Abstract: Background: Delivering effective primary care to where it’s needed most—specifically remote Aboriginal communities—is hampered by high turnover and low stability of health clinic staff. This research investigates changes over time in staff turnover and stability in remote communities in the Northern Territory. Method: This study used descriptive statistics and multiple linear regression to analyse Department of Health payroll data, 2004-2015, for all staff based at 54 government-run remote NT clinics. Main outcome measures: annual turnover rates and 12-month stability rates in a specific remote community. Main outcomes were investigated by clinic, calendar year, professional discipline, employment level, age and geographical remoteness. Results: Annual turnover rates for all staff averaged 118% (95%CI 113, 124), declining significantly over time (175% in 2004 to 92% in 2015; p<0.05). Turnover rates were significantly lower during the NT Emergency Response (66% lower, 95%CI 48, 85). The most stable clinic had a mean 12-month stability rate for all staff that was 6 times higher than the least stable clinic (11%-66%, c2 35.6, p<0.01). There was a significant trend of increasing stability rates for all staff during the study period (increasing from 41% in 2004 to 51% in 2015; c212.5, p<0.01), averaging 49% overall (95%CI 46, 52). Aboriginal Health Practitioners had significantly lower annual turnover rates (53%; 95%CI 46, 61), higher stability rates (71%; 95%CI 62, 78) and longer median employment survival (1.19 years; p<0.01) compared to other professional groups. Nurses had significantly higher annual turnover rates (150%; 95%CI 141, 160) than administrative staff, though stability rates were no different. Median survival of nurses and administrative staff were 0.46 and 0.62 years respectively. Discussion: Turnover rates for all staff almost halved between 2004 and 2015 and 12-month stability rates improved significantly. Turnover, averaging 92%, and 12-month stability at 49%, are both at unacceptable levels, thus compromising continuity of care. This is particularly problematic for effective management of complex and chronic conditions. These staffing patterns demand high and sustained resourcing, and constant effort to stabilise the remote health workforce. Increased recruitment and training of local Aboriginal people into clinical and non-clinical professions are key to improved access and culturally safe care in remote clinics. Job satisfaction and retention can also be improved by ensuring that all employees feel valued and supported, and their community knowledge and cultural skills are recognised and respected along with their clinical skills.
Russell, Deborah, Zhao, Yuejen, Ramjan, Mark, Guthridge, Steve, Wright, Jo, Jones, Mike, Humphreys, John, Wakerman, John, 2019, Trends in health workforce turnover and stability in remote Northern Territory communities, Conference Paper, viewed 27 October 2020, https://www.nintione.com.au/?p=15770.