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Rural/Remote Recruiting and Retention Value-Based Redesign (R5) Project

Hunter New England Local Health District
Project Added:
12 October 2015
Last updated:
26 October 2015

The Rural/Remote Recruiting and Retention Value-Based Redesign (R5) Project

Summary 

This project addressed factors that had a significant impact on vacant full-time equivalent (FTE) positions, staff turnover, length of vacancies and the quality of consumers’ experience and engagement in care. 

Aim

To improve consumer experience and engagement through a redesigned recruitment, retention and staff induction process, using local solutions and resources.

Benefits

  • Reduces staff turnover and vacant FTE positions.
  • Reduces staff complaints and issues raised by visitors.
  • Enhances staff development and performance, with improved workplace culture.
  • Increases client contact and compliance with urgency of response time.
  • Improves overall consumer engagement and experience, resulting in better patient outcomes.

Project status

Dates

  • Start: January 2011
  • Finish: December 2013

Status

Sustained - The project has been implemented, is sustained in standard business.

Background 

Mehi/McIntyre Mental Health service is split evenly between three sites, all located in the most isolated areas of the district (RA3 and RA4 classification). As a result, it experienced high staff turnover and low position occupancy rates. Staff who remained with the organisation struggled to reflect its expectations, leading to performance levels of consumer experience and engagement well below what was deemed acceptable.

Studies show that issues such as isolation, attrition and low staffing can lead to outcomes including poor consumer engagement, increased severity and duration of illness and decreased life expectancy. This project aimed to address the issues of recruitment and retention, to improve the experience and engagement of consumers in the mental health sector.

Implementation 

  • Key performance indicators (KPIs) were reviewed across a number of domains, including vacant FTE positions, staff turnover, length of vacancies and the quality of consumers’ experience and engagement in care.
  • A literature review was undertaken to compare data from research papers, which showed similar trends and highlighted factors that contributed to the trends being witnessed.
  • Staff rounding allowed the team to gain a better qualitative picture of what was currently occurring and what staff required to provide quality care for local consumers.  
  • Rounding with new staff and exit interviews also allowed for an assessment of current practices and an understanding of what could be improved in order to address recruitment and retention issues.
  • A review of Incident Information Management System (IIMS) data was undertaken, to find common themes at times when consumers experienced less than optimal care.
  • The recruitment process was redesigned as follows:
    • established partnerships with Rural Doctors Network
    • collaborated with other local health recruiters to share eligibility lists and line up recruitment episodes
    • developed pre-recruitment packages for interested applicants
    • identified application mentors for interested applicants
    • allocated management time for engagement of prospective applicants
    • reviewed promotional literature and advertising based on rounding of all new employees and those placed on eligibility lists
    • engaged staff to encourage sharing of job advertisements
    • involved staff and heads of discipline in recruitment process.
  • The retention and staff development phase was developed as follows:
    • used telehealth to provide additional supervision and support
    • created community partnerships with social clubs to help staff settle into the organisation
    • developed partnerships with other services in larger centres, to provide training via temporary contracts so overtime could be reduced before they started employment
    • developed clear accountability and process documents for all major workplace activities
    • increased support for cluster staff to move between sites, providing physical links around the team
    • provided peer mentoring for all new staff, with a focus on local workplace culture and social integration outside of work
    • acknowledged team of completion of induction
    • developed relocation plan when employment was offered
    • formed a self-directed and paced induction program, based on mental health competencies and incorporating corporate requirements as well as local information
    • leveraged opportunities to present staff successes and positive news with the broader health community. 

Implementation sites

Mehi/McIntyre Mental Health Service, Hunter New England Local Health District (HNELHD) 

Results 

Measures used to quantify the issues were assessed over the period of implementation, to evaluate the overall effectiveness of the redesign.


2010
2011
2012
2013
IIMS relating to staff behaviour / Complaints
9
3
6
0
Client contacts (% KPI)
43.7%
66.0%
58.6%
106%
Compliance with urgency of response time
4.0% 4.0%
35.0%
60.9%
Total client contact hours (% hours worked) 
28.3%
42.8%
35.8%
48.0%
% Clients not seen within 91 days
38.0%
31.0%
14.0%
4.0%
Issues raised by official visitors
6
4
0
0
Number of vacant FTE positions
12
10
0
0
Staff turnover
55.0% 25.0%
10.0%
12.0%

In addition to these measures, qualitative data was collected to provide an insight into the success of individual strategies, including staff rounding, 30 and 90-day conversations, exit interviews and three-month performance reviews.

Consumer feedback questionnaires, patient experience tracker (PET) machines and patient rounding was used to consistently monitor quantitative outcomes from staff recruitment and retention processes and refine the curriculum for the induction of new staff.

The results show that the deficits initially identified are now congruent with results across the district and in some measures exceeded expected targets. KPIs are now collected at monthly accountability meetings, to ensure the program remains sustainable.

Some elements of the redesign process have been employed across the district, including the involvement of heads of discipline in recruiting and the use of checklists at key points of care.

Lessons learnt 

  • This project has potential to be implemented across all services, due to its values-based structure.
  • There have been enquiries from other mental health services within HNELHD regarding the implementation of some or all aspects of the redesign, however perceptions around the workload involved and reliance on standard recruitment processes due to time pressures remain a barrier for uptake.
  • Education can help to overcome barriers in take up and implementation of the project.
  • Breaking down and reporting work load commitments and the increased work from longer vacancy periods and recruitment of low performing staff can help to encourage uptake of this project.

Further reading

  • World Health Organisation. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. WHO Publishing: Geneva; 2010.
  • Hunter New England Local Health District. Hunter New England Local Health District Mental Health Clinical Services Plan 2014-2018. HNE LHD: Newcastle; 2014.
  • Chisholm M, Russell D, Humphreys J. Measuring rural allied health workforce turnover and retention: What are the patterns, determinants and costs? Australian Journal of Rural Health 2011; 19(2): 81-88.
  • Dept. of Health. 2009. Australian Standard Geographical Classification - Remoteness Area (ASGC-RA). Commonwealth of Australia.

Contact

Leigh Philpott
Service Manager, Mehi/McIntyre Mental Health Service
Hunter New England Local Health District
Phone: 02 6757 0222 / 0427 564 289
leigh.philpott@hnehealth.nsw.gov.au

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