Improving health workforce retention in remote Australia: a best-worst scaling study.

内容摘要

Many Australian remote primary health care (PHC) services are characterised by persistent workforce shortages and suboptimal staff retention, with patients experiencing low care continuity, culturally unsafe care, and consequently poorer health outcomes. This study aims to quantify preferences for remote PHC staff for different workforce retention initiatives. A Best-Worst Scaling (BWS) survey was administered (online and face-to-face) to staff working in remote Australian PHC services. Responses were analysed using conditional logit modelling and latent class analysis to determine differences in respondents' preferences. 228 respondents completed the survey. The majority worked in an Aboriginal or Torres Strait Islander Community Controlled Health Service (ATSICCHS) (71%). Overall, the most preferred retention initiatives were provision of a retention bonus (preference score 100); additional annual leave and flexible time-off (88); support for training, higher education or research (79); strengthened professional support networks and wellbeing engagement (71); and higher salary (68). There were many similarities and some significant differences in preference scores between First Nations and non-Indigenous respondents. First Nations staff were significantly more likely to prefer increased First Nations leadership (100 versus 39); increased training and mentoring by local First Nations people (97 versus 55); increased opportunities for promotion or advancement (87 versus 0); increased recognition and celebrating staff achievements (86 versus 29); more on-Country training (83 versus 22); improved role recognition and clarity (79 versus 30); and employment for local First Nations community members (77 versus 22). Latent class analysis Group 2 members had significantly lower preference scores for First Nations leadership (30 versus 71) and on-Country training (27 versus 52) and significantly higher preferences for financial incentives such as retention bonuses (100 versus 40); higher salary (92 versus 0); annual leave and flexible time off (91 versus 38); and cost of living subsidies (80 versus 8). Retaining staff in remote PHC services is complex and staff preferences for retention initiatives vary. PHC services should package retention initiatives in bundles that are tailored to accommodate diverse staff preferences. These findings can inform context-specific retention initiatives by remote PHC services seeking to stabilise their workforce.