0.16 to 0.10) and with a p value of 0.66 ( table 5 ).

Funnel plot for publication bias for systematic review and meta-analysis of turnover intention among health care workers in Ethiopia.

Test for funnel plot asymmetry (Egger’s test) of turnover intention among healthcare workers in Ethiopia

Sensitivity analysis

Leave-out-one sensitivity analysis.

The leave-out-one analysis was done to evaluate the effect of each study on the pooled prevalence of turnover intention of healthcare workers in Ethiopia by excluding each study step-by-step. The results showed that the excluded studies did not make any significant difference in the pooled estimate of turnover intention of healthcare workers in Ethiopia ( figure 4 ).

Sensitivity analysis of pooled prevalence for each study being removed at a time for systematic review and meta-analysis of turnover intention among healthcare workers in Ethiopia.

This systemic review and meta-analysis was aimed at estimating the pooled prevalence of turnover intention among Ethiopian healthcare workers. This study revealed that, from 29 included studies, the pooled prevalence of turnover intention among Ethiopian healthcare workers was found to be 58.9% (95% CI 54.24 to 61.93). This finding indicates that more than half or one in two healthcare workers have intention to leave their current job.

The result of this study is similar with findings documented in a study considering job satisfaction and turnover intentions among healthcare staff providing services for prevention of mother-to-child transmission of HIV in Dares Salaam, Tanzania with a reported turnover intention of 54% 43 and medical doctors turnover intention in Iraq, which was reported to be 55.2%. 44 This might be due to similar working conditions such as most healthcare workers working in the government sector, low wage and compensation and low job satisfaction.

However, the finding of this study is higher than the studies conducted in sub-Saharan Africa (51.96%), 10 Saudi Arabia (40%), 45 China (30.4%), 9 Iran (32.7%) 46 and Taiwan (14.5%). 47 This can be explained by the difference in sociodemographic and economic status, wages and compensation and difference in study population in which most of the studies took a single type of health profession as a study population while this study took a wide mix of healthcare workers.

The pooled prevalence of turnover intention in this systematic review and meta-analysis is lower than the result documented in Ghana, which reported a turnover intention of healthcare workers to be 69%. 48 This might be due to the status of low job satisfaction and carrier development chances reported in Ghana. The finding of this systematic review and meta-analysis also indicates a lower pooled prevalence of turnover intention compared with a study conducted about Nurse Managers’ turnover intention in US Hospitals with a reported turnover intention of 72% in the next 5 years. 49 This can be explained by the reported burnout, career change, retirement and promotion demands of the nurse managers. The finding of this study also indicates a low pooled prevalence of turnover intention compared with a study conducted about turnover intentions of psychiatric nurses in China with a reported turnover intention of 72%. 50 This may be a result of the increasingly demanding, risky and unpredictable nature of the work that psychiatric nurses perform; these nurses have reported higher levels of workplace stress than normal ward nurses.

The subgroup analysis of this systematic review and meta-analysis showed that there is significant difference of turnover intention across different regions of Ethiopia. Regarding the pooled prevalence by region, the highest pooled prevalence of turnover intention was reported in Sidama regional state, 66.93% (95% CI 33.9 to 99.95) and the lowest turnover intention was documented in studies involving multiregional study areas 47.5% (95% CI 42.45 to 52.55). The possible explanations for these variations might be due to inclusion of single type of healthcare workers as a study population and the few number of studies conducted in Sidama region.

Conclusion and recommendation

The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia with one in two health professionals showing intention to leave their current job. This finding is higher compared with most other countries. This finding shows an alarming problem, which can be a future determinant of high turnover since intention to leave is an immediate predictor of turnover. The government and policymakers should come up with different mechanisms, including a wide variety of healthcare workers’ retention strategies, so as to reduce the turnover intention of healthcare workers. Further meta-analysis should also be conducted to identify associated factors of turnover intention.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

We would like to forward our deepest gratitude to all authors and study participants of the studies included in this systematic review and meta-analysis.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2

Contributors AYG: conceived and designed the study, methodology, data analysis and interpretation and writing original draft. GAK, YSA, EYE, GAA, KEH and GAA: established the search strategy, extract the data, and assess the quality of included studies. All authors participated in software, writing review and editing of the manuscript. All the authors read and approved the manuscript. The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Understanding the Causes of High Labor Turnover and Absenteeism in the Ethiopian Textile and Garment Industry: Interviews with (Female) Workers and Management Personnel

• First Online: 24 November 2023

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• Michaela Fink 5  

Part of the book series: Sozialwissenschaftliche Zugänge zu Afrika ((SZA))

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This chapter presents findings of a study on the Ethiopian textile industry with regard to the perceived major causes of absenteeism and turnover by both workers and management personnel. The findings premarily (derive) from qualitative data obtained through interviews. Interviews with female operators and human resource managers revealed mostly opposing views when explaining high rates of turnover and absenteeism: While the majority of the female workers interviewed blamed the mismatch between low pay and high workload, managers often referred to the workers’ ‘mindset’ and their ‘poor work ethic’s. The chapter highlights that effective measures to reduce employee turnover and absenteeism need to take both perspectives into consideration. The chapter concludes with actor-based recommendations for workforce stabilization.

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The BMZ supports the creation of fair and sustainable jobs in Ethiopia’s industrial parks through its project titled ‘Promoting Sustainable Growth in the Textile and Garment Industry in Ethiopia’ (eTex I). The project is aimed at job-effective growth, and improving the social and environmental sustainability of the textile and garment industry. The project was implemented from 2016 to 2020 by the German Corporation for International Cooperation (GIZ) GmbH in close collaboration with its political partners. BMZ’s efforts are currently being continued under the GIZ’s Sustainable Industrial Clusters (S.I.C.) project (2021–2024). S.I.C. is co-funded by the United Kingdom Foreign, Commonwealth & Development Office (FCDO) and continues to promote decent jobs and sustainable growth in Ethiopia’s manufacturing sector.

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Fink, M. (2023). Understanding the Causes of High Labor Turnover and Absenteeism in the Ethiopian Textile and Garment Industry: Interviews with (Female) Workers and Management Personnel. In: Gronemeyer, R., Fink, M. (eds) Industrialization in Ethiopia: Awakening - Crisis - Outlooks. Sozialwissenschaftliche Zugänge zu Afrika. Springer VS, Wiesbaden. https://doi.org/10.1007/978-3-658-41794-9_2

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The Impact of Employee Turnover on Organizational Performance: A Case Study of Mada Walabu University, Bale Robe, Ethiopia

This research focuses on the impact of staff turnover on organizational effectiveness and performance in Mada Walabu University. High staff turnover rates may jeopardize efforts to attain organizational objectives. In addition, when an organization loses a critical employee, there is a negative impact on innovation, consistency in providing service to primary users may be jeopardized and major delays in the delivery of services to customers may occur. The research design used in this study was the descriptive approach, which allowed the researcher to use semi-structured questionnaires when collecting data. The survey method used in this study because the target population only composed of 425 employees. The study employed Purposive, Simple Random sampling and Convenience sampling techniques. A high response rate of 100% obtained using the personal method of data collection; questionnaire structured in a 5-point Likert scale format. Furthermore, the study interviewed human resource head and ten voluntary employees by convenient sampling techniques. The study finding suggests that high labor demand and job opportunities in the market, lack of opportunity for career advancement in the organization, Unsatisfied with working condition and no involvement in decision-making, are the foremost causes of employee's turnover on organizational performance. The study finding also showed that staff turnover causes loss of some of the very experienced and skilled employees, reduction in work productivity and quality of services rendered as well as it causes too much wastage of resources when new staff settles and lose public confidence in the operation of the organization. In order to return the reduced university's capacity in terms of national attrition rates, higher education access target, quality education assurance, significant community and technology transfer and standardized research-based problem-solving culture due to staff turnover.

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How retailers can attract and retain frontline talent amid the Great Attrition

High attrition in retail is nothing new: annual employee turnover among frontline retail workers has been at least 60 percent for a long time. Retailers regularly face the challenge of replacing more than half of their store staff every year. But that challenge has grown amid record inflation and a continuing global pandemic: half of frontline retail employees are considering leaving their jobs in the next few months alone. Perhaps worse, 63 percent of frontline retail managers are thinking about quitting in the near future. And many of them do not want to work in retail anymore.

No other US industry is more affected by the “ Great Attrition ” than retail, simply because it employs more people than any other sector in the US economy. The following six charts show highlights from our research involving more than 1,000 US frontline retail workers  across a range of retail formats, including grocery retailers, big-box stores, department stores, restaurants, convenience stores, and other small formats. These charts illustrate the attrition problem  in US retail—but also point the way to potentially powerful solutions.

By understanding what frontline workers want in a job, retailers can create a competitive advantage. Our research shows that frontline employees at the leading retailers are twice as motivated in their day-to-day jobs and leave half as often. At the best frontline retail employers, comparative-store sales are three percentage points higher than at low performers. If retailers simply continue business-as-usual approaches to hiring and retention, they risk chronic staffing shortages for the rest of 2022 and beyond. Attracting, developing, and retaining frontline talent must become a top agenda item for retail CEOs.

The biggest workforce. Around 20 percent of US employees—or approximately 31 million people—work in the retail and hospitality sector. That is approximately 9 million more employees than in each of the two next-largest industries (the public sector and professional and business services). The sheer size of the retail workforce means that the decisions and actions of retail employees affect not just the companies they work for but the broader US economy as well. Unfortunately, as the next chart shows, the retail industry struggles to retain frontline workers.

A mass exodus. The retail and hospitality sector faces a much more serious retention challenge than any other sector. The “quit rate” in US retail and hospitality is the highest among sectors and is outpacing the overall US quit rate by more than 70 percent. Frontline retail employees are recognizing that they have more employment options—and more tools to access those options—than ever before.

Will they stay or will they go? The exodus shows no signs of slowing, especially when we zoom in on retail’s front lines. Almost half of all frontline retail employees—compared with only 38 percent of US workers overall—are considering leaving their jobs in the next few months. Perhaps more concerning, nearly half of the frontline retail employees who want to leave their current jobs plan to seek employment outside the retail sector. Retailers are competing not only with each other for frontline talent but also with other industries and nontraditional work options.

What workers want. “Not enough workplace flexibility” is the number-one reason frontline retail workers are considering leaving their jobs. No other industry’s employees rank lack of flexibility as the top driver of attrition. Ironically, the nature of frontline retail work makes offering flexibility quite challenging. Can retailers create a more flexible workplace for store staff? The best frontline retail employers are innovating to do so—for example, by offering shift swapping among peers and more autonomy for employees to decide what role they would like to play in the store on any given day. Flexibility can take many forms, and different flexibility features resonate among various talent pools.

Like workplace flexibility, “health and well-being” was ranked more highly in frontline retail (where it was the third-most-cited factor) than in any other sector we studied. Similarly, employees from only one-third of other sectors ranked “meaningful work” more highly than frontline retail employees did (number five).

Rounding out the top five for frontline retail are two factors that matter in nearly every sector we have researched: career development (number two) and compensation (number four). Two other factors ranked closely behind the top five: supportive colleagues and inspiring leaders.

How to support managers. Frontline retail employees are a diverse population, with varying needs and levels of satisfaction. For instance, we found much higher risk of attrition among managers: they are 1.75 times likelier than nonmanagers to consider leaving their jobs (63 percent versus 36 percent).

The gap is stark, so we dug into what matters to managers versus nonmanagers and found important differences. Flexibility is even more important to managers, for example. Nonmanagers, on the other hand, overindex on career development, compensation, health and well-being, and inspiring leadership—all attributes that managers influence. Retailers will therefore need a significant improvement in manager satisfaction to be able to create the workplace environment that nonmanagers desire.

Differences among demographic groups. Among age groups, frontline retail employees 35 and older are most likely to consider leaving their jobs in the near term. Much like in our analysis of managers and nonmanagers, we found key differences in what matters among age groups. The top driver of attrition for employees under 35 is a lack of career development, which ranks as only the fifth most important factor for employees 45 and older. Meanwhile, a lack of supportive colleagues (which, in our research, included aspects such as feeling unfairly treated, feeling overworked, or working with unreliable people) is the most important factor for those 45 and older, but falls to only the eighth most important for those under 35.

In US frontline retail, women are as likely as men to consider leaving their jobs in the coming months but cite different reasons. Women are more likely to point to a lack of inspiring leadership as a reason to leave, while men more often point to poor career development. Flexibility matters to both men and women.

This research complements our experience working alongside leading frontline retail employers. Our findings suggest four imperatives for retailers:

• Understand your frontline talent pools and build a distinctive employee value proposition. The frontline retail workforce is large and includes a diverse set of workers with a wide range of needs. Retailers must identify the talent pools that fit best with their company, determine what matters to those segments of workers, and develop an employee value proposition tailored to the unique needs of those employee segments.
• Innovate to offer differentiated flexibility. While office workers have seen an increase in flexible work, flexibility remains the most pressing issue for frontline retail employees. In pursuit of more flexibility, many have left traditional frontline jobs to take on gig work. Retailers must think more creatively about how to offer flexibility on the front lines—for instance, by providing options for employees to increase or decrease their hours to accommodate their other part-time jobs, allowing them to work at other store locations on certain days, and giving them more control over how their work gets done.
• Simplify frontline retail jobs and make them more engaging. A lack of meaningful work (boring or repetitive work, work with little social impact, or work with no connection to the mission of the organization) is a top five driver of frontline retail attrition. The most innovative frontline retail employers are investing in technology to automate activities, freeing up time and energy for more meaningful roles in the store. Retail leaders should assess frontline employees’ most mundane activities and look for ways to simplify them, which can improve productivity and help make the job more attractive.
• Invest to build strong managers and a development culture. Managers are not satisfied—they are inclined to leave their frontline retail jobs at a 75 percent higher rate than nonmanagers. Yet managers are the foundation for any improvement in frontline retail attrition. Factors in managers’ control, such as inspiring leadership and career development, matter a lot to nonmanagers. Managers can offer on-the-ground perspective to help retailers design a new employee experience. Retailers also need to rely on managers to lead the execution of any new employee strategy. Clearly, the importance of investing in the manager role cannot be overstated; it will have a cascading impact on the rest of the organization.

We expect competition for frontline retail talent to remain intense, which will spur a wave of innovations in employee experience. The best retail employers will create a new competitive advantage: a highly engaged frontline workforce that significantly improves customer experience and financial performance. More than 30 million retail workers stand ready to benefit from it.

David Fuller and Aneliya Valkova are associate partners in McKinsey’s Chicago office, where Bryan Logan is a partner and Pollo Suarez is a consultant.

The authors wish to thank Bonnie Dowling, Marino Mugayar-Baldocchi, Laura Pineault, Jane Qu, Arjun Singh, and Hang Yang for their contributions to this article.

This article was edited by Monica Toriello, an executive editor in the New York office.

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