Engaged employees are a top contributor to quality and growth, and that means ensuring no one gets lost in the shuffle, according to Chapters Health System CEO Andrew Molosky.
Chapters is one of the largest nonprofit hospice providers in the United States. Currently the company has achieved a turnover rate of 12% for nurses and 10% for CNAs. According to 2022 data from the University of Southern California, average turnover rates throughout the health care continuum hover around 27% for registered nurses and 35.5% for CNAs.
Culture and visible, involved leadership are crucial to attracting and keeping employees, but companies also have to ensure they are staying engaged with their staff over the course of their employment, Molosky indicated.
“The weak link in your chain in the organization is the people who have come in and got the first 90 days real nicely, and then all of a sudden they became a brick in the wall. That can’t happen,” Molosky said at the Home Care 100 Conference in Florida. “Everybody loves somebody the first six weeks; everybody celebrates the person who’s been there 20 years. But what about the two-year employee? If you look at your turnover numbers, that’s where you’re hurting. I promise you, if you really track one-year turnover or five-year turnover, that’s where you’re at risk.”

Chapters has been on a growth trajectory during the past five years.
In October of last year, four nonprofit hospices in the western United States affiliated with Chapters, expanding the Florida-based hospice and senior services provider to three new states — California, Nevada and Oregon.
In addition to its new Western locations, the nonprofit Chapters Health System provides hospice, palliative and home health care, as well as durable medical equipment and pharmacy services, across Florida, Georgia, New York and New Jersey. Following the company’s 2023 affiliation with Capital Caring Health, its network expanded to Maryland, Virginia and the District of Columbia, encompassing 14 counties and four metropolitan areas.
“Our expansion out West represents our organizational belief in working out of a position of strength, or a kind of hub-and-spoke model, where you have organizations of long-standing reputation anchoring a certain geography, and you build your health care ecosystem delivery model around that,” Molosky previously told Hospice News. “It’s way more than just dots on a map. Our ability to provide an entire ecosystem approach is jump started when you have a group or a density in a geographic area.”
Chapters also offers hospice and palliative care services through five other brands: Chapters Health Palliative Care, Good Shepherd Hospice, Capital Caring Health, Hospice of Okeechobee, HPH Hospice and LifePath Hospice.
The company has been recognized as a “great place to work,” seven years running, including by Fortune magazine who listed them among the best employers in the aging services sector. At Home Care 100, Molosky said that he believes that employees’ jobs are to take care of patients, and leaders’ jobs are to take care of employees. This includes those that enter the organization through acquisitions or affiliations.
A key strategy is to ensure leaders know what is important to employees, as well as ensuring an open line of communication for them to voice those interests and concerns, Molosky indicated.
Chapters Health System works to achieve this in a number of ways. One is to build an infrastructure of communication that makes leadership accessible and allows for “bi-directional accountability,” he said at the conference. Chapters does this through regular “town hall” meetings, routine employee opinion surveys, “open door” policies among managers and other methods.
“[Staff] are never more than minutes away or days away from seeing you in person. They’re never more than six months away from you being publicly accountable to them. They’re never more than a few months away from a pulse or engagement survey,” Molosky said. “You’re not going to go very far showing up and bragging about what’s going right. So again, it’s highly visible, bi-directional and mutually accountable.”