Health Workforce Research

UCRH Health workforce

Our health workforce research program aims to develop a better understanding of factors contributing to the recruitment and retention of health practitioners in rural areas and the healthy ageing of the rural health workforce, as well as to build the skill base of rural and remote practitioners.

Current Health Workforce Research Projects

Factors affecting the recruitment and retention of Allied Health Professionals in rural New South Wales

Allied Health Professionals (AHPs) make a valuable contribution to health care through diagnostic and preventive services as well as delivering therapies ranging from speech therapy for children with autism to physiotherapy to help keep elderly people out of hospital. Yet there is a shortage of AHPs in rural Australia, and a consequent need to understand how to attract and retain them in rural practice.

Our research surveyed nearly 2,000 AHPs working in rural NSW and interviewed groups of AHPs across the state to determine their work preferences and motivations. We found that working rurally was regarded as attractive for its broad scope of practice, and that AHPs liked rural lifestyles, but were troubled by their professional isolation and limited access to professional development. Motivations also differed depending on their career stage.

This research is being used to influence health policy, for example through providing expert testimony to the 2012 Senate inquiry on ‘The factors affecting the supply of health services and medical professionals in rural areas’. Current UCRH Allied Health workforce research follows on from this work and aims to refine our understanding of how to recruit and retain rural AHPs, and to bring the findings to the attention of health managers and policy makers in order to improve access to important allied health services in rural areas.

Funding: NSW Institute of Rural Clinical Services & Teaching, $27,820 (2008-2013)

Staff involved: Dr Sheila Keane, Senior Lecturer Allied Health

Collaborators: University of Newcastle, University of Tasmania, Flinders University, Services for Australian Rural and Remote Allied Health (SARRAH)

The impact of self-practice of Cognitive Behaviour Therapy (CBT) techniques and self-reflection on skill acquisition in CBT therapists (2008-ongoing)

Self-practice/self-reflection (SP/SR) training for aspiring CBT therapists was developed by James Bennett-Levy (Bennett-Levy et al., 2001), and has been trialled with promising results in New Zealand, UK, Ireland, Germany and Austria.

Until recently, studies have been largely qualitative. Recent collaborative studies have asked: Can positive effects of SP/SR training be demonstrated quantitatively? What factors facilitate participants’ engagement with SP/SR? Can we identify what elements of the reflective process result in the most positive skill development? To date, three papers (2014-15), two book chapters (2009, 2014) and an SP/SR workbook (Guilford Press, due Feb 2015) have resulted from this project.

Staff involved: Associate Professor James Bennett-Levy

Collaborators: University of Newcastle (UK), Cumbria NHS Trust (UK), Northumberland NHS Trust (UK), Massey University (NZ), Flinders University.

Facilitators and Barriers to the Use of Imagery-based Interventions by cognitive-behaviour therapists

Research over the past 10 years has shown Imagery-based interventions to be one of the effective types of therapeutic intervention with certain types of psychological disorder (e.g. Post-traumatic stress disorder, social anxiety, abuse problems etc.).

However, it has become clear that therapists often have reservations about using imagery-based interventions in their therapy (e.g. “it might get out of control” – “I feel like I don’t know what I’m doing”). We are conducting qualitative and quantitative studies to determine what the main barriers are to therapists using imagery interventions, and identifying strategies that may help to facilitate their use.

Staff involved: Associate Professor James Bennett-Levy

Collaborators: Bolton University (UK)


Recently Completed Health Workforce Research Projects

Nurse Practitioner Led Services in Primary Health Care in Rural NSW - Two Case Studies

The latest figures in the second Australian Nurse Practitioner (NP) census by Middleton, Gardner G, Gardner A and Della (2009) showed twelve of 208 working NPs were located in primary health care settings in Australia (Middleton et al, 2011, 451). The majority of NPs were employed in metropolitan areas. Few previous studies describe NP roles in detail, or in rural primary health care settings.

This study describes in detail the roles of two NPs in rural primary health care settings in NSW. One NP specialised in the delivery of an integrated mental health service and the other on leadership in aged care.

The case studies of these two NPs offer an in-depth description of why and how these roles were established, what the NPs do, and what impact they had within the context of small rural towns. The study provided valuable information on how best to incorporate NPs into these types of settings.

Staff Involved : Ms Frances Barraclough, Professor Lesley Barclay, Dr Jo Longman

Prolonging working life amongst rural older GPs: developing strategies and instruments

The rural Australian environment is facing a potential crisis in the supply and retention of GPs, and this is compounded by an aging and earlier-retiring workforce compared with metropolitan areas. The objective of this study was to explore the most important retention factors in a sample of older rural GPs.

Semi-structured interviews were conducted with 16 rural GPs practising in the NSW Northern Rivers region. A survey was also conducted to measure demographics, work-related, occupational health, and health and lifestyle behaviours amongst GPs.

GPs reported using, or perceiving as useful, a range of strategies to enable a happy and productive working life beyond traditional retirement age. These strategies covered personal, practice-based, and professional strategies as well as systemic factors beyond the practice. The most ubiquitous experiences, initiatives or conditions representing these overarching themes related to being able to achieve a sensible workload, working in a supportive team environment, and being able to fulfil one’s individual need for clinical variety or specialised professional interests.

From a health policy reform perspective, the greatest impact on reducing early retirement intentions among ageing GPs could potentially be made by intervening in areas of working hours, burnout and work-related sleep issues, followed by job satisfaction, psychological distress, health, general workability and mental and physical work ability.

Presenteeism (being at work whilst sick) amongst GPs can be addressed by implementing interventions in relation to physical activity, stress reduction, sleep hygiene and improving work-life balance and the physical demands of the job.

Through consultation with older rural GPs, insights were gained into how to develop and implement effective retention strategies by identifying those factors which are amenable to intervention at either the personal, practice, local or legislative level. A set of potential solutions were proposed are instrumental in keeping valued Australian rural GPs happily working for longer.

Funding: Sydney Medical School Early Career Researcher & New Staff Grant Scheme. $22,000. University Centre for Rural Health $8,000 (2010-2014)

Staff: Dr Sabrina Pit, Ms Vibeke Hansen, Professor Lesley Barclay

Collaborators: Northern Rivers GP Network, Dr Peter Honeyman, Dr Dan Ewald.

Online Cognitive Behaviour Therapy (CBT) training for rural mental health professionals (2010-2012)

Distance from metropolitan centres, and the cost and lack of training opportunities represent significant barriers for rural health mental health professionals to enhance their therapy skills. Online CBT training shows promise as a viable way to address these issues and provide training in the workplace.

This study investigated whether providing fortnightly professional support for 15 minutes during a 12-week online program might enhance the effectiveness of online training. The study, published in Australian Psychologist (2012) found no difference in reported skills benefits in the supported and unsupported conditions, but significantly higher program completion rates in the supported condition.

Funding: Department of Health and Ageing, $38,000

Staff involved: Associate Professor James Bennett-Levy, Mr Jem Mills, Helen Perry

Collaborators: James Cook University, Northumberland NHS Trust (UK)

The effectiveness of recruitment strategies on general practitioners’ survey response rates – a systematic review.

Low survey response rates in general practice are common and lead to loss of power, selection bias, unexpected budgetary constraints and time delays in research projects. By conducting a systematic review, this project sought to assess the effectiveness of recruitment strategies aimed at increasing survey response rates among GPs.

GP survey response rates may improve by using the following strategies: monetary and non-monetary incentives, larger incentives, upfront monetary incentives, postal surveys, pre-contact with a phone call from a peer, personalised packages, sending mail on Fridays, and using registered mail. Mail pre-contact may also improve response rates and have low costs. Improved reporting and further trials, including sequential mixed mode trials and social media, are required to determine the effectiveness of recruitment strategies on GPs’ response rates to surveys.

Funding: Primary Health Care Research, Evaluation and Development

Staff: Dr Sabrina Pit

Collaborators: Ms Tham Vo; Dr Sagun Pyakurel,

Towards sustainable employability in health care: a systematic review of the effectiveness of interventions

Most industrialised countries face the challenge of needing to increase workforce participation, particularly among people over 50 years. To date, there has been no systematic review that has examined the effectiveness of different interventions on sustainable employability amongst health care personnel. Policy makers, researchers and experts in work, health and safety will be able to use demonstrated effective strategies to promote sustainable employability in health care personnel.

Funding: International Research Collaboration Award, University of Sydney. $8900.

Staff: Dr Sabrina Pit

Collaborators: Dr Suzan Robroek, Occupational Health, Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.

Drivers, barriers and facilitators of Allied Health students undertaking rural clinical placements in Australia: Results of an E-survey

International research shows conclusively that students undertaking rural clinical placements are more likely to pursue rural practice after graduation. This is important to address the chronic rural workforce shortages in the Allied Health professions.

This study surveyed 219 Allied Health students, 125 clinical supervisors and 13 university clinical placement officers to determine what might motivate students to elect to take up a rural placement, and to assess the benefits and feasibility of sustaining rural placements where there is a shortage of clinical supervisors.

Despite the challenges to supervision, students benefited from the broad exposure to different conditions typical of rural practice and gained personal confidence as well as enhanced clinical skills. Stud ents who had undertaken a rural placement were 1.64 times more likely to intend to work in a rural or remote area than students who had not done so. Given the shortage of AHPs available for student supervision, additional work is needed to identify ways of making rural placements more available and sustainable.

Funding: NSW Health Education and Training Institute (HETI), $100,000 (2013)

Staff involved: Sheila Keane, Senior Lecturer Allied Health

Collaborators: Southern Cross University, Services for Australian Rural and Remote Allied Health (SARRAH)

“Healthy Kyogle” – a student service learning project

In 2009 Health Workforce Australia was funded by the Australian Government to address a national health workforce shortage, including training more students to enter the health professions. Research has shown that rural placements increase the likelihood that students will take up rural practice on graduation, but the increase in student numbers has put pressure on already limited availability of rural clinical training placements.

This research project explored the feasibility of establishing a new Occupational Therapy (OT) student service learning placement in a small rural community where no OT services currently existed.

Results identified key elements of establishing a new service learning placement, including broad consultation, clinical governance and communication systems. Universities and students were very satisfied with the educational benefits and during the course of their 10-week placement, under the supervision of an experienced OT, three students provided OT services to 411 clients, delivering 198 individual and 190 group occasions of service in schools and public health settings.

These students also developed resources and provided education to health staff and teachers. Placement feasibility was challenged only by the limits on student supervision, requiring innovations such as inter-professional supervision, remote supervision, and peer learning strategies.

Service-learning is potentially a mutually beneficial intersection of unmet service needs and learning goals. The UCRH is currently using results of this research to establish further service learning placements in a rural aged care setting.

Funding: NSW Interdisciplinary Clinical Training Network (ICTN), $79,469 (2012-2013)

Staff involved: Sheila Keane, Senior Lecturer Allied Health

Collaborators: Southern Cross University, Northern NSW Local Health District

Ageing well and productively: pathways to healthy workforce participation and care giving and the impact of medications and health care on healthy workforce involvement and care giving

This four-year fellowship looked at healthy workforce participation amongst the ageing population.

Funding: NHMRC Early Career Fellowship, $139,500 (2008-2012)

Staff: Dr Sabrina Pit , Dr Megan Passey

Collaborators: University of Newcastle (Professor Julie Byles), NHMRC Clinical Trials Centre (Professor Deborah Schofield, Dr Rupendra Shrestha)

Stakeholders' views on shared learning models in General Practice: a national survey

Rising numbers of medical students, Prevocational General Practice Placements Program (PGPPP) trainees and GP registrars requiring general practice placements, coupled with regional workforce shortages, have created time and financial impacts on Australian General Practitioner (GP) supervisors.

Vertically integrated (VI) education/training is a potential solution to capacity constraints. One of the ways in which VI can occur is through the teaching of multiple levels of learner together in shared education sessions (shared learning). This study examined via a national survey of multiple stakeholders how a shared learning model of teaching in general practice may affect GP training capacity in Australia.

A national anonymous online survey of GP supervisors , GP registrars , Prevocational General Practice Placement Program trainees), and medical students was conducted in Australia in 2012-13. The study measured items such as shared learning activities, barriers and facilitators, level of support from key stakeholders.

Funding: Health Workforce Australia

Staff: Dr Sabrina Pit

Collaborators: North Coast GP Training (Lead). Dr Thea van de Mortel (lead), Dr Peter Silberberg, Dr Christine Ahern.

An evaluation of existing vertically integrated training practices at North Coast General Practice Training

The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master-apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model.

This study explored stakeholders’ perceptions of shared learning in general practices in northern NSW, Australia. A qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices.

Three researchers conducted a thematic analysis on 33 transcripts. Participants perceived many benefits to shared learning, including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload.

Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to receive remediation; address a specific deficit or immediate learning needs; learn communication or procedural skills; be given personalised feedback; or be observed by their supervisor during consultations.

Learners’ acceptance of shared learning appeared partially dependent on their supervisors’ small group teaching and facilitation skills. Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners.

Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model, thereby maximising learners’ learning outcomes and experiences.

Funding: GP Education and Training, $195,840

Staff involved: Dr Sabrina Pit, Professor Lesley Barclay

Collaborators: North Coast GP Training (Lead). Dr Thea van de Mortel (lead), Dr Peter Silberberg, Dr Christine Ahern.

Intention to stay and intention to leave: Are they two sides of the same coin? A cross sectional structural equation modeling study among health and social care workers

“Intention to leave” (ITL) has been used interchangeably with the more positive construct “intention to stay” (ITS) by human resource practitioners and researchers. The objectives were: (i) to test whether these constructs were similar measures of the same construct, and (ii) to assess the strength of the relationship between ITL and ITS with work-related outcomes.

Methods: The Workforce Dynamics Questionnaire (WDQ) was administered to 298 staff. The WDQ included two items on ITL and was supplemented with three items on ITS. Structural equation modelling (SEM) was used.

Results: The response rate was 43%. The correlation between the two constructs was negative and quite high (r= -0.84), indicating potential issues with discriminant validity. However, the constructs behaved differently in relation to job satisfaction and job integration. ITS was a strong predictor (0.95, p<0.001), whereas ITL was not significantly related (0.34, p=0.195) to JS. The direct effects of JI on ITS was 0.30 and on ITL was -0.42. The indirect effects of JI were more contrasting, being 0.56 for ITS and -0.30 for ITL, via job satisfaction.

Conclusions: This is the first study amongst British health and social care workers that has demonstrated that ITS and ITL are not measuring the same constructs. While there is overlap, care should be taken when using these constructs interchangeably, particularly when measuring these concepts in organizations and when developing retention programs, policies, or activities to modify ITS and ITL.

Funding: Southern Cross University

Staff: Dr Sabrina Pit

Collaborators: Southern Cross University (Professor Susan Nancarrow, Dr Joanne Bradbury ), University of Sheffield (Dr Steven Ariss)

Early Career Researchers Publish or Perish: How to increase your publication output

Researchers are challenged to “publish or perish”. However, a range of barriers to writing can result in sub-optimal productivity, particularly for early career researchers. Researchers in rural areas may face additional challenges of distance and limited access to colleagues.

Implementing strategies to address some of these obstacles was identified as a priority for a group of early career, rural researchers. In late 2010, the Wiljo-Piri Writing Group was established, embarking on 1) fortnightly lunch-time meetings for support, networking and the public setting of writing goals; and 2) pairing of ‘writing buddies’ committed to writing daily, with contact before and/or after each writing session to provide motivation and accountability.

Key measures for improvement were publication output – publications per person per year (PPY) – and perceptions of effectiveness of strategies. Publication output varied between individuals and over time, but overall PPY rates improved from 0.5 to 1.25. ‘Buddy writing’ helped facilitate adherence to routine writing sessions and was associated with perceptions of increased creativity, efficiency, confidence and ability to focus.

Conclusions: Structured peer support can be a powerful tool to create and maintain regular writing practices and increase publication output. ‘Buddy writing’ is applicable to any research or academic setting, and helps maintain commitment to daily writing sessions. Furthermore, such interventions can provide peer support for those working in rural settings, helping to address issues such as geographical and professional isolation.

Staff: Dr Jenn Johnston, Dr Shawn Wilson, Ms Liz Rix, Dr Sabrina Pit.

A small unconditional non-financial incentive suggests an increase in survey response rates amongst older General Practitioners (GPs): a randomised controlled trial.

This study assessed the effectiveness of offering a small unconditional non-financial incentive to increase survey response rates amongst GPs within a randomised controlled trial. GPs were randomised to receive an attractive pen or no pen during their first invitation for participation in a survey. GPs could elect to complete the survey online or via mail.

This study did not find a statistically significant effect of a small, unconditional, non-financial incentive (in the form of a pen) on survey response rates. No GPs completed the online version. A small unconditional non-financial incentive, in the form of a pen, may improve response rates for GPs.

Staff: Dr Sabrina Pit, Ms Vibeke Hansen.

Collaborators: Northern Rivers GP Network (Dr Dan Ewald)

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