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.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

2019 ◽  
Vol 43 (6) ◽  
pp. 682 ◽  
Author(s):  
Priya Martin ◽  
Katherine Baldock ◽  
Saravana Kumar ◽  
Lucylynn Lizarondo
Keyword(s):  
Clinical Supervision ◽  
Health Workforce ◽  
Health Professionals ◽  
Allied Health ◽  
Rural And Remote ◽  
High Quality ◽  
Allied Health Professionals ◽  
Remote Health ◽  
Rural And Remote Health

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.

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.

Mind the gap: is it time to invest in embedded researchers in regional, rural and remote health services to address health outcome discrepancies for those living in rural, remote and regional areas?

2019 ◽  
Vol 25 (2) ◽  
pp. 104 ◽  
Author(s):  
Anna Moran ◽  
Helen Haines ◽  
Nicole Raschke ◽  
David Schmidt ◽  
Alison Koschel ◽  
...  
Keyword(s):  
Health Outcome ◽  
Health Services ◽  
Capacity Building ◽  
Research Capacity ◽  
Knowledge Generation ◽  
Research Capacity Building ◽  
Rural And Remote ◽  
Research Activity ◽  
Remote Health ◽  
Rural And Remote Health

Research capacity building in healthcare works to generate and apply new knowledge to improve health outcomes; it creates new career pathways, improves staff satisfaction, retention and organisational performance. While there are examples of investment and research activity in rural Australia, overall, rural research remains under-reported, undervalued and under-represented in the evidence base. This is particularly so in primary care settings. This lack of contextual knowledge generation and translation perpetuates rural–metropolitan health outcome disparities. Through greater attention to and investment in building research capacity and capability in our regional, rural and remote health services, these issues may be partially addressed. It is proposed that it is time for Australia to systematically invest in rurally focussed, sustainable, embedded research capacity building.

scholarly journals Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review

2017 ◽  
Vol 41 (2) ◽  
pp. 234 ◽  
Author(s):  
Kylie Gwynne ◽  
Michelle Lincoln
Keyword(s):  
Health Workforce ◽  
Aboriginal People ◽  
Aboriginal Health ◽  
Evidence Based ◽  
Rural And Remote ◽  
Policy Makers ◽  
Australian Aboriginal ◽  
Health Delivery ◽  
Remote Health ◽  
Rural And Remote Health

Objective The aim of the present study was to identify evidence-based strategies in the literature for developing and maintaining a skilled and qualified rural and remote health workforce in Australia to better meet the health care needs of Australian Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) people. Methods A systematic search strategy was implemented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist. Exclusion and inclusion criteria were applied, and 26 papers were included in the study. These 26 papers were critically evaluated and analysed for common findings about the rural health workforce providing services for Aboriginal people. Results There were four key findings of the study: (1) the experience of Aboriginal people in the health workforce affects their engagement with education, training and employment; (2) particular factors affect the effectiveness and longevity of the non-Aboriginal workforce working in Aboriginal health; (3) attitudes and behaviours of the workforce have a direct effect on service delivery design and models in Aboriginal health; and (4) student placements affect the likelihood of applying for rural and remote health jobs in Aboriginal communities after graduation. Each finding has associated evidence-based strategies including those to promote the engagement and retention of Aboriginal staff; training and support for non-Aboriginal health workers; effective service design; and support strategies for effective student placement. Conclusions Strategies are evidenced in the peer-reviewed literature to improve the rural and remote workforce for health delivery for Australian Aboriginal people and should be considered by policy makers, funders and program managers. What is known about the topic? There is a significant amount of peer-reviewed literature about the recruitment and retention of the rural and remote health workforce. What does this paper add? There is a gap in the literature about strategies to improve recruitment and retention of the rural and remote health workforce for health delivery for Australian Aboriginal people. This paper provides evidence-based strategies in four key areas. What are the implications for practitioners? The findings of the present study are relevant for policy makers, funders and program managers in rural and remote Aboriginal health.

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