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 a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and 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
Objectives: This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention.
Importance of study: Health care access issues are largely associated with the persistent problem of health workforce under-supply and maldistribution.
Study type: A comprehensive study of workforce turnover and retention in remote communities in the Northern Territory (NT). The study analysed data from NT Government administrative datasets including hospital admissions, primary health care visits, personnel information, patient travel, government payroll and accounting systems. Primary qualitative data from patients and health service staff were also collected and analysed. In order to inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, the researchers also undertook a narrative review of the relevant international literature to derive the best available empirical evidence relating to remote health workforce retention.
Conclusion: 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.
- There is growing evidence that structural community participation—as evidenced by Aboriginal and Torres Strait Islander Community Controlled Health Services—results in culturally safe services that reflect the priorities of the community, improve access and health outcomes, and employ greater numbers of Indigenous people.
- Over recent years, policies have increasingly promoted the use of short-term and agency staffing in remote communities. Anecdotally, this has resulted in several undesirable effects, including concern about cost and quality of care, particularly related to continuity of care in a complex, cross-cultural environment.
- There are some knowledge gaps that should inform future research in this area. These include achieving a better understanding of the drivers of very high turnover in the remote health workforce and why retention is better in some communities than others.