a pilot trial of a ‘whole-of-person’ - rural health

A pilot trial of a ‘whole-of-person’

approach to improving rural health

workforce retention

Dr. Cath Cosgrave

Research Fellow – Nursing and Allied

Health Rural Workforce | Department of

Rural Health – Wangaratta, Victoria

Faculty of Medicine , Dentistry and Health

Sciences | The University of Melbourne

This presentation has been supported by the Australian Government Department of Health through the Rural

Health Multidisciplinary Training Programme

Department of Rural Health

Push & pull effects• Three types of factors influence rural recruitment and retention

Workplace

Career-building opportunities and

Social & personal

• Factors either have a:

Pull effect to come and stay OR

Push effect to leave

• Research mostly focused on the workplace and career-building & only

minimally on the social and personal aspects.

• Very little understanding on how all three collectively impact.


PhD study - research question

How do employment

and rural-living factors

impact turnover

intention among early

career, rural-based

community mental health

professionals in their

first few years of

working?


PhD research study

• Pilot study – 5 service managers

• Constructivist grounded theory methodology – investigating lived

experiences

• Early career focus

• Multi professional approach – allied health & nursing

• 11 month data collection period

• 26 In-depth, semi-structured, face-to-face interviews with eligible

health professionals

• 2 LHD in 9 towns – inner & outer regional, rural & remote

• 4 batches – purposive and theoretical sampling

•4-12mths

•Learning the job

•0-3mths

•Rabbit in the headlights

•13mths

•Comfortable in the job


Initial Adjustment

Longer-term Adjustment

Having Adapted

Turnover Intention Theory- Basic social

process: Adjusting to change


The turnover intention theory- concepts & causal

relationships

Professional satisfaction

Relationships, role & career

Personal satisfaction

Sense of belonging

Social connection

Assessment of

Expectations being met

Turnover intention

Satisfied-stay

Unsatisfactory-

Leave

Determinants: Life-stage

Time living in the town

Determinants: Career-stage;

Time in the job (adjustment/adaption)


Changes in personal & professional satisfaction over time

In the Adjusting stage

• Workplace

• Career (CPD)

In the having adapted stage

• Community & location

• Career (CPD & progression)

Adjusting

0 - 12 Months

Changes in Personal & Professional Satisfaction Over T ime

Personal

Satisfaction

Personal

Satisfaction

Professional

Satisfaction

Professional

Satisfaction

Having Adapted

13 Months+


Differing turnover risk at different stages (1/2)

In the adjusting stage

Degree of turnover intention risk determined by extent of:

Prior relevant work experience

and

Being settled-in & belongingness

Highest risk group: Early career &

Outsider-newcomers

THIS TURNOVER is AVOIDABLE


Differing turnover risk at different life stagesIn the Having Adapted stage

Turnover is most strongly influenced by life-stage

Highest risk group:

Early adulthood (early career)

from

any background (i.e. both locals & outsiders)

THIS TURNOVER IS UNAVOIDABLE


The ‘Whole-of-Person’ Rural Retention Framework - Dr C. Cosgrave

Workplace

Co

mm

unity &

L

ocation

Career

Feeling Settled-In

and a Sense of

Belonging to

Community & Place

Working in a Positive,

Supportive, Inclusive

Team & Workplace

Having

Opportunities to

Develop Skills &

Build a Career

Project Aim:

To develop a service-specific, community-based

retention strategy, informed by the WoP retention

framework, to improve new health professionals’ job and

personal satisfaction in order to reduce avoidable

turnover.

• Context-specific strategies are informed by the retention and interview

data and the WoP retention framework

• Working group in each site (Dr Cosgrave, project worker, Senior staff)

• Steering group – oversight, performance tracking



Whole-of-person retention program 2017-2018

• Co-funded UoM-DRH partnership project with 2 Victorian Public Health services

(large regional hospital & small rural hospital <50 beds)

• Project worker in each site

• Participatory Action Research methodology

• Target groups:

Allied health & nursing (regional hospital-allied health only)

Early career (yrs 1-5) -especially 1-3 years,

New staff from any career stage -outsider-newcomers to area

• Research activities:

– reviewing/tracking service’s turnover &retention data;

– In-depth interviews with target staff & identified key-informants

– Follow-up interviews (email & face-to face) 3-6mths with target staff -

job/personal satisfaction & evaluation of WoP strategies

Progress to date


Deliverables &

milestones

Small Hospital Regional Hospital

Commenced October 2017 January 2018

Interviews with target

staff (ongoing)

11 AH (7disciplines),

4 Nurses

27 AH (10 disciplines)

Interviews with key

informants

7 10

WoP Recommendations

Formulated/Approved

Feb 2018 (approved) April 2018 (Approval in

May )


Key Findings -1

Organisational Sml rural

Regional

Inconsistent approaches to clinical supervision, mentoring & CPD across AH disciplines

Many AH managers not confident in managing people

& how to support professional & career development of staff

Particular workplace challenges in very small AH

discipline teams (2) or sole practitioners – low job satisfaction is commonplace

AH silos -work organised in disciplines, socialise in disciplines -little crossover

No pre-qualification pathways to support a grown your own AH workforce strategy


Key Findings -2

Key Findings sml

rural

Region

al

Recruitment delays & process unclear for candidates &

managers

Biggest pull factor- job opportunities - limited new

grad employment opportunities & competitive – especially

for dietitians, exercise physiologists.

Other strong pull factors are rural background and

relocating for a relationship (life stage)

Recruitment Sml rural

Regional


Initial Adjustment (0-3 mths) Sml rural

Regional

Key Findings -3

All new early career staff experience a very challenging

initial adjustment to the job

Suitable rental accommodation is hard to find

High levels of loneliness among outsider-newcomers –

especially if single, in early-adulthood- ,often homesick

Information on groups & activities in town/area can be

hard to find.

Initial impressions among newcomer-outsiders

“nothing to do here”


Longer-term Adjustment (4-12mths) Sml rural

Regional

Key Findings -4

Inconsistent linking up of new AH staff with existing

support for early career AH– AH Educator, PD group

Many outsider-newcomers commonly return ‘home’

every/most weekend resulting in heavy reliance on social

in the workplace- Victorian?

All new staff very keen to build or broaden their social

network- regardless of career stage.

Sporting and activity groups can be unwelcoming and

cliquey.


Having adapted (from 13 +) Sml rural

Regional

Key Findings- 5

After year, outsider-newcomers commonly begin to

appreciate rural lifestyle: quiet, affordable, good work/life

balance. Especially those in or entering middle- adulthood

Leaving rural -main push factor: job insecurity & under-

employment. Especially staff in maternity leave positions

from yr. 2. Leave for permanent full-time work offers.

Leaving rural - other push factors: Joining a partner &

settling down plans – life stage.

Recommendations – Small Rural Hospital


Organisational & Adapting to change stages

Recommendations Workplace Community & Location

Career

Organisational – Model Innovation & sustainability

1. Establish an AH Educator position - NEW permanent

2. Develop a WoP early career (yrs 1-3) support program - AH & nursing

3. Ongoing training & support for Snr clinicians & managers in WoP model

4. Review policy on AH external CPD – funding, recommended courses Yrs 1-3 for

disciplines

Recruitment 5. Establish Relocation incentive package

6. Establish 3-yr early career contract – outlining WoP model – including CPD

offered for discipline

7. Develop recruitment marketing strategy – pull factors service &

community/place

8. Review Recruitment process – streamlined & timely

Initial Adjustment (0-3 mths)

9. Establish Settling-in & welcome to town strategy

Initial & longer-term Adjustment (0-12mths)

10. Establish a Social connection in the workplace strategy (buddy, social events)

Longer-term Adjustment & Having adapted (from 0mths+)

11. Develop an early career Interprofessional learning & development program &

training calendar

12. Establish a Building social connection in the community strategy

Recommendations – Large Regional Hospital


Organisational & Adapting to change stages

Recommendations Workplace

Community & Location

Career

Organisational – Model Innovation & sustainability

1. Develop strategies to support a more inclusive AH culture encouraging respect and breaking down discipline silos

2. Develop an AH WoP early career (yrs 1-3) support program

3. Provide ongoing training & support for Snr clinicians & managers in WoP model

4. Review policy on AH external CPD – funding, courses Yrs 1-3 for disciplines

5. Review policy/processes on provision of AH clinical supervision & mentoring

Recruitment 6. Establish Relocation incentive package

7. Establish 3-yr early career contract – outlining WoP model – including CPD offered for discipline

8. Develop recruitment marketing strategy – pull factors service & community/place

9. Review Recruitment process – streamlined & timely

10. Investigate feasibility of a ‘grow-your-own’ AH workforce – (AHA pathway, 1 yr internship)

11. Investigate feasibility of improving job security for well performing AH staff in maternity leave positions or locums

Initial Adjustment (0-3 mths)

12. Establish Settling-in & welcome to town strategy

Initial & longer-term Adjustment (0-12mths)

13. Establish a Social connection in the workplace strategy (buddy, social events)

Longer-term Adjustment & Having adapted (from 0mths+)

14. Establish a Building social connection in the community strategy


What’s working well, so far?• Project workers -senior AH staff members of service - good staff

links & service understanding

• Commitment to partnership & trust

• Widespread understanding & acceptance of turnover intention theory

– unavoidable/avoidable turnover

– impact of life & career stages &

– importance of belongingness

• Strong participation of new staff in research

• Some exemplar managers & senior clinicians already implementing a WoP approach

• Interest in participating from community and council –community forums 40+px

The Challenges• WoP requires a major cultural change needs:

– Organisational readiness

– CEO & executive understanding, support &

resourcing

– Whole-of-organisation responsibility

– Patience

• Community approaches to support professional

workforce retention – few examples - Canada


a pilot trial of a ‘whole-of-person’ - rural health

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