Background: Retention of respiratory therapists (RTs) has been a major challenge across the nation. The prevailing approach is to apply linear thinking which reduces the problem and its solution to additive parts, such as increasing pay rates. This mode of thinking does not adequately consider the characteristics and influences of the containing system, the many elements within the problematic organizational system or their interdependencies and interactions. Retention may be better framed as a complex system problem wherein organizations are social systems which include members and groups who collaborate within and between social sub-systems (Figure 1). In this project, retention of RTs is framed as a complex system problem that requires a complex system thinking approach to frame, navigate, and solve. Methods: Navigating complex systems problems requires systems-informed methodologies and tools. This project utilized the Cynefin Framework to frame the problem and interactive planning and idealize design to develop a prototype to solve or dissolve the problem. Interactive planning is a methodology where the problem’s stakeholders creatively design a new system for RT retention based on what is viable, feasible, and desirable. The process generates elements of a prototype design in which current and future challenges of RT retention would not occur. Using an influence-interest matrix, 70 stakeholders from Thomas Jefferson University Hospital were identified and invited to participate in a volunteer workshop. The research was considered exempt by Jefferson IRB. Results: Of those contacted, 24 responded positively, and 14 attended a workshop facilitated by three systems-educated practitioners. The data that emerged from the design session were collected and coded which created 27 codes and 8 code. Data were categorized into the following: Mission Statements, Value Propositions, Functions/Outputs, Processes, Structure, and Financial. Conclusions: An iterative model for the ideal RT retention system emerged (Figure 2). The system was designed to evolve and adapt in cycles based on the changing environment which will influence subsequent iterations of the system. The components are interconnected and interdependent rather than linear and additive. Critical elements of culture, professional development and educational partnership rarely part of a traditional retention system were identified and integrated.
Juby et al. (Sun,) studied this question.