I’ll be completely up front about this. I love healthcare.
I really can’t tell you why , it’s just an area i’ve always enjoyed interviewing people about and writing stuff up. There’s a lot happening with design, development but also resourcing Australia’s health needs.
To start to address the latter, i’ve been researching where the problems lie to identify how the heck we can fix them….
Tackling the rural workforce challenge
The rural workforce challenge is one that isn’t going away, but unlike many of the challenges in the healthcare system, it’s an area where workforce strategy can make huge leaps towards solving the problem.
We know the story, right? The workforce projections produced by HWA in the “2025” report make it pretty plain that without major reform in the pattern of health service delivery, Australia faces major shortfalls in the nursing and related workforce Australia wide, and in the supply of general practice and many specialities outside inner metropolitan areas.
We train people in these metropolitan areas, but we also need people in rural areas, so how do we start to get them there?
Associate Professor Russell Roberts is the Director of Mental Health and Drug and Alcohol Services at Western NSW. Over the last five years he has led the commissioning of a $43 million mental health capital development program, including the workforce planning, recruitment and training of over 200 health staff in rural NSW. As part of his research, Russell has been identifying the ways we can solve the rural challenge.
The research carried out revealed there are five main factors that attract and retain talent. In order of importance, these are lifestyle, family, health, field of work and variety of work.
“There are several factors for why rural areas struggle to attract talent. The key is to break these factors down into things you can impact (or influence) and things you can’t, that’s how you establish where you should focus your efforts,” Russell explained.
The research showed that the hardest part is attracting people in the first place. It’s much harder to encourage people to work in a country town once they’ve already established a life in a metropolitan city but once people shift, results show they are more likely to stay there longer than they intended to.
The first area to look at is the initial investment into a lifelong career; the training. Our medical centres deliver quality training programmes all over the country, but Russell’s been delivering training programmes that stand out above the rest to really draw people into the rural environment: “You need to offer training programmes that are better than any opportunities available in the city. We offer quite generous scholarships for our staff to do post graduate study, giving allowances for development opportunities to further their professional skills; supporting conference attendance and flying in specialists for hands on training so people can get good training locally.”
The importance of training is an area supported by Jennifer Mason who has been driving The Mason Review of Australian Government Health Workforce Programs. She highlighted the importance of not overlooking your local resources:
“The best results will come from enrolling rurally based students into locally based training, or students with significant links to rural or particular disadvantaged communities. These are the graduates most likely to remain in the community post-graduation, or to return after postgraduate or other experience. For this reason, a key recommendation of the report is the creation of an integrated rural pathway for medical students, facilitating a coherent and supported pathway for medical students in their undergraduate and postgraduate training, significantly based in rural experience, with of course appropriate rotation into emergency and other modules.
Appropriate support for Aboriginal and Torres Strait Islander students entering health related careers is a crucial element. The effective use of roles such as Aboriginal Health Workers is very important.”
It’s not just the professional development opportunities that should be used to attract potential employees from inner and outer areas. As Russell’s research showed, lifestyle factors can have a huge impact on a person’s decision to move, particularly once initial training has been completed:
“The hardest part of a workforce strategy is getting over that inertia of moving, so we have to look at how we can provide incentives for people to give it a try.
“There’s a whole series of attractive factors looking beyond the training itself. You have to market the lifestyle that’s available with many of these areas; great places to live, relax, great restaurants, they’re safe, there’s social cohesion. These factors are extremely important, especially to people with families. There’s a community responsibility there to make rural locations attractive to live in, and we should be marketing that lifestyle.”
Of course, this initial attraction is only half the story and the return on investment in workforce strategies will only be truly redeemed if staff retention rates are kept throughout their career in a rural setting.
“We know that there are some prominent factors for why people leave. One is to get a better training opportunity, the other is career advancement then finally, pay and conditions. If we look at how we start to compete in these areas, on top of the training mentioned earlier, we can create structures where there are opportunities for career advancement for people specifically in rural settings. The pay issue is obviously harder to tackle, as it is anywhere. Government however are starting to talk about the potential of offering incentives for people to work in rural settings, so we’ll see how that develops,” Russell said.
It’s these factors that will still be key when attracting international trained staff to Australia’s rural areas, as Jennifer explains: “Even if a process of reform commences, the statistics show that Australia will continue to be drawing upon a high proportion of overseas trained medical staff. The report makes recommendations, drawing upon the work of other reviews and reports, about removing bureaucratic barriers which impede orderly recruitment of overseas trained staff to the areas where they are most needed and the provision of appropriate support to those staff and their families.”
We’re already seeing huge success from international and cross country programmes that have been rolled out incorporating these workforce strategies. According to Russell, it’s when the ‘personal touch’ can make a pivotal difference: “We’ve employed around 200 staff from all over the country and internationally. When we brought the first half dozen people over from the UK, we made sure there was someone to personally welcome them at the airport and then drive to drive them to their new home town. We helped them in their first weeks by touring the town’s amenities and arranging meetings with schools, sports clubs, real estate agents etc. The effect of this personal touch was transformative. The resulting ‘word of mouth’ multiplied applications tenfold”.
The strategies that will attract staff and help bridge our workforce gap into the future will have to look beyond training alone and promote the full rural working lifestyle.”
Are nurses the primary healthcare providers of the future?
Under current policy settings, without reform, a recent study predicted a national shortage of 109,000 nurses and 2,700 doctors by 2025. HWA modelling indicates the most effective policy intervention for meeting the increased demand would be to adopt a process of reform and innovation to increase the productivity of the future workforce.
So could part of the problem actually become the solution?
Catherine Stoddart, Chief Nurse and Midwifery Officer at the Health Department Western Australia certainly thinks so. She explains “In the key area of health reform, nursing has a big role to play, with highly vulnerable populations that are complex.
“Nursing could effectively be that primary healthcare provider of the future. We’ll see the emergence of nurse practitioner led clinics, of nurses as business leaders in their own right in that primary healthcare interface space.”
There’s been constant change in the demands upon the nursing role over the years in response to advances in scientific knowledge, changes in health care needs and tightening budgets. As a result, the opportunity for nurses to transform to a more strategic position has emerged. Catherine highlighted how the fundamental attributes of nursing mixed with a new set of business skills can drive the health sector to meet objectives:
“For healthcare leaders you have to hold on to the fundamental value base you have from your professional experience. Hold onto the value of the individual caring, compassion, all those things that you hold true. It doesn’t mean that you can’t have the business acumen and the skillset around talking the language of the treasury, or politics, or finance. If you misalign your value base with where you’re going in your leadership, it’s transparent to other people. That’s really important to do. Our great nursing leaders are very clear about why they make the decisions, where they come from and then how they inspire people. Bridging the two is really important.”
To meet this ambition there’s clearly some training gaps that need to be filled. Across Western Australia, Catherine has been leading some major change across the health system to improve patient quality and maximise efficiency with new workforce models.
One of the most recent projects launched is the Leading Great Care programme, designed to address the needs of today’s nursing and midwifery frontline leaders. The primary focus of the program is to invest and equip SRN 1-7 to ensure safe and effective clinical practice, management and development of the team and positively contribute to the delivery of the organisations objectives:
“Leading Great Care was founded on some research with our nursing and midwifery ladies in the state, to find out what they thought would be the ideal leader. It provides the fundamentals for anything. As a nurse, you have to manage a team of people. It’s foundational management skills from budgeting, safe staffing, through to managing difficult conversations with families, and other clinicians. Those fundamental skills are really important for being able to trigger healthcare, and influence reform.
We will fund all kinds of educational programmes that build capability; we provide scholarships for clinical, management and research expertise.”
In WA, as with many other areas across Australia there’s the additional challenge of providing a rural workforce. Catherine highlights the work being done to increase retention and provide development opportunities to ensure talent in these more remote environments:
“One of the key reasons people leave their job, is because of the leadership they receive. It’s really important, from a workforce and satisfaction perspective that people are informed about the best models for leadership. This will help us provide great care into the future.
“We have a very strong workforce focus, through WA country health service. Our key area is trying to drive retention, allowing nurses to maximise their skills. We know that professional and personal isolation are two of the reasons why people leave that rural and remote environment. We’re trying to tackle those elements by providing professional opportunities, upskilling opportunities and letting people work to the top of their practice effectively. We also have a couple of programmes where people rotate into that space, like the Ocean to Outback programme, and Country to Coast. People can have an experience of a rural environment to get a bit of a taste test, and see if they like it.”
I spoke with Russell, Catherine and Jenny ahead of their presentations at Workforce Efficiency in Healthcare 2013.
Find out more by visiting http://www.healthcareworkforce.com.au