Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review

Abstract

Background Evidence-based programs (EBPs) are used across disciplines to integrate research into practice and improve outcomes at the individual and/or community level. Despite widespread development and implementation of EBPs, many programs are not sustained beyond the initial implementation period due to many factors, including workforce turnover. This scoping review summarizes research on the impact of workforce turnover on the sustainability of EBPs and recommendations for mitigating these impacts. Methods We searched 10 databases for articles that focused on an EBP and described an association between workforce turnover and the sustainment or sustainability of the program. We created a data abstraction tool to extract relevant information from each article and applied the data abstraction tool to all included articles to create the dataset. Data were mapped and analyzed using the program sustainability framework (PSF). Results and Discussion A total of 30 articles were included in this scoping review and mapped to the PSF. Twenty-nine articles described impacts of workforce turnover and 18 articles proposed recommendations to address the impacts. The most frequent impacts of workforce turnover included increased need for training, loss of organizational knowledge, lack of EBP fidelity, and financial stress. Recommendations to address the impact of workforce turnover included affordable and alternative training modalities, the use of champions or volunteers, increasing program alignment with organizational goals, and generating diverse funding portfolios. Conclusion The sustainment of EBPs is critical to ensure and maintain the short- and long-term benefits of the EBP for all participants and communities. Understanding the impacts of workforce turnover, a determinant of sustainability, can create awareness among EBP-implementing organizations and allow for proactive planning to increase the likelihood of program sustainability.

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

“…Training is a common implementation strategy used to enhance the knowledge and skills of clinicians, or those working in community settings, to effectively implement EBIs. Systematic reviews of the sustainability of EBIs have however consistently found that staff turnover is a key determinant to EBI sustainment (9,10). High staff turnover can significantly impact an organisations ability to continue to deliver an EBI, as there is a loss of corporate knowledge when trained staff leave, while new staff may have limited understanding of the need for the EBI or competence to effectively deliver it.…”

What Contributes to Sustainability? Examining Access to Medications for Opioid Use Disorder in Low-Adopting VHA Facilities

“…Pascoe and colleagues found that staffing issues can be addressed by several strategies including the use of champions or volunteers. 19 We found that a couple of facilities had at least one person who spent focused time on spreading the use of MOUD. This is similar to having a champion which is defined as individuals who dedicate themselves to supporting and driving through an implementation.…”

“…A recent scoping review showed that workforce turnover is a significant threat to the sustainability of evidence-based programs. 19 MOUD delivery is a provider-delivered treatment and not a self-management intervention. The staffing issues reported in this study included turnover, vacancies, and shortages that also affected time available dedicated to MOUD implementation.…”

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

“…This was only a small number of people over the 12 months of the study but may have influenced the results. This is a known issue in the sustainability of change [ 41 ]. In addition, while every effort was made to ensure the data analysis was a true representation of the implementation, the inclusion of the facilitators in data analysis may have had unknown impact on the overall outcomes.…”