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Retaining Our Allied Health Professionals … Innovation and advice from Rural

Retaining Our Allied Health Professionals … Innovation and advice from Rural. Health Workforce Australia Conference, November 2013 Tanya Lehmann Principal Consultant Allied Health, Country Health SA LHN President, Services for Australian Rural & Remote Allied Health. Acknowledgement.

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Retaining Our Allied Health Professionals … Innovation and advice from Rural

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  1. Retaining Our Allied Health Professionals…Innovation and advice from Rural Health Workforce Australia Conference, November 2013 Tanya Lehmann Principal Consultant Allied Health, Country Health SA LHN President, Services for Australian Rural & Remote Allied Health

  2. Acknowledgement

  3. Overview of Presentation • Why do we need more Health Professionals in rural & remote Australia? • What does the evidence say about retention of AHPs? • The CHSALHN Allied Health journey • How do we get and retain more AHPs in rural and remote Australia?

  4. Rural and Remote Australia • Home to 1/3 of Australians • Higher proportion >65, lower proportion <25 yrs • More likely to be obese, smoke, drink alcohol to excessive levels, be less physically active; have a disability; die from cancer, heart disease, suicide • More likely to have lower income, education, employment • More likely to work in high risk job • More likely to be Aboriginal (70%) • Health status declines with increasing remoteness Remoteness Areas in Australia Source: ABS (2008) Australian Social Trends.

  5. Access to Health Services • Decreases with increasing remoteness • 2006-7 Annual shortfall of primary health care expenditure of $2.1 billion • MBS/PBS - access to doctors, dentists, pharmacies • 25 million services (2006-7) • Contributed to need for an extra $830 million to be spent on acute (hospital) care, or 600,000 extra acute episodes • Plus ‘other PHC’ deficit of at least $800 million • allied health professionals, oral health care, equipment • Plus ‘aged care’ deficit of $500 million • Lower access and longer waits for residential aged care • Total $3 billion PHC and Aged Care deficit • $829 million overspend on hospital care • Rural & remote people twice as likely to be admitted to hospital for potentially preventable admission • largely attributable to health workforce gaps 1. The National Rural Health Alliance, Fact Sheet 27

  6. Maldistributed Health Workforce • 23% Australia’s Doctors, 25% Physiotherapists • Relative number of health professionals decreases with increasing remoteness (except nursing) • Impact of: • Funding/employment models (market failure) • Population (demographic profile, critical mass for specialty) • Context (professional isolation, community infrastructure) Sources: AIHW nursing and midwifery labour force survey 2009, AIHW Medical labour force 2009, and AIHW Health and community services labour force 2006

  7. Evidence: Retention of AHPs • Australian research focus on Doctors • attract higher incomes, government-funded incentive schemes (training, relocation, retention) • practice under a small business model of patient care • Profile of AHPs is different • Younger (mean 36), female (>80%) • Public / private sector employment • Can’t assume the same factors attract and retain AHPs as work for Doctors • Factors that attract AHPs to commence rural practice differ from those that influence them to remain.1 • Factors differ by remoteness of the position 1. Schoo, A. M., Stagnitti, K. E., Mercer, C., & Dunbar, J. (2005). A conceptual model for recruitment and retention: Allied health workforce enhancement in Western Victoria, Australia. Rural and Remote Health, 5: 477.

  8. Retention of AHPs LOW Modifiabilty HIGH • Professional Factors • Work is challenging, has impact • Access to support, CPD • Infrastructure & equipment • Career pathway, remuneration Personal and Professional Satisfaction • Social Factors • Personality (adventure seeking, risk taking) • Personal aspirations (altruistic) • Affordable housing, community amenities & infrastructure • Spouse employment Workforce Retention • External Factors • Geographic location – lifestyle, friendly community Adapted from: Humphreys, J. S., Wakerman, J., Wells, R., Kuipers, P., Jones, J., Entwistle, P. & Harvey, P. (2007). Improving primary health care workforce retention in small rural and remote communities – How important is ongoing education and training? Australian Primary Health Care Research Institute, Canberra, ACT.

  9. CHSALHN Allied Health 2006 • Approximately 360 headcount • 13% of SA Health AHPs to service 33% SA population • 15% of AHPs in SA (all sectors) in country compared to 24% rural & remote nationally (2001 Census) • Very flat structure • 90% AHPs ‘base grade’ • Of 10% ‘senior’, 50% in non-clinical roles • Limited relationship with others of same profession • Little growth identified in most professions over previous 10 years • On average, 3.5 years younger than metro AHPs • In general, younger staff further in more remote locations • Few with tenure >4 years, most >2 years • Vacancy rates high • Ranging from 16% Dietetics, to 29% Physio, 53% Podiatry • Staff “invisible to” / not valued by metro colleagues

  10. Opportunities for Improvement “ Necessity is the Mother of invention, but Irritation is the Father “ • Career structure / opportunities • Access to professional development • Access to professional supervision / support • Use of allied health assistant / clinical support roles • Professional networks • Readiness for remote/rural practice • Workforce tracking capacity • Workload measurement and management • Access to /effective use of IT • Inequitable access to services

  11. The journey • 2008 Country Allied Health Advisory Group • 2008/2009 AHP Workforce Development Project • County Allied Health Forum • Workforce data, including SA AH Workforce Survey • Simplified and standardised HR processes, job descriptions • Designed AHP Career Structure • Professional Networks • Country Allied Health Collaborative • 2009 Country Allied Health Clinical Enhancement Program (CAHCEP) $75K • 2010 AHP Schedule in Enterprise Agreement • Addition of $250K CPD funding to CAHCEP • 2008/9 Supervision and Mentorship Project • Clinical Support Policy, Framework • 2010 Clinical Governance Structure - $800K investment by CHSALHN in Clinical Leads (x9), Clinical Seniors (53) • 2011/12 Clinical Supervision training • 2013 Clinical Supervision eModules, adoption State-wide • 2010, 2013 Recruitment campaigns • 2011/12 ASHP Leadership Group, AH Line Mgrs

  12. CHSALHN Allied Health Now • Approximately 500 headcount • 25% of SA Health AHPs to service 33% SA population • Clear career structure • EA: clinical, management, education/research • Clinical leadership roles in CHSALHN (location negotiable) • Strong professional networks across CHSALHN • FTE growth in all professions, moving towards more equitable distribution by population • Still younger than metro, but much better supported and retaining for longer • More with tenure >4 years • Vacancy rates lower for all professions • Other SA LHNs and jurisdictions are picking up and adopting our frameworks, training • More applications from metro clinicians for country senior jobs

  13. More AHPs in rural and remote • Supply, Attraction and Retention • Training & professional support • Education, training, recruitment, retention incentives • Rural pathways, Rural Generalism • Recruitment • Filling vacant positions, backfill leave • Increasing the number of ‘positions’ • Viable private practice, joined up workforce • Public / private work, flexible work arrangements • Retention • Meaningful work • sustainable, effective service models - Assistants, telehealth, evaluation, research, publication • Career pathways and flexibility • Good support: supervision, CPD, peer support • Focus on social & personal factors

  14. Tanya LehmannPrincipal Consultant Allied HealthCountry Health SA Local Health Networktanya.lehmann@health.sa.gov.au0437 293 627

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