Retaining Health Professionals Research Articles

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Describing a medical school's rural activity footprint: setting selection and workforce distribution priorities.

There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region. In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes. As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting.

Positive psychological capital in health professionals: A systematic literature review

Introduction: Health organisations need to attract and retain health professionals as well as protect and improve their mental health following the premises of positive psychology, particularly with regard to positive psychological capital. Objective: This review aimed to map studies that addressed positive psychological capital in empirical research with samples of health professionals. Method: A systematic literature review of articles addressing positive psychological capital in samples of physicians and nurses was conducted. The search for primary studies was carried out in April 2023, in the databases: PubMed, CINAHL, MEDLINE, Nursing & Allied Health Collection, Scopus and Web of Science. Results: 20 articles were included in the review in which the main concepts with which positive psychological capital was related were analysed, according to their nature, positive or negative, observing the role that positive psychological capital assumed as a variable, the instruments used to measure this concept and the statistical analysis performed. Conclusions: Positive psychological capital was positively associated with work engagement, perceived organisational support, intention to stay, positive aspects of the work environment, innovative behaviours, and leader-member exchange. Furthermore, this concept was negatively related to work stressors, emotional exhaustion, and psychological distress. The main gap highlighted in the primary studies was the use of cross-sectional designs, which prevent the inference of causality. These results reinforce the need for an intervention with regards to physicians and nurses based on the development of positive psychological capital.

Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries

BackgroundGovernments use return-of-service (RoS) schemes to train, employ and retain health professionals in the public sector. We determined the effectiveness of RoS schemes in four Southern African countries.MethodsThis retrospective cohort...

Identifying the strengths, weaknesses, opportunities and threats (SWOT) of return-of-service bursary schemes for health workforce capacity: a qualitative study of Botswana, Lesotho and Eswatini

BackgroundInvesting in training citizens in return for service is a strategy used by Botswana, Eswatini and Lesotho to strengthen their health workforce. These strategies, known as return-of service (RoS) schemes,...

Transformation-oriented leadership in German hospitals: beneficial attributes and competencies

Abstract Introduction Due to a shortage of health professionals and economic pressure, many German hospitals are required to transform the clinical work environment to increase job satisfaction, but also to attract and retain health professionals. Leadership is a key factor for the successful implementation of organization-wide change. The aim of this study was to identify the attributes and competencies among leaders that are beneficial for implementing and managing hospital-wide transformations. Methods A qualitative study design. In 2020, 18 face-to-face, semi-structured interviews were conducted with chief nursing officers, ward managers, nurses and physicians in five German hospitals which have started implementing a hospital-wide transformation (e.g. Magnet® or Pathway®). Interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using the content analysis method according to Mayring. Results Results show five beneficial leadership elements to instigate and steer hospital-wide transformation: (1) Charismatic leaders are role models and idealists with well-communicated visions that are grounded in clinical practice and reflect the clinical practitioners. (2) Mentally strong leaders have courage, stamina, and are resilient. (3) Empowering leaders are highly supportive and increase the intrinsic motivation of employees. (4) Imparting interprofessional appreciation refers to leaders who cultivate a respectful relationship with persons from other professional groups and recognize their daily performance. (5) Agile leaders are well and quickly accessible for employees and respond situationally to changing demands in everyday work. Conclusions Interviewees described characteristics of hospital leaders as success factors for establishing and maintaining continuous change processes. Charismatic and supportive leaders are critical to transform the hospitals’ culture and values. In addition, equitable interprofessional collaboration is of utmost importance. Key messages • Charismatic, agile, empowering leaders can have a positive impact on system-wide change processes. • The successful transformation of hospitals’ work environment needs interprofessional appreciation and the mutual acknowledgement of competences.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Public Service Motivation and Determining Factors to Attract and Retain Health Professionals in the Public Sector: A Systematic Review.

(1) Background: The motivational determinants of health professionals to choose and remain in the public sector have been increasingly addressed, including the customized approach of Public Service Motivation (PSM). However, to date, no systematic research overview has been performed in this domain, leaving the body of literature unstructured. This article fills this gap by assessing the motivational factors of choice for the public sector in the health field, and the conceptual and methodological trends of this research stream. (2) Methods: This study follows the PRISMA protocol to ascertain patterns in past research and inform researchers, practitioners, and policymakers. Eighty-nine documents published between 1998 and 2021 were retained after selecting them according to their theme and outlined goals. (3) Results: Common motivational determinants are remuneration, available resources, work conditions, and frequency of contact and interaction with patients. The PSM construct and scale are often employed as main frameworks, but there is also a concern in assessing motivation drawing on psychological constructs that reflect the challenging line of work and environment that is health care, such as presenteeism, stress, and perception of hindrances. (4) Conclusions: By focusing on health professionals’ motivation, this study contributes to a timely systematization in challenging times for health institutions and their human resources.

Expectations and problems of the healthcare management support program for public assistance recipients

Objectives In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been implemented for them. This study aimed to investigate the expectations and problems of welfare offices, as well as their requests to the central government and prefectures about the healthcare management support program for public assistance recipients, which has been mandated since 2021.Methods In November 2019, snowball sampling was used to select 23 welfare offices for sending self-administered questionnaires about the healthcare management support program. Respondents were asked open-ended questions about their expectations and problems regarding the program, as well as their requests to the central government and prefectures. A subsequent interview survey was conducted from November 2019 to February 2020, gathering additional information on the questionnaire survey.Results We received consent for the questionnaire survey and interview survey from 16 welfare offices (response rate 69.6%). It was revealed that the staff in charge of the healthcare management support program at the welfare office expected the program to improve recipients' health awareness and condition and for it to be applied to other residents in the community. They reported difficulty in developing the implementation system, setting up the indicators and target population, and retaining health professionals. They requested the central government and prefectures to clarify the indicators and the criteria for evaluation, provide reference materials, introduce precedents, communicate and coordinate with welfare offices and related organizations in the community, hold meetings to share information, and secure financial resources.Conclusion Findings from our study suggest a need to strengthen the cooperation between the central government, prefectures, and local governments and to establish a multilayered system to implement the healthcare management support program effectively in welfare offices.

Importance of attachment to place in growing a sustainable Australian Rural Health Workforce: A rapid review.

Personal, community, and environmental factors can influence the attraction and retention of regional, rural, and remote health workers. However, the concept of place attachment needs further attention as a factor affecting the sustainability of the rural health workforce. The purpose of this rapid review was to explore the influence of a sense of place in attracting and retaining health professionals in rural and remote areas. A systematic rapid review was conducted based on an empirical model using four dimensions: place dependence, place identity, social bonding and nature bonding. English-language publications between 2011 and 2021 were sought from academic databases, including studies relevant to Australian health professionals. A total of 348 articles were screened and 52 included in the review. Place attachment factors varied across disciplines and included (a) intrinsic place-based personal factors; (b) learning experiences enhancing self-efficacy and rural health work interest; (c) relational, social and community integration; and (d) connection to place with lifestyle aspirations. This rapid review provides insight into the role of relational connections in building a health workforce and suggests that community factors are important in building attachment through social bonding and place identity. Results indicate that future health workforce research should focus on career decision-making and psychological appraisals including place attachment. An attachment to place might develop through placement experiences or from a strong rural upbringing. The importance of the relational interactions within a work community and the broader community is seen as an important factor in attracting, recruiting, and sustaining a rural health workforce.

Brain drain of Tunisian competencies: The case of health professionals

Abstract The world is witnessing mobility of human resources facilitated by globalization and by international agreements on trade in services GATS. The advanced demographic transition in developed economies and increase in aging population have put pressures on demand of professionals from countries of the south to sustain economic growth. Health systems in countries of the south are facing increasing rate of migration of health workforce including physicians and allied personnel. Such situation led WHO to promote the code of ethical recruitment of international health professionals. The optional nature of the code did not allow its wider implementation. The brain drain of scare resources represents a real challenge for health systems in several countries including Tunisia. Since 2011, the pace of migration of Tunisian health professionals and particularly physicians have increased because of worsening working conditions, limited career path and uncertainty about the future. Europe and particularly France, Canada, Germany and Gulf states constitute the main destination of Tunisian migrants partly explained by cultural aspects including Arabic and French languages and similarity of Francophone model of medical education. The present qualitative study including focus group discussions with main stake holders aims at: Measuring the brain drain of Tunisian health professionalsAssessing the impact of brain drain on the Tunisian health systemSharing initiatives aimed at retaining health professionals in public sector and inside the country.Learning lessons from other countries on working models for well organized and mutually beneficial migration of health professionals.

Work-related stress among health professionals in Swiss acute care and rehabilitation hospitals-A cross-sectional study.

This study aimed to identify significant work stressors associated with stress symptoms, job satisfaction, intention to leave and health-related outcomes among health professionals. The workforce shortage of health professionals is a current concern, and a reduction of work-related stress is thus essential for retaining health professionals. Studies on the extent of work-related stress in different health professions are limited. The research was conducted with a cross-sectional study encompassing 26 randomly selected acute care and rehabilitation hospitals. The sample consisted of 3,398 health professionals. The study was undertaken in accordance with the STROBE checklist for observational studies. Work-private life conflicts were significantly associated with health professionals' stress symptoms, job satisfaction, intention to leave the organisation and profession, their general health status, burnout symptoms and quality of sleep. Also, opportunities for development and the behaviour of the direct line manager (e.g. quality of leadership, unfair behaviour, rewards given) along with various profession-specific stressors were the important predictors revealed. This study shows the high relevance of preventing and reducing work-private life conflicts, enhancing leadership qualities as well as opportunities for development among health professionals working in acute care and rehabilitation hospitals. Also, differences between health professions should be taken into consideration in developing strategies for reducing stress at work. The results of this study are particularly relevant for health professional leaders and reveal the urgent need in hospital practice for effective strategies to improve health professionals' work-private life balance, opportunities for development and quality of leadership.

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study.

Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers. Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.

The utility of conceptualisations of place and belonging in workforce retention: A proposal for future rural health research.

This paper explores the utility of sense of place, place attachment and belonging-in-place for research into rural health workforce retention. One of the key contributors to health disparities between rural and metropolitan-based residents is inadequate staffing of rural health services, and many rural places around the world struggle to retain health professionals. Despite some recognition of the complex array of factors and circumstances impacting rural workforce retention, research focuses primarily on organisational and role-based causes. Health geography and concepts associated with place currently being used in some rural research may offer much to workforce retention research, especially when applied alongside person-centred approaches.

Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions

BackgroundDespite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery.MethodsIdentification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers.ResultsWe identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW).ConclusionsServices are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.

What is the financial incentive to immigrate? An analysis of salary disparities between health workers working in the Caribbean and popular destination countries

BackgroundThe continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong motivator for HRH to migrate abroad. This study adds to limited available literature on HRH salaries within the Caribbean region and establishes the wage gap between selected Caribbean and popular destination countries.MethodsSalaries are reported for registered nurses, medical doctors and specialists. Within these cadres, experience is incorporated at three different levels. Earnings are compared using purchasing power parity (PPP) exchange rates allowing for cost of living adjusted salary differentials, awarded to different levels of work experience for the chosen health cadres in the selected Caribbean countries (Jamaica, Dominica, St Lucia and Grenada) and the three destination countries (United States, United Kingdom and Canada).ResultsRegistered nurses in the destination countries, across all experience levels, have greater spending power compared to their Caribbean counterparts. Recently qualified registered nurses earn substantially more in the UK (86.4%), US (214.2%) and Canada (182.5% more). The highest PPP salary ($) gap amongst more experienced nurses (5-10 years) is found within the US, with a gap of 163.9%. PPP salary gaps amongst medical doctors were pronounced, with experienced cadres (10–20 years of experience) in the US earning 316.3% more than their Caribbean counterparts, whilst UK doctors (183.5%) and Canadian doctors (251.3%) also earning significantly more. Large salary differentials remained for medical specialists and consultants. US specialist salaries were 540.4% higher than their Caribbean based counterparts, whilst UK and Canadian specialists earned 95.2 and 181.6% more respectively.ConclusionThe PPP adjusted HRH salaries in the three destination countries are superior to those of comparable HRH working in the Caribbean countries selected. The extent of the salary gaps vary according to country and the health cadre under examination, but remain considerable even for newly qualified HRH. The financial incentive to migrate for HRH trained and working in the Caribbean region remains strong, with governments having to consider earning potential abroad when formulating policies and strategies aimed at retaining health professionals.

Investigating Employment and Career Decision of Health Sciences Teachers in the Rural School Districts and Communities: A Social Cognitive Career Approach

Teachers’ shortage in the field of K-12 teaching in general and health subjects teaching in particular is one of the most significant challenges in both developed and developing countries, particularly in rural school districts and communities. Leaders at rural school districts strive to establish connections and plans to recruit experienced health educators from different sources and satisfy the on-going manpower demands in rural areas. This study examined two premises: First, why health professionals and staff from urban regions decide to change their career to health science teaching in rural communities and school districts. Second, how to recruit and retain health professionals and staff to rural communities and school districts. The Interpretative Phenomenological Analysis model was employed to explore the beliefs of 11 health professionals in the rural school district. Stable employment, money sources, and understanding of teaching mission of health science education were three major areas of study. The findings of this study would serve as a blueprint for rural communities and school districts to attract potential health professionals and staff into the current education system.

Effects of Brain Drain on the South African Health Sector; Analysis of the Dynamics of its Push Factors

While there has been a plethora of studies that addresses migration in Africa, many have yet to successfully unpack the effects of brain drain on the South African health sector. Using textual analysis of the available literature relevant to the topic under consideration; this work seeks to identify the major structural and socio-economic push factors that drive the migration of health professionals in South Africa, relying on Revestain’s laws of migration and Lee’s push/pull theory of migration. The study also looks at explaining other factors that contribute to the migration of health professionals in South Africa. We argue that for South Africa to retain health professionals, the government needs to increase the training of health workers, improve their working conditions and security, upgrade infrastructure and ensure availability of resources as well as develop a more open immigration policy prioritizing skilled immigration.

Effects of Brain Drain on the South African Health Sector; Analysis of the Dynamics of its Push Factors

While there has been a plethora of studies that addresses migration in Africa, many have yet to successfully unpack the effects of brain drain on the South African health sector. Using textual analysis of the available literature relevant to the topic under consideration; this work seeks to identify the major structural and socio-economic push factors that drive the migration of health professionals in South Africa, relying on Revestain’s laws of migration and Lee’s push/pull theory of migration. The study also looks at explaining other factors that contribute to the migration of health professionals in South Africa. We argue that for South Africa to retain health professionals, the government needs to increase the training of health workers, improve their working conditions and security, upgrade infrastructure and ensure availability of resources as well as develop a more open immigration policy prioritizing skilled immigration.

76: IDENTIFICATION OF RETENTION STRATEGIES FOR NEUROSURGEONS IN IRAN: RESULTS FROM EXPERT PANELS

Background and aims:The key challenge is how to encourage and retain health professionals in their work location. There is a list of policy options for the purpose but applying an...