2017-2019 年，北领地和西澳大利亚偏远社区的原住民社区控制的卫生服务机构中卫生人力流动和保留模式。
Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017-2019.
机构信息
Menzies School of Health Research, Charles Darwin University, PO Box 795, Alice Springs, Northern Territory, 0871, Australia.
Northern Territory Department of Health, Darwin, Northern Territory, Australia.
出版信息
Hum Resour Health. 2024 Aug 22;22(1):58. doi: 10.1186/s12960-024-00942-9.
BACKGROUND
Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs' geographical and demographic characteristics.
METHODS
The study used 2017-2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.
RESULTS
There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and 'other health workers' combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).
CONCLUSIONS
Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs' resources and may also support quality of service delivery due to improved cultural safety and continuity of care.
背景
在澳大利亚，原住民社区控制的卫生服务机构（ACCHSs）旨在为原住民群体提供全面和文化安全的初级卫生保健（PHC），以优化其获得途径。提供优质服务的核心是保留员工。然而，目前缺乏专门针对 ACCHSs 的员工离职和保留模式的已发表研究。本研究量化了北领地（NT）和西澳大利亚（WA）地区和偏远地区的 ACCHS 的员工离职和保留情况，并检查了离职和保留指标与 ACCHS 的地理位置和人口统计学特征之间的相关性。
方法
本研究使用了 2017-2019 年 22 个由 11 个 ACCHS 管理的地区和偏远地区 PHC 诊所的卫生工作者的薪资数据。主要结果衡量标准包括诊所和组织层面的年度离职率和 12 个月稳定性率。
结果
任何时间点，每个偏远诊所平均有五名面向客户（原住民卫生从业人员、辅助医疗专业人员、医生、护士/助产士和“其他卫生工作者”）和两名非面向客户（行政和实体）的员工。员工的年平均离职率非常高，诊所层面的离职率为 151%，组织层面的离职率为 81%。客户服务员工的年平均离职率分别为 164%和 75%，而非客户服务员工的离职率分别为 120%和 98%，诊所和组织层面。12 个月稳定性率较低，诊所层面的稳定性率仅为 49%，组织层面的稳定性率为 58%。非原住民员工的年平均诊所层面离职率为 162%，原住民员工的离职率为 81%。这两个劳动力指标与诊所的相对偏远程度、服务的常规客户数量以及每个诊所的员工平均人数（p 值均<0.01）中度至高度相关。
结论
参与 NT 和 WA 偏远地区的 ACCHS 的医疗保健员工离职率非常高，保留率很低。总体而言，随着与地区中心距离的增加，诊所层面的离职率增加，原住民员工的离职率较低，这表明增加原住民员工的雇用可能有助于稳定人员配置。提高保留率可以减轻 ACCHS 资源的负担，并且由于提高了文化安全性和护理的连续性，也可能支持服务交付的质量。
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