Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017-2019.
Humans
Personnel Turnover
/ statistics & numerical data
Northern Territory
Western Australia
Native Hawaiian or Other Pacific Islander
Health Services, Indigenous
/ statistics & numerical data
Rural Health Services
Female
Health Workforce
/ statistics & numerical data
Health Personnel
/ statistics & numerical data
Primary Health Care
/ statistics & numerical data
Community Health Services
/ statistics & numerical data
Male
Aboriginal Community Controlled Health Services
Aboriginal and Torres Strait Islander peoples
Health workforce
Indigenous health services
Primary health care
Remote health
Retention
Turnover
Journal
Human resources for health
ISSN: 1478-4491
Titre abrégé: Hum Resour Health
Pays: England
ID NLM: 101170535
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
received:
11
11
2023
accepted:
08
08
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
22
8
2024
Statut:
epublish
Résumé
Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs' geographical and demographic characteristics. The study used 2017-2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels. There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and 'other health workers' combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01). Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs' resources and may also support quality of service delivery due to improved cultural safety and continuity of care.
Sections du résumé
BACKGROUND
BACKGROUND
Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs' geographical and demographic characteristics.
METHODS
METHODS
The study used 2017-2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.
RESULTS
RESULTS
There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and 'other health workers' combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).
CONCLUSIONS
CONCLUSIONS
Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs' resources and may also support quality of service delivery due to improved cultural safety and continuity of care.
Identifiants
pubmed: 39175025
doi: 10.1186/s12960-024-00942-9
pii: 10.1186/s12960-024-00942-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
58Subventions
Organisme : Australian Research Council
ID : DP190100328
Informations de copyright
© 2024. The Author(s).
Références
World Health Organization. Continuity and coordination of care: a practice brief to support implementation of the WHO framework on integrated people-centred health services. Geneva: WHO; 2018.
Australian Institute of Health and Welfare. Spatial variation in Aboriginal and Torres Strait Islander people’s access to primary health care. Canberra: AIHW; 2015.
Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, et al. Remote health workforce turnover and retention: what are the policy and practice priorities? Hum Resour Health. 2019;17(1):99.
doi: 10.1186/s12960-019-0432-y
pubmed: 31842946
pmcid: 6915930
van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract. 2010;16(5):947–56.
doi: 10.1111/j.1365-2753.2009.01235.x
pubmed: 20553366
Busbridge MJ, Smith A. Fly in/fly out health workers: a barrier to quality in health care. Rural Remote Health. 2015;15(2):3339.
pubmed: 26001557
Tarlier DS, Browne AJ, Johnson J. The influence of geographical and social distance on nursing practice and continuity of care in a remote First Nations community. Can J Nurs Res. 2007;39(3):126–48.
pubmed: 17970463
Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, et al. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. Int J Environ Res Public Health. 2021. https://doi.org/10.3390/ijerph18063014 .
doi: 10.3390/ijerph18063014
pubmed: 33804104
pmcid: 7999419
Zhao Y, Thomas SL, Guthridge SL, Wakerman J. Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia’s Northern Territory. BMC Health Serv Res. 2014;14(1):463.
doi: 10.1186/1472-6963-14-463
pubmed: 25281064
pmcid: 4282496
Pearson O, Schwartzkopff K, Dawson A, Hagger C, Karagi A, Davy C, et al. Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia. BMC Publ Health. 2020;20(1):1859.
doi: 10.1186/s12889-020-09943-4
Tilton E, Thomas D. Core functions of primary health care: a framework for the Northern Territory. Darwin: Northern Territory Aboriginal Health Forum; 2011.
Gomersall JS, Gibson O, Dwyer J, O’Donnell K, Stephenson M, Carter D, et al. What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Aust N Z J Public Health. 2017;41(4):417–23.
doi: 10.1111/1753-6405.12687
Baba JT, Brolan CE, Hill PS. Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities. Int J Equity Health. 2014;13(1):56.
doi: 10.1186/1475-9276-13-56
pubmed: 25301439
pmcid: 4283121
Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework: 2020 summary report. Canberra: AIHW; 2020.
Russell DJ, Zhao Y, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015. Hum Resour Health. 2017;15(1):52.
doi: 10.1186/s12960-017-0229-9
pubmed: 28810919
pmcid: 5558760
Jongen C, McCalman J, Campbell S, Fagan R. Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Serv Res. 2019;19(1):910.
doi: 10.1186/s12913-019-4750-5
pubmed: 31783750
pmcid: 6883573
Australian Health Ministers’ Advisory Council. National Aboriginal and Torres Strait Islander health workforce strategic framework 2016–2023. Canberra: Commonwealth of Australia; 2017.
Russell DJ, Humphreys JS, Wakerman J. How best to measure health workforce turnover and retention: five key metrics. Aust Health Rev. 2012;36(3):290–5.
doi: 10.1071/AH11085
pubmed: 22935120
National Aboriginal Community Controlled Health Organisation. NAACHO members n.d., https://www.naccho.org.au/naccho-members/ ]
Australian Institute of Health Welfare. Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections. Canberra: AIHW; 2023.
Kosel KC, Olivo T. The business case for workforce stability. Irving: VHA Inc; 2002.
Sabety AH, Jena AB, Barnett ML. Changes in health care use and outcomes after turnover in primary care. JAMA Intern Med. 2021;181(2):186–94.
doi: 10.1001/jamainternmed.2020.6288
pubmed: 33196767
Reddy A, Pollack CE, Asch DA, Canamucio A, Werner RM. The effect of primary care provider turnover on patient experience of care and ambulatory quality of care. JAMA Intern Med. 2015;175(7):1157–62.
doi: 10.1001/jamainternmed.2015.1853
pubmed: 25985320
pmcid: 5561428
Wong ST, Regan S. Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural Remote Health. 2009;9(1):1142.
pubmed: 19298094
Zhao Y, Wakerman J, Zhang X, Wright J, VanBruggen M, Nasir R, et al. Remoteness, models of primary care and inequity: medicare under-expenditure in the Northern Territory. Aust Health Rev. 2022;46(3):302–8.
doi: 10.1071/AH21276
pubmed: 35508434
Gwynne K, Lincoln M. Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review. Aust Health Rev. 2017;41(2):234–8.
doi: 10.1071/AH15241
pubmed: 27209274
Meyer L, Joseph TL, Anderson-Smith B, et al. Career pathways for the Aboriginal and Torres Strait Islander health workforce: literature review report. Melbourne: The Lowitja Institute; 2020.
Zhao Y, Russell DJ, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Costs and effects of higher turnover of nurses and Aboriginal health practitioners and higher use of short-term nurses in remote Australian primary care services: an observational cohort study. BMJ Open. 2019;9(2): e023906.
doi: 10.1136/bmjopen-2018-023906
pubmed: 30787082
pmcid: 6398713
McCullough K, Whitehead L, Bayes S, Williams A, Cope V. The delivery of primary health care in remote communities: a grounded theory study of the perspective of nurses. Int J Nurs Stud. 2020;102: 103474.
doi: 10.1016/j.ijnurstu.2019.103474
pubmed: 31835121
Argent J, Lenthall S, Hines S, Rissel C. Perceptions of Australian remote area nurses about why they stay or leave: a qualitative study. J Nurs Manag. 2022;30(5):1243–51.
doi: 10.1111/jonm.13603
pubmed: 35312130
Barker I, Steventon A, Deeny S. Continuity of care in general practice is associated with fewer ambulatory care sensitive hospital admissions: a cross-sectional study of routinely collected, person-level data. Clin Med. 2017;17(Suppl 3): s16.
doi: 10.7861/clinmedicine.17-3-s16