Retaining Our Allied Health Professionals

…Innovation and advice from Rural

Health Workforce Australia Conference, November 2013

Tanya LehmannPrincipal Consultant Allied Health, Country Health SA LHNPresident, Services for Australian Rural & Remote Allied Health

SA Health

Acknowledgement

SA Health

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?

SA Health

> 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 AustraliaSource: ABS (2008) Australian Social Trends.

Rural and Remote Australia

SA Health

> 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

Access to Health Services

1. The National Rural Health Alliance, Fact Sheet 27

SA Health

> 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)

Maldistributed Health Workforce

Sources: AIHW nursing and midwifery labour force survey 2009, AIHW Medical labour force 2009, and AIHW Health and community services labour force 2006

SA Health

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.

SA Health

Retention of AHPs

Professional Factors- Work is challenging, has impact- Access to support, CPD- Infrastructure & equipment- Career pathway, remuneration

Social Factors- Personality (adventure seeking,

risk taking)- Personal aspirations (altruistic)- Affordable housing, community

amenities & infrastructure- Spouse employment

External Factors- Geographic location – lifestyle,

friendly communityLOW

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Workforce Retention

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.

SA Health

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

SA Health

Opportunities for Improvement

> 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

“ Necessity is the Mother of invention, but Irritation is the Father “

SA Health

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

SA Health

SA Health

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

SA Health

SA Health

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

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