Workforce

About: Workforce is a research topic. Over the lifetime, 32140 publications have been published within this topic receiving 449850 citations. The topic is also known as: labour force & labor force.

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

Abstract: 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. 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’. 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: 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.

A conceptual model for recruitment and retention: allied health workforce enhancement in Western Victoria, Australia.

Abstract: Attracting and retaining allied health professionals in rural areas is a recognised problem in both Australia and overseas. Predicted increases in health needs will require strategic actions to enhance the rural workforce and its ability to deliver the required services. A range of factors in different domains has been associated with recruitment and retention in the allied health workforce. For example, factors can be related to the nature of the work, the personal needs, or the way an organisation is led. Some factors cannot be changed (eg geographical location of extended family) whereas others can be influenced (eg education, support, management styles). Recruitment and retention of allied health professionals is a challenging problem that deserves attention in all domains and preparedness to actively change established work practices, both individually as well as collectively, in order to cater for current and predicted health needs. Changes to enhance workforce outcomes can be implemented and evaluated using a cyclic model. The Allied Health Workforce Enhancement Project of the Greater Green Triangle University Department of Rural Health (GGT UDRH) is working towards increasing the number of allied health professionals in the south west of Victoria. Based on themes identified in the literature, an interactive model is being developed that addresses recruitment and retention factors in three domains: (1) personal or individual; (2) organisation; and (3) community.

The general pediatrician: projecting future workforce supply and requirements.

Abstract: Objective. Trends affecting both the supply and requirements of child health physicians call into question earlier assessments about the adequacy of the general pediatric workforce. To understand the ef- fects of these trends over time, we developed a model that projects the national supply of practicing general pediatricians over a 20-year period (2000 -2020). Design. The model incorporates current data on the practicing pediatrician workforce in the United States, pediatric residency graduates entering general pediatrics, and gender- and age-specific measures of productivity and of retirement or death. In addition, it accounts for projected changes in the size and ethnicity of the child population and the proportion of children currently re- ceiving outpatient care from family practitioners. Main Outcome Measures. Time trend of the supply of general pediatricians and the number of children in the population per practicing pediatrician. Results. The baseline model projects that the number of general pediatricians will expand by nearly 25 000 by the year 2020, a 64% increase from the year 2000, whereas the child population is projected to expand by only 9%. The increase was robust to sensitivity analyses measur- ing the impact of each of the model's variables on the future supply of pediatricians. In all probable scenarios, the general pediatrician workforce will expand signifi- cantly more rapidly than the child population. In addi- tion, the trend in pediatrics is in marked contrast to the other primary care specialties. Conclusions. Despite a number of factors that might attenuate the growth of the general pediatrician work- force, none seems sufficient to slow its expansion in relation to the pediatric population. To maintain practice volumes comparable to today, pediatricians of the future may need to provide expanded services to the children currently under their care, expand their patient popula- tion to include young adults, and/or compete for a greater share of children currently cared for by nonpediatricians. Pediatrics 2004;113:435- 442; workforce, child/children, primary care, access, graduate medical education.

The relationship between entering medical students' backgrounds and career plans and their rural practice outcomes three decades later.

Abstract: PurposeAlthough many studies have investigated predictors of physician practice in rural areas, few have accounted for the importance of physicians' backgrounds. This study analyzed the relationship between the backgrounds and future career plans of entering medical students and their rural practice

Retaining Novices to Become Expert Child Protection Practitioners: Creating Career Pathways in Direct Practice

Abstract: In many post-industrial countries, concerns have been raised about high turnover of professional staff and the high proportion of novice practitioners on the frontline in child protection agencies. High turnover imposes costs on individual practitioners, employing organizations, service users (particularly vulnerable children) and society more broadly. We analyze the views of employers, policy makers and researchers in Australia, England and Sweden about factors contributing to high turnover at the frontline. We find that a combination of retention disincentives (push factors) and alternative career opportunities (pull factors) contributes to high turnover among frontline practitioners. Based on these findings, we propose a strategy for enhancing workforce retention at the frontline in child protection. The strategy involves creation of a career pathway that enables, and encourages, novice child protection workers to become advanced practitioners.