India’s healthcare sector keeps running into the same equation. Hospitals and home care providers hire aggressively, yet shortages on the ward and in the home refuse to ease. The reason is simple: trained professionals are leaving almost as fast as they are joining, and each exit takes experience and patient trust with it.
In this conversation with ThePeoplesBoard, Gopala Krishna Mantha, CHRO at Apollo Home Healthcare, argues that the workforce crisis is also a retention crisis. He unpacks why clinicians leave, how early signs are missed, and what employers must change on rosters, careers and supervision to keep them.
TPB Team: Why is hiring more healthcare professionals not enough to solve the industry’s workforce shortage?
Gopala: Hiring addresses the number of people who join; it does nothing about the number who leave. If an organisation hires a hundred nurses in a year and loses eighty, the shortage has barely moved, and the organisation has spent heavily on recruitment, onboarding and training only to start again.
There is a quieter cost too. Every exit takes away experience, clinical judgement and the trust a patient or family had built with that person. When attrition is high, teams stay permanently junior, and the experienced staff who remain carry the extra burden of supervising and training newcomers. That extra load pushes them towards burnout and resignation, and the cycle repeats.
So the shortage is not only a supply problem. It is equally a question of whether we create workplaces where trained professionals want to stay and grow. Retention is the most cost-effective form of hiring.
TPB Team: What are the biggest reasons healthcare professionals leave their organisations, even when demand for their skills is high?
Gopala: In my experience, people rarely leave for one reason. It is usually a build-up of smaller frustrations. The most common are an unmanageable workload and staffing ratios, rigid or unpredictable rosters that clash with family life, and the feeling of not being heard or valued.
The relationship with the immediate supervisor matters enormously. A fair, supportive supervisor can hold a team together through difficult periods; a dismissive one can drive good people away even when pay is competitive.
Career stagnation is another major factor. Skilled professionals want to see where they will be in three or five years. When they cannot see a path, they find one elsewhere, often with opportunities abroad. Pay fairness, safety concerns and emotional exhaustion complete the picture. High demand for their skills simply means that when these basics are missing, they have plenty of options.
TPB Team: How can healthcare organisations identify the early signs that employees are considering leaving?
Gopala: Resignation is usually the last step of a decision made weeks or months earlier, so the signs are visible if we look for them. Behavioural indicators include a rise in unplanned leave, frequent shift-swap requests, reduced participation in training or team meetings, less discretionary effort and a change in tone during conversations.
Data helps confirm what managers sense. Pulse surveys, patterns in attendance, declining acceptance of assignments and dips in patient feedback can all point to disengagement. Certain moments carry higher risk, such as the first ninety days, the period after appraisal cycles, and life events like marriage or relocation.
The most reliable tool, though, is the stay conversation: a regular, informal check-in where a supervisor asks what keeps the person here, what frustrates them and what might make them leave. Acting on those answers early is far more effective than making a counter-offer once a resignation letter is on the table.
TPB Team: How do workload, long shifts and emotional fatigue influence retention among healthcare workers?
Gopala: They are among the most powerful drivers of attrition, mainly because their effect is cumulative. One demanding shift is manageable; months of extended shifts, night duties and insufficient rest between them gradually erode sleep, health and family time.
Emotional fatigue adds another layer. Healthcare professionals regularly witness pain, decline and death, and absorb the anxiety of patients’ families. Without an outlet, this leads to compassion fatigue, where caring itself becomes exhausting. Tired, emotionally drained people are more likely to make errors, fall ill and disengage, and eventually they leave the employer, or sometimes the profession altogether.
Organisations can make a real difference through predictable rosters, guaranteed rest between shifts, rotating staff away from emotionally intense assignments, debriefing after difficult cases, and creating space for peer support and counselling.
TPB Team: What can healthcare employers do to retain experienced professionals instead of repeatedly hiring and training replacements?
Gopala: The first step is to recognise that experienced professionals are not just service providers; they are the organisation’s teachers and quality anchors. Retention strategies should reflect that.
Clear career pathways matter most: clinical ladders, specialist roles in areas such as critical care, palliative care or geriatrics, and mentor or preceptor roles that come with formal recognition and compensation. Continuous learning and certification opportunities signal that the organisation is investing in their future.
Pay must be benchmarked regularly and reward tenure and expertise fairly. Flexibility is equally important. Professionals at different life stages, such as parents of young children or those caring for elderly relatives, may need part-time or flexible options rather than an all-or-nothing choice. Finally, welcoming back former employees who left on good terms is a sensible way to regain experience that has already been trained.
TPB Team: How can organisations balance patient care demands with the need to protect employee well-being?
Gopala: I do not see these as competing priorities. A well-rested, supported professional delivers safer and more compassionate care, so protecting employee well-being is part of protecting patients.
In practice, it starts with staffing according to patient acuity rather than simple headcount, and maintaining a relief or float pool so absences do not automatically turn into double shifts. Sensible limits on consecutive shifts, protected breaks and transparent leave planning help staff plan their lives.
Professionals also need a safe channel to raise concerns about unsafe workloads without fear of consequences. Reducing administrative burden through better processes and technology returns time to patient care. And setting clear expectations with patients and families about the scope of services protects staff from being stretched into tasks well outside their role.
TPB Team: Do healthcare organisations give frontline employees enough attention for retention compared with doctors and senior specialists?
Gopala: Honestly, not always. Historically, retention efforts, recognition and leadership attention have tended to focus on doctors and senior specialists, partly because they are seen as harder to replace.
Yet nurses, care assistants spend the most time with patients and shape the majority of the patient experience. Their attrition rates are also typically higher, and each exit directly affects continuity of care.
Frontline employees deserve the same intentional approach: a voice in decisions that affect their work, visible recognition, structured career progression and supervisors who have the time and skills to support them. I see this changing gradually across the sector, but there is still significant ground to cover.
TPB Team: How can HR use exit interviews, employee feedback and attrition data to identify the real causes of workforce shortages?
Gopala: Exit interviews often capture polite rather than honest answers. ‘Better salary’ or ‘personal reasons’ are easy to say and rarely the full story. To get closer to the truth, interviews should be conducted by someone other than the reporting manager, and a follow-up conversation thirty to sixty days after exit often yields more candid insight.
Exit data becomes far more useful when combined with other sources such as engagement surveys, stay interviews and grievance records. Attrition should then be analysed by role, location, supervisor, tenure band and shift pattern. Early attrition in the first few months points to issues with hiring fit or onboarding, while concentrated attrition under particular managers points to leadership gaps.
It also helps to separate regretted from non-regretted exits. Most importantly, HR must close the loop by sharing findings and the actions taken, so employees see that their feedback leads to change.
TPB Team: What retention challenges are unique to home healthcare and other patient-facing roles outside traditional hospital settings?
Gopala: Home healthcare professionals largely work alone, in someone else’s home, without colleagues nearby. That independence can be rewarding, but it also brings isolation, both professional and personal, and the pressure of making decisions without immediate support.
Safety and dignity are real concerns, especially for women professionals working in unfamiliar households. Boundaries can blur when families expect domestic tasks that fall outside the clinical role. Long-duration or live-in assignments can limit rest and personal space, while daily travel adds fatigue. Professionals also form deep bonds with long-term patients and experience genuine grief when those patients pass away.
Because they are rarely seen at a central workplace, these professionals can feel invisible to the organisation. Addressing this requires regular supervisor check-ins, round-the-clock support lines, clear service-scope agreements with families, safety protocols, opportunities for peer connection, and thoughtful matching of professionals to assignments based on skills, language and location.
TPB Team: Can better workforce planning reduce employee burnout and prevent avoidable resignations? If so, how?
Gopala: Yes, and I would go further: much of what we call burnout is actually a planning failure rather than a lack of individual resilience. When demand peaks are not anticipated, the gap is absorbed by the same people working longer hours.
Good workforce planning uses data to forecast demand, including seasonal illness patterns and periods when staff traditionally take leave, and builds buffer capacity rather than running teams at full utilisation all the time. Cross-training creates flexibility, so one shortage does not overload one group. Leave should be planned in advance and honoured.
Planning should also look at the talent pipeline through partnerships with nursing and allied health institutions. Finally, workload indicators such as overtime hours, consecutive working days and assignment intensity should be monitored as early warning signals, in the same way we monitor clinical indicators.
TPB Team: If a healthcare organisation could change one HR practice to improve retention, what should it prioritise?
Gopala: If I had to choose one, I would invest in frontline supervisors. People often join an organisation for its reputation but leave because of their immediate manager.
Many nursing and clinical supervisors are promoted for their clinical excellence and then expected to manage people without being taught how. Equipping them with people-management skills, giving them the time and authority to support their teams, and holding them accountable for team retention and well-being as much as for operational targets would change the day-to-day experience of thousands of employees.
A supervisor who holds regular stay conversations, recognises good work, distributes workload fairly and acts on concerns early is the single most effective retention mechanism a healthcare organisation can have.
The thread running through Gopala’s answers is that healthcare retention is not solved in the recruitment room. It is shaped on the roster, in the supervisor’s weekly check-in, in how career paths are drawn for nurses and care assistants, and in whether frontline voices are heard at all. For home healthcare, where professionals work alone in a patient’s home, the stakes rise further in terms of safety, isolation and boundaries. His case is that organisations willing to invest in frontline supervisors and honest workforce planning will keep the experience the sector cannot afford to lose.
