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
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
Rural and Remote Australia
> Home to 1/3 of Australians
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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.
SA Health
Access to Health Services
> Decreases with increasing remoteness
> 2006-7 Annual shortfall of primary health care
expenditure of $2.1 billion
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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
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allied health professionals, oral health care, equipment
> Plus ‘aged care’ deficit of $500 million
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Lower access and longer waits for residential aged care
> Total $3 billion PHC and Aged Care deficit
> $829 million overspend on hospital care
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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
SA Health
Maldistributed Health Workforce
> 23% Australia’s Doctors, 25% Physiotherapists
> Relative number of health professionals decreases
with increasing remoteness (except nursing)
> Impact of:
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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 SA
2006 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
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 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.
Personal and Professional Satisfaction
LOW
Modifiabilty
HIGH
Retention of AHPs
Workforce
Retention
SA Health
CHSALHN Allied Health 2006
> Approximately 360 headcount
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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
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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
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In general, younger staff further in more remote locations
> Few with tenure >4 years, most >2 years
> Vacancy rates high
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Ranging from 16% Dietetics, to 29% Physio, 53% Podiatry
> Staff “invisible to” / not valued by metro colleagues
SA Health
Opportunities for Improvement
“ Necessity is the Mother of invention,
but Irritation is the Father “
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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
SA Health
The journey
> 2008 Country Allied Health Advisory Group
> 2008/2009 AHP Workforce Development Project
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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
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Addition of $250K CPD funding to CAHCEP
> 2008/9 Supervision and Mentorship Project
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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
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25% of SA Health AHPs to service 33% SA population
> Clear career structure
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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
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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
SA Health
Tanya Lehmann
Principal Consultant Allied Health
Country Health SA Local Health Network
tanya.lehmann@health.sa.gov.au
0437 293 627