scholarly journals What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services?

2013 ◽  
Vol 37 (2) ◽  
pp. 256 ◽  
Author(s):  
Deborah Jane Russell ◽  
John Wakerman ◽  
John Stirling Humphreys
Keyword(s):  
Literature Review ◽  
Health Workforce ◽  
Primary Healthcare ◽  
Health Workers ◽  
Geographic Location ◽  
Rural And Remote ◽  
Retention Strategies ◽  
Professional Groups ◽  
Workforce Retention ◽  
Health Worker Retention

Background. Optimising retention of rural and remote primary healthcare (PHC) workers requires workforce planners to understand what constitutes a reasonable length of employment and how this varies. Currently, knowledge of retention patterns is limited and there is an absence of PHC workforce benchmarks that take account of differences in geographic context and profession. Methods. Three broad strategies were employed for proposing benchmarks for reasonable length of stay. They comprised: a comprehensive literature review of PHC workforce-retention indicators and benchmarks; secondary analysis of existing Australian PHC workforce datasets; and a postal survey of 108 rural and remote PHC services, identifying perceived and actual workforce-retention patterns of selected professional groups. Results. The literature review and secondary data analysis revealed little that was useful for establishing retention benchmarks. Analysis of primary data revealed differences in retention by geographic location and profession that took time to emerge and were not sustained indefinitely. Provisional benchmarks for reasonable length of employment were developed for health professional groups in both rural and remote settings. Conclusions. Workforce-retention benchmarks that differ according to geographic location and profession can be empirically derived, facilitating opportunities for managers to improve retention performance and reduce the high costs of staff replacement. What is known about the topic? Health services located in small rural and remote locations are likely to continue to experience workforce shortages and high costs of recruitment. Health workforce retention is therefore crucial. However, effective rural health workforce planning and use of strategies to maximise retention of existing health workers is hindered by inadequate knowledge about baseline employment-retention patterns. What does this paper add? Differences in health worker retention patterns by geographic location and profession are most evident after the first 6 months through until the end of the second year of employment. Health worker-retention benchmarks that differ according to geographic location and profession are proposed. What are the implications for practitioners? Benchmarking workforce retention in comparable health services can enable identification of best practice and the underpinning retention strategies. Workforce planners can use this, together with knowledge of baseline retention patterns and the high cost of staff replacement, to guide the design, timing and implementation of cost-neutral retention strategies.

Developing a Competitive Advantage: Considerations from Australia for the Recruitment and Retention of Rural and Remote Primary Health Workers

2008 ◽  
Vol 14 (1) ◽  
pp. 106 ◽  
Author(s):  
Julaine Allan ◽  
Patrick Ball
Keyword(s):  
Human Resources ◽  
Health Workforce ◽  
Health Workers ◽  
Health Service Delivery ◽  
Research Literature ◽  
The Body ◽  
Rural And Remote ◽  
Retention Strategies ◽  
Recruitment And Retention ◽  
Workforce Issues

Globally, health workforce shortages in rural and remote areas significantly affect the capability of health systems, both public and private, to deliver their services. Regional and national governments and academic and professional bodies have been active in attempting to address the situation. This paper overviews the extensive human resources literature on recruitment and retention. Findings are contrasted with recent Australian and international research literature investigating health workforce issues. The context of rural health service delivery, workforce issues and recruitment and retention strategies implemented are discussed. Recruitment and retention issues for the rural and remote health workforce would be well understood if human resources knowledge was applied to the problem. However, few retention strategies were identified other than for general practitioners and no analyses of their effectiveness could be found. Health employers need to use the body of knowledge developed in the business sector to implement recruitment and retention strategies consistently, evaluate them and report the findings. "Silos" created by a sector or discipline-specific approach can be broken down by seeking knowledge from a number of disciplines. Health research can then focus on developing models of health care that address professional and community needs.

scholarly journals Remote health workforce turnover and retention: what are the policy and practice priorities?

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
John Wakerman ◽  
John Humphreys ◽  
Deborah Russell ◽  
Steven Guthridge ◽  
Lisa Bourke ◽  
...  
Keyword(s):  
Health Workforce ◽  
Staff Turnover ◽  
Retention Strategies ◽  
Remote Areas ◽  
Health Workforce Retention ◽  
Workforce Retention ◽  
Fit For Purpose ◽  
Workforce Turnover ◽  
Very High ◽  
Remote Health

Abstract Background Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention. Main text Annual turnover rates of NT remote area nurses (148%) and Aboriginal health practitioners (80%) are very high and 12-month stability rates low (48% and 76%, respectively). In remote NT, use of agency nurses has increased substantially. Primary care costs are high and proportional to staff turnover and remoteness. Effectiveness of care decreases with higher turnover and use of short-term staff, such that higher staff turnover is always less cost-effective. If staff turnover in remote clinics were halved, the potential savings would be approximately A$32 million per annum. Staff turnover and retention were affected by management style and effectiveness, and employment of Indigenous staff. Review of the international literature reveals three broad themes: Targeted enrolment into training and appropriate education designed to produce a competent, accessible, acceptable and ‘fit-for-purpose’ workforce; addressing broader health system issues that ensure a safe and supportive work environment; and providing ongoing individual and family support. Key educational initiatives include prioritising remote origin and Indigenous students for university entry; maximising training in remote areas; contextualising curricula; providing financial, pedagogical and pastoral support; and ensuring clear, supported career pathways and continuing professional development. Health system initiatives include ensuring adequate funding; providing adequate infrastructure including fit-for-purpose clinics, housing, transport and information technology; offering flexible employment arrangements whilst ensuring a good ‘fit’ between individual staff and the community (especially with regard to cultural skills); optimising co-ordination and management of services that empower staff and create positive practice environments; and prioritising community participation and employment of locals. Individual and family supports include offering tailored financial incentives, psychological support and ‘time out’. Conclusion Optimal remote health workforce stability and preventing excessive ‘avoidable’ turnover mandates alignment of government and health authority policies with both health service requirements and individual health professional and community needs. Supportive underpinning policies include: Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce;A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services;Policies that facilitate transition to community control, prioritise Indigenous training and employment, and mandate a culturally safe work context; andAn employment policy which provides flexibility of employment conditions in order to be able to offer individually customised retention packages There is considerable extant evidence from around the world about effective retention strategies that contribute to slowing excessive remote health workforce turnover, resulting in significant cost savings and improved continuity of care. The immediate problem comprises an ‘implementation gap’ in translating empirical research evidence into actions designed to resolve existing problems. If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right and ensure the coordinated implementation of multiple strategies, including better linking existing strategies and ‘filling the gaps’ where necessary.

scholarly journals A critical review of rural medical workforce retention in Australia

2001 ◽  
Vol 24 (4) ◽  
pp. 91 ◽  
Author(s):  
John Humphreys ◽  
Judith Jones ◽  
Mike Jones ◽  
Graeme Hugo ◽  
Errol Bamford ◽  
...  
Keyword(s):  
Literature Review ◽  
Conceptual Framework ◽  
Critical Review ◽  
Literature Survey ◽  
Knowledge Gap ◽  
Medical Workforce ◽  
Rural And Remote ◽  
Remote Communities ◽  
Ongoing Research ◽  
Workforce Retention

The problem of how best to recruit and retain doctors in rural and remote communities has led governments to adopt a range of medical workforce incentives, including retention grants. A comprehensive literature survey suggests that medical workforce retention has been poorly distinguished from other supply issues such as recruitment, and that its determinants and the process leading to retention are poorly understood. Such a knowledge gap is likely to limit the effectiveness of retention incentives. This article reports the results of this literature review, and advances a conceptual framework as the basis for ongoing research and evaluating how best to deliver effective retention interventions.

scholarly journals A Discrete Choice Experiment on Factors Influencing Attrition and Motivation of Frontline Health Workers in Remote and Rural Areas in Nigeria

2021 ◽  
Author(s):  
Sunny C Okoroafor ◽  
Chukwuemeka Nwachukwu ◽  
Martin Osubor
Keyword(s):  
Discrete Choice ◽  
Health Workforce ◽  
Choice Experiment ◽  
Health Workers ◽  
Rural And Remote ◽  
Remote Areas ◽  
Factors Influencing ◽  
Frontline Health Workers ◽  
Rural And Remote Areas

Abstract Background The current policy thrust in Nigeria is to ensure that there exists qualified, skilled, and adequate health workforce for the achievement of universal health coverage. To achieve this, evidence combination of strategies/interventions on factors influencing attraction, retention, and motivation of the health workforce is needed to ensure the equitable distribution of the health workforce across the country.Methods We conducted a discrete choice experiment study to determine the combinations of incentives that may increase the retention of frontline health workers in rural and remote areas in Nigeria. The study was undertaken across rural and urban locations in Bauchi State between August and October 2018 amongst 145 students and practicing health workers. Results Health workers are 14.6 and 14.4 times more likely to take up a rural posting or continue to stay in their present rural posts if there was basic housing and improvement of the quality of the facilities respectively. The preference for rural job location increased by 6.17 times if good schools for children's education were provided. The highest willingness-to-pay was for the provision of basic housing or housing allowance with a high utility of 0.609 followed by improved quality of facility with sufficient staff number and type, equipment, drugs, and medical supplies with a utility value of 0.607. Conclusion Improving the working conditions of health workers will support retention in rural health posts. Based on the findings, we recommend the introduction of housing incentives in rural and remote areas to support the retention of health workers. This should be accompanied by deliberate interventions to improve the quality of the health facilities ensuring adequate and functional equipment and uninterrupted supplies.

scholarly journals Interventions for health workforce retention in rural and remote areas: a systematic review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Deborah Russell ◽  
Supriya Mathew ◽  
Michelle Fitts ◽  
Zania Liddle ◽  
Lorna Murakami-Gold ◽  
...  
Keyword(s):  
Health Professionals ◽  
Rural Areas ◽  
Health Workers ◽  
Rural And Remote ◽  
Remote Areas ◽  
Rural And Remote Areas ◽  
Rural Retention ◽  
Workforce Retention ◽  
Study Designs ◽  
Rural Training

Abstract Background Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. Methods The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case–control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. Results Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. Conclusion Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.

scholarly journals Retention strategies and interventions for health workers in rural and remote areas

2020 ◽  
Vol 18 (1) ◽  
pp. 87-96
Author(s):  
Sonia Hines ◽  
John Wakerman ◽  
Timothy A. Carey ◽  
Deborah Russell ◽  
John Humphreys
Keyword(s):  
Health Workers ◽  
Rural And Remote ◽  
Retention Strategies ◽  
Remote Areas ◽  
Rural And Remote Areas

How best to measure health workforce turnover and retention: five key metrics

2012 ◽  
Vol 36 (3) ◽  
pp. 290 ◽  
Author(s):  
Deborah J Russell ◽  
John S Humphreys ◽  
John Wakerman
Keyword(s):  
Health Services ◽  
Health Workforce ◽  
Rural And Remote ◽  
Retention Strategies ◽  
Single Measure ◽  
Worker Turnover ◽  
Comprehensive Picture ◽  
Workforce Turnover ◽  
Remote Health ◽  
Rural And Remote Health

Objective. This article identifies, critically appraises and illustrates the use of five key workforce turnover and retention metrics that are well suited for use by Australian rural health workforce planners. These are crude turnover (separation) rates, stability rates, survival probabilities, median survival and Cox proportional hazard ratios. Examples of their calculation are presented using actual data obtained from payroll records in Australian rural and remote health services. Conclusion. The use of this small number of metrics as a ‘workforce measurement package’ can help overcome many of the limitations evident when a single measure is reported in isolation, by providing a more comprehensive picture of turnover and retention patterns. We suggest that health services themselves can calculate the simplest measures, whereas regional and centralised health authorities with higher levels of expertise undertake survival analysis and comparisons of compiled data. Implications. These key metrics can be used routinely to measure baseline levels of health worker turnover and retention, to quantify important determinants of turnover and retention, and importantly, to make valid comparisons. This enables areas for improvement to be better targeted using appropriate retention strategies, and changes resulting from retention interventions to be evaluated effectively. What is known about the topic? A vast array of turnover and retention metrics has been described in the literature. However, which of these are likely to be most useful for measuring Australian rural and remote health workforce turnover and retention is not well understood. What does this paper add? In recognition of the shortcomings of using single measures in isolation, this article identifies, critically appraises and illustrates the use of five key workforce turnover and retention metrics, recommending their use as a ‘package’. What are the implications for practitioners? Regular use of the identified metrics can enable health workforce planners to recognise which areas to target for improvement, devise appropriate retention strategies and evaluate changes occurring as a result of retention incentives or interventions.

Sign in / Sign up

Export Citation Format

Share Document