1. Retention doesn’t start with perks — it starts with leadership accountability

Reducing turnover by ~40% isn’t about one silver bullet. It’s about getting the fundamentals right — and holding leaders accountable to them.

At Sutter, that meant aligning around a clear long-term vision (“Destination 2030”), doubling down on leadership expectations, and building a culture where engagement is everyone’s job — not just HR’s.

They paired that with consistent employee listening through surveys and feedback loops, but the key wasn’t just collecting data — it was acting on it in visible ways.

“It starts with sharpening our focus on leadership accountability, our culture, and our employee engagement.”

The takeaway: retention improves when leaders know they’re responsible for the employee experience — and are equipped (and expected) to do something about it.

2. Your biggest retention leak is probably in the first year

One of the most actionable insights: early tenure turnover is often where organizations lose the most people — and the fastest.

Sutter saw a drop-off in the first year and went straight at it by redesigning onboarding end-to-end. Not just orientation, but the full “first impression” experience.

They focused on:

• Clear role expectations from day one
• Equipping employees with tools and resources immediately
• Deep manager involvement in onboarding
• Creating belonging early (not months later)

“Employees join excited — the question is, why do they fall off shortly after?”

They also layered in small but meaningful moments (like anniversary recognition) to reinforce connection.

The takeaway: if you fix the first 90–180 days, you’ll move your retention numbers faster than any long-term program.

3. Managers are the system — train them like it

Nothing new here… but the way Sutter operationalized it matters.

Managers weren’t just told they’re important — they were treated as the primary lever for engagement, development, and retention.

That meant:

• Investing heavily in manager training
• Giving them practical tools (not just theory)
• Making them accountable for employee outcomes

“Our managers are really the anchor to how employees feel.”

And importantly, this wasn’t positioned as “extra work” — it was framed as core to the role.

The takeaway: if your managers aren’t consistently equipped and supported, nothing else you build will scale.

4. Career development only works if it’s owned by everyone — starting with leaders

A lot of companies talk about career development. Few actually embed it into how work gets done.

At Sutter, the goal is bold: 100% of employees have articulated career aspirations and a development plan.

But the key move? Starting at the top.

Executives were the first to build and share their own development plans — modeling the behavior before asking the rest of the organization to follow.

“We believe it starts with leaders. We have to model that behavior.”

From there, they built:

• Structured career conversations between managers and employees
• Tools to identify skill gaps and growth paths
• Learning platforms (including AI-enabled tools) to support development
• A “development for all” approach, not just high potentials

The takeaway: development doesn’t scale through programs — it scales through habits, modeled by leaders.

5. Meet employees where they are — not where your systems are

One of the more nuanced insights: not all employees interact with work the same way — so your people strategy can’t be one-size-fits-all.

In healthcare, many employees aren’t sitting at desks. So traditional L&D models don’t work.

Sutter adapted by:

• Creating mobile simulation labs that bring training to employees
• Designing learning experiences specific to different roles (e.g., nurses vs. accountants)
• Building flexible, accessible development tools

“We have to bring the tools and resources to them.”

The takeaway: if your employees can’t easily access your programs, they don’t exist.

6. The best HR leaders simplify complexity into three priorities

At 60,000+ employees, complexity is guaranteed. Deborah’s approach to managing it is refreshingly simple.

She focuses on three areas:

1. Talent — Are employees thriving and growing?
2. Organization — Are we structured and operating effectively?
3. Culture — Are we engaged, aligned, and living our values?

And she ties all of it back to business outcomes — constantly.

“I never lose sight of understanding our business… and how our work drives those outcomes.”

The takeaway: great HR leadership isn’t about doing more — it’s about focusing relentlessly on what matters most.

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