‘Viable and impactful’ – the rural health workforce solution

RURAL communities can attract more health workforce professionals to their community, increase revenue for their town and widen access to preventive care, early diagnosis and early treatment for health conditions, should they commit to the Attract Connect Stay program.

These were a few of many findings to come out of the evaluation of the Attract Connect Stay pilot program by Dr Anna Moran of unplex.

The Attract Connect Stay project

Attract Connect Stay (ACS) is an evidence-based, place-informed rural health workforce solution, underpinned by 10 years of rural health workforce research. The ACS program was funded by the Foundation for Rural Regional Renewal (FRRR) as a two-year, community-based participatory action research project.

The purpose of the program was to develop and pilot a Blueprint that codified the necessary steps required to plan for and implement the ACS solution, embodied by a Health Workforce Recruiter Connector (HWRC), into rural communities in New South Wales and Victoria, Australia.

What happened?

Based on a synthesis of all information gathered, it was concluded that the ACS project fully achieved three of five of its goals and partially achieved the remaining two. ACS enabled real-time development and piloting of an evidence-informed Blueprint in co-design with a single rural community in Australia.

“Key learnings from the project included a deep and thorough understanding of the critical activities and mechanisms required to successfully implement a HWRC into small (population 8,000 – 20,000) rural communities in Australia. These have been codified in the Blueprint,” Dr Moran says.

Pilot site A was hugely successful, within the first 6 months of a Health Workforce Recruiter Connecter in place they saw seven health professionals and their families supported to move to and/or settle/connect into the rural community. This includes 2 GPs, 1 Pharmacist, 1 Exercise Physiologist, 1 Diabetes Educator, 1 Nurse Practitioner, and 1 Speech Pathologist.

“The addition of the first GP in August 2022 has led to 70 patients being moved off the waiting list, equating to 224 hours of additional clinical care provided to the community over a 3.5-month period. The second GP will commence in mid-November 2022, enabling the Glen Innes Highlands to move at least 70 more patients off the waiting list and provide significantly more hours of clinical care.” Dr Moran says

“The net movement of seven healthcare professionals and their family members (2 adults and 3 children) to Glen Innes Highlands represents a (conservative) approximate gain of $520,000 to the community based on annual average household spending for a typical Australian resident.”

Furthermore, there has been deep satisfaction with the program and gratitude to the community from the overseas trained GP and his family.

“I feel really excited, and comfortable too. So, I think we are really prepared and we are planning to stay for the long term,” the new GP stated.

Dr Moran noted this has led to a positive experience of the community from the outset, early engagement with the community and early signs of the family having the support they need to settle into and connect with the community.

Where to from here?

The evaluation determined that Attract Connect Stay is a viable and impactful solution to addressing complex rural health workforce problems in small- to medium-sized rural communities.

Viability and impact however, are contingent upon the rural community:

• Intimately and collectively understanding and wanting to overcome the health workforce problems they face.
• Critically assessing whether or not they have the necessary pre-conditions to successfully undertake the Attract Connect Stay solution to address their health workforce problems.
• Rallying together and leveraging their assets and strengths to undertake all steps in the program in the appropriate order.
• Generating and/or securing appropriate funding that supports place-based implementation of the program.
• Seeking mentoring to adapt each step in the program to the local context.

And so, there is still work to be done. Opportunities for rural communities to source sustainable and secure funding for implementing a HWRC are needed for the long-term success of the ACS solution.

“Further work is needed to improve health workforce literacy and to understand how the ACS solution and the Blueprint can be used to support communities to go beyond just strengthening their medical workforce and to extend their efforts to attracting and retaining allied health professionals ” Dr Moran says.

You can read the full evaluation here.

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Blog – How to solve chronic rural health workforce shortages in your community

Dr Cath Cosgrave has been on a mission to address the chronic rural health workforce shortages across the country. With a decade of research under her belt, including countless hours of interviews with health professionals and rural community members, Dr Cosgrave has discovered not only discovered the key factors fueling the current shortage – but she has also created a solution.

It’s not surprising to know there are many complex reasons rural communities struggle to attract and retain a strong health workforce.

Dr Cosgrave’s key findings are:

• Attracting and retaining a rural health workforce is complex – there are no simple solutions because people are also complex
• Social factors strongly affect the retention of newcomers
• The first 12 months is particularly challenging for newcomers
• Rural communities need to be more inclusive and welcoming of newcomers; they need support to form social bonds, especially with locals
• Health professional workforce strengthening strategies must be tailored for – particular social and geographical context of a community and – actively involve residents in their planning and delivery

However, knowing these – even though complex, has allowed for action to be taken. Using her research as the guide, Dr Cosgrave created the Whole-of-Person Retention Improvement Framework (WoP-RIF), which identifies three domains impacting retention:

1. Workplace/Organisation
2. Role/ Career
3. Community/Place

It’s from these findings and the WoP-RIF that Attract Connect Stay program was born – and there have been some incredible results for the early-adopting communities.

Why Attract Connect Stay?

National Rural Health Commissioner Ruth Stewart has thrown her support behind the program, citing Attract Connect Stay as one of the community-led solutions able to implement real change for rural communities.

“In our rural communities….we need multi-disciplinary (healthcare) teams working in strong models that provide professional support and sustainable employment. We know that when the strategies to implement that —are in place, it works to keep people. That’s what I love so much about the Attract Connect Stay program,” Ruth said.

“Cath’s (whole-of-person retention improvement) framework provides us with the opportunity to improve our understanding and act on social elements and strategies to attract and retain professionals to the rural workforce. It recognises the importance of community involvement – it’s not just ‘what can the Government do for us?’; it’s ‘what can we do for ourselves and our community?’, to attract and retain rural health workforce.

She said the fact the program recognises the importance of the whole person – not just who that person is (professionally) and what that person can do when they walk through the door of the workplace – makes the difference.

“Recognising who they are when they are living in the community, how they can connect to that community and contribute in many ways not just their in their working life – that’s important.”

How do we know it works to combat rural health workforce shortages?

Anna Moran of Unplex, has worked closely with Dr Cath Cosgrave on evaluating the Attract Connect Stay program. Her role has been as an embedded evaluator, meaning she has evaluated the experiences of the communities who have embraced the program, and its impact.

“We know these roles (Health Workforce Recruiter Connector ) allow for net movement of skilled professionals to rural communities and they allow for an increased awareness of lifestyle and employment opportunities in rural townships,” Dr Moran said.

“Most importantly – we’ve seen significant levels of satisfaction among newcomer health professionals who have used the program. For these new to area employees, we’ve seen high levels of intention to stay …. beyond 12 months, as well as a positive experience of moving to a rural community and have developed a sense of belonging.”

From the mouths of the participants

Sheryn Nourse, from Glen Innes Highlands said the most important factor underpinning the success of Attract Connect Stay so far was that the community was ready to participate.

“Attract Connect Stay came to our community at a time of crisis. One of our 4 medical practices was closing which releases several hundred patients back into an already overloaded system.

“Glen Innes was selected as the NSW Attract Connect Stay pilot site – and we’d already done some significant thinking before we went into the program which gave us a great foundation.

She said understanding the Attract Connect Stay model is key to success for any community.

“People have to understand that Attract Connect Stay isn’t about solving the problems in the health system – its about building and strengthening from the bottom, up; growing a local constituency and building community support.”

Bim Rutherford of Greater Shepperton said since the inception of the program 22 months ago, they have relocated 332 new-to-area professionals and their families. Only 5 have left in the last 12 months.

“We’ve brokered really amazing relationships with local real estate professionals to ensure accommodation for incoming professionals, and that has been one of the key successes to attracting people to the area,” Bim said.

Meanwhile Mark Drury of Dundaloo Support Services, who is at the very early stages of implementing the Attract Connect Stay program, said partnering with Mid Coast Council has been an exciting to start. One of the key factors in getting people on board was utilising Cath’s knowledge of, and passion for, the program.

“Cath is awesome at delivering her research, and it’s an obvious no-brainer when community leaders listen to her that it’s something they need to go with…it’s really important to use her to keep the momentum going.”

What next?

Attract Connect Stay is available to all rural communities across Australia, who want to address and resolve their health workforce issues.

How to Attract Healthcare Workers to Your Community: The Solution that Works is a webinar featuring the abovementioned professionals, all whom have experience with the program. You can delve more into what they had to say here.

To discover whether your community is ready, visit our website here. Or subscribe here to organise a free 30 minute consultation with Dr Cosgrave to discuss whether the Attract Connect Stay solution is right for your community

Blog – ‘Magic sauce’ ingredients helping improve access to healthcare in rural communities.

Chronic healthcare workforce shortages and high turnover of health professionals are a common challenge facing many rural communities. But there is a solution! 

Attract Connect Stay is using some ‘magic sauce’ ingredients as part of a proven strategy to help build a stronger healthcare workforce in rural communities. 

Growing a strong health workforce in rural communities 

The Attract Connect Stay model is built on Dr Cath Cosgrave’s 25+ years’ experience working with rural communities developing community-centred, strength-based strategies to effectively address local health and community service issues.  

Dr Cosgrave has long been passionate about addressing rural access inequities and resourcing challenges, coupled with her desire to support rural communities to become thriving and sustainable places to live and work.   

It was in 2019 on a Churchill Fellowship trip to Canada, she came across Marathon community’s approach to addressing their own critical health workforce shortages. 

“In 2009, in Marathon, Ontario Canada the community responded to a critical healthcare workforce shortage by establishing a locally-funded, locally-recruited and community-managed Health Workforce Recruiter Connector position. Since then, there have been no health workforce shortages,” Dr Cosgrave says. 

She knew there were some lessons to be learned from the Marathon community’s approach. 

Why does it work? 

Dr Cosgrave says there are some key ‘magic sauce’ ingredients of Marathon’s Health Workforce Recruiter Connector that helped shape the Attract Connect Stay program. 

These are:  

Funding
1. Local businesses and services (including local government; health services and major employers/businesses) are the main source of funding for the HWRC position
2. HWRC is a dedicated position and sustainable local funding sources are secured within three years of starting.  

Contracting
3. HWRC is engaged on an annual deliverables contract basis with set total hours.  

Delivery approach
4. HWRC is demand driven position and the incumbent works flexibly to meet local healthcare workforce needs as they arise
5. HWRC provides a concierge service and has customer service skills and experience
6. HWRC has strong local networks and skills and experience building external networks
7. HWRC updates the community on recruitment and retention developments and successes are celebrated  

Management
8. The HWRC is overseen by a management committee comprising community leaders and local health organisations  

Community engagement
9. Residents of the local community provide in-kind supports to allow interested candidates and new workers (and their families) to experience the lifestyle and recreational features of the local area
10. Residents of the local community develop a strong understanding of the challenges of attracting, and retaining health professionals and understand the need to fund a dedicated and continuous Health Workforce Recruiter Connector position. 

How does it look for your community? 

The goal of the Attract Connect Stay project is to create a website with tools and resources to support rural communities to successfully establish, manage and financially sustain their own Rural Health Recruiter Connector position.  

“It’s important to take some time to consider the magic ingredients in your community,” Dr Cosgrave says. 

“Things such as funding and fundraising, management, contract terms, implementing a customer-service approach and engaging the whole community.” 

If you’re unsure whether your community is ready for the Attract Connect Stay program – it’s simple to discover. Part 1 of the Attract Connect Stay readiness course will help you decide if the Attract Connect Stay solution is a good fit for your rural community. And it’s free! 

Get started here. 

Blog – Helping rural communities grow a stronger health workforce

Living in a rural area appeals to many for an abundance of reasons – but it often means sacrificing access to a strong health workforce. It doesn’t have to be this way. 

Following almost a decade of research and hundreds of interviews with rural health staff, Dr Cath Cosgrave has created a person-centred and holistic approach aimed at tackling the long-standing health workforce shortage problem facing many rural communities.  

The Attract Connect Stay program is gaining attention across Australia, giving new hope to rural communities that they can, in fact, attract and retain great healthcare professionals in their region. 

The rural health workforce issue 

Chronic health workforce shortages and high turnover of health professionals are a common challenge facing many rural communities. 

Dr Cosgrave explains the big issue is maldistribution. There is an oversupply of health professionals in metropolitan areas and an undersupply in rural areas. 

“These health workforce shortages intensify the more remote the community is, particularly for the allied health and medical workforces,” Dr Cosgrave said. 

“In Australia, the impact of this maldistributed health workforce is that rural Australians experience poorer health outcomes than their city counterparts—living shorter lives, acquiring greater levels of chronic disease, sustaining more injuries, and experiencing poorer mental health.” 

Why is this so? 

Dr Cosgrave’s research has revealed that health professionals’ decisions to accept a rural health position, and their subsequent decision to stay or leave, are complex and influenced by ‘a myriad of highly interactive dimensions within personal, organisational, social and spatial domains’. 

These influences can be broadly categorised into three domains: 

• organisational (or workplace); 

• role (including profession and career development opportunities); and 
• personal (including individual characteristics, spousal and family support, social aspects, and lifestyle interests). 

While career and workplace opportunities are important in retaining healthcare professionals, community and ‘feeling settled’ plays a crucial role in retention. 

“The research identifies if ‘newcomers’ did not develop strong social bonds within the first 12-months of relocating, then turnover is likely,” Dr Cosgrave explains. 

How do we help? 

There are current government and rural health service initiatives aimed at boosting the rural health workforce but they fail to address two significant influences on recruitment and retention. 

These factors are: 

• the personal needs of individual health professionals; and 
• the unique contextual circumstances of rural communities. 

“There is an urgent need for a ‘fundamental reframing’ of the rural health recruitment and retention problem. This change is not about rejecting the old – in fact there is much merit in governments’ pursuit of a rural pipeline strategy given its positive influence on the rural practice intentions of medical graduates,” Dr Cosgrave says. 

“The reframing required, is to move from a narrow economic understanding of the maldistributed health workforce problem towards a more person-centred and holistic approach.” 

The development of the Whole-of-Person Retention Improvement Framework and the Attract Connect Stay program, is Dr Cosgrave’s response to this call. 

Enter: Attract Connect Stay 

Attract Connect Stay is a proven, grass roots, bottom-up program, mobilising the passion, knowledge and practical skills of residents, community groups and local organisations to better attract and retain health workforce professionals.  

The Attract Connect Stay solution is to establish a locally-funded, locally-recruited and community-managed – Health Workforce Recruiter Connector (HRWC). 

“The HWRC’s role is to build networks to better identify and successfully ATTRACT out-of-area health professionals who are a ‘strong fit’ for local healthcare positions and for the local community,” Dr Cosgrave says. 

“The HWRC is then responsible for assisting newcomer health professionals (and their families) to CONNECT by supporting them with settling-in (including helping partners find suitable employment) and helping them build social connections. The HWRC does this by drawing on and linking newcomers into local networks and supports.  

“The overall aim of HWRC position is to build and strengthen the local health workforce by identifying and attracting out-of-area health professionals to relocate and then supporting them in tailored ways that will encourage them to choose to STAY.” 

How do you get involved? 

It’s simple – and free. Dr Cosgrave has created a free, three step course that allows you to determine whether your community is a good fit for Attract Connect Stay and how to implement and sustain it, step-by-step. 

You can find out more, or get started, here.