The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

Abstract

People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

“…The WoP-RIF resulted from the author's grounded theory study investigating the full range of 'life' factors influencing the turnover intention of AHPs and nurses working in rural public health services in New South Wales, Australia. It was developed from a substantive theory explaining turnover intention, which was then cross-referenced with the extensive body of rural health retention literature [14]. The WoP-RIF has three domains-workplace/organisational, role/career and community/place-and the necessary preconditions for improving retention through strengthening job and personal satisfaction are set out under each domain.…”

“…In addition, for recruitment and retention strategies to be effective in rural settings, as well as being evidence based, they must be context specific and founded on a sound understanding of the unique factors at play in each service and place [13]. In response to this complexity and the need for a person-centred, evidence-based and context-informed approach, the author developed a rural health workforce conceptual framework-the Whole-of-Person Retention Improvement Framework (WoP-RIF)-to support Australia's rural health service executives and line managers, rural communities, and governing bodies to develop effective strategic actions to improve rural health workforce retention [14]. While the WoP-RIP's focus is on retention, it does not ignore recruitment or attraction.…”

“…While the WoP-RIP's focus is on retention, it does not ignore recruitment or attraction. Rather, retention is conceptualised as starting with recruitment and the importance of 'person-environment-fit' selection is emphasised with attraction as a key component of recruitment [14].…”

The importance of organizational commitment in rural nurses' intent to leave

“…In small rural and remote communities, where work teams can be very small with frequent gaps in staffing (Wakerman et al., 2019), team dynamics, everyday practice experiences, and locally available workplace and community supports may strongly influence RNs/NPs' and LPNs' organizational commitment. In rural and remote settings, work systems need to suit the realities of local contexts to be perceived as working well and being supportive (Cosgrave, 2020).…”

Condiciones y medio ambiente de trabajo en salud: modelo conceptual para áreas remotas y rurales

“…Retención en áreas rurales: recientemente, Cossgrave propuso un marco específico para la retención de personal de salud en áreas rurales, holístico y centrado en las personas. La autora identificó condiciones necesarias para mejorar la retención en cada una de las dimensiones: trabajar de manera amigable y un lugar de trabajo solidario e inclusivo; tener oportunidades para desarrollar habilidades y acceder a una carrera profesional; y sentirse socialmente conectado y con sentido de pertenencia (25).…”