Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study

Abstract

ObjectivesTo evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff.DesignRetrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems).SettingAll 48 government primary healthcare clinics in remote communities in NT, Australia (2011–2015).Participants25 413 patients drawn from participating clinics during the study period.Outcome measuresAssociations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity.ResultsThe proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction.ConclusionsOverall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis

“…In our analysis, the Australian PHC delivery is comprehensive that it provides a wide range of services for a variety of target populations. In terms of the ranges of services, Australian PHC assess and deal with social determinants and / or risk factors [17,24,25,30,36,45,48,53,62,63,65,90,98,99,125], acute and chronic diseases [27,47,52,59,81,82,84,96,97,101,104,105,108,110,111,114,117,118,120 ], mental health [26,46,61,68,126,132], cancer and palliative care including aged care [43,86,103,122], pharmacy and medication safety [35,107], evidence-based practice and knowledge translation [55,…”

“…Table S2 in the Online Supplementary Document describes characteristics of 15 studies [26,35,52,60,82,10 5,107,112,113,115,117,123,124,129,130] conducted on quality of care and its attributes (including continuity of care, effectiveness, and safety). Of these studies, seven reported quality of care [26,52,82,105,112,113,124], three described the effectiveness of different interventions to ensure the quality of care [117,129,130] and two studies reported continuum of care [60,115]. There are several factors including client or system factors [52,105] affecting the quality of care.…”

“…Of these studies, seven reported quality of care [26,52,82,105,112,113,124], three described the effectiveness of different interventions to ensure the quality of care [117,129,130] and two studies reported continuum of care [60,115]. There are several factors including client or system factors [52,105] affecting the quality of care. Yet, the attributes and factors affecting quality of care are neither consistent across PHC settings nor easily measurable [124].…”

Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study

“…There are also a range of factors associated with the recruitment and retention of healthcare staff to remote areas including being of rural origin, completion of training in a rural location, the lifestyle that is offered in remote areas, playing a role in improving Aboriginal and Torres Strait Islander health, and adequate access to resources and support for the family of the health professional (e.g., childcare, education for children) [12][13][14][15]. Anecdotally, there is a commonly held belief that there is a relationship between continuity of care and a stable workforce, but there is little evidence to support this, as is demonstrated by Jones and colleagues [16]. Securing a health workforce to provide culturally appropriate and evidence-based, clinically sound care for Aboriginal peoples in remote regions has been difficult [17].…”

Fatores individuais e contextuais associados à permanência e à carga horária de médicos em serviços de Atenção Primária à Saúde do município de São Paulo

“…Os últimos resultados podem refletir o acaso, mas também podem indicar fatores contextuais dos serviços que atenuem os potenciais efeitos negativos da diminuição da estabilidade da força de trabalho e aumento da rotatividade médica. (112) Outro estudo de coorte retrospectivo conduzido nos Estados Unidos com 359.470 usuários do Medicare entre 2008 e 2017, com objetivo de analisar o impacto do desligamento de médicos na APS (Primary Care Physicians: geriatras, médicos de família, pediatras, ginecologistas e obstetras), mostrou que a perda da continuidade se relacionou negativamente com a qualidade dos serviços de saúde, associando-se a uma queda de 6% do total de vacinados; diminuição em 18% do uso de serviços de APS; aumento em 6% das visitas às demais especialidades médicas e em 18% aos serviços de urgência e emergência. (27) Além de fatores contextuais, como características da região e dos serviços de APS, que poderiam explicar os diferentes resultados encontrados na literatura, é possível supor que o impacto da rotatividade nos serviços também se relacione ao perfil da força de trabalho.…”