Factors Affecting the Retention of Indigenous Australians in the Health Workforce: A Systematic Review

Abstract

Indigenous Australians are under-represented in the health workforce. The shortfall in the Indigenous health workforce compounds the health disparities experienced by Indigenous Australians and places pressure on Indigenous health professionals. This systematic review aims to identify enablers and barriers to the retention of Indigenous Australians within the health workforce and to describe strategies to assist with development and retention of Indigenous health professionals after qualification. Four electronic databases were systematically searched in August 2017. Supplementary searches of relevant websites were also undertaken. Articles were screened for inclusion using pre-defined criteria and assessed for quality using the Mixed Methods Assessment Tool. Fifteen articles met the criteria for inclusion. Important factors affecting the retention of Indigenous health professionals included work environment, heavy workloads, poorly documented/understood roles and responsibilities, low salary and a perception of salary disparity, and the influence of community as both a strong personal motivator and source of stress when work/life boundaries could not be maintained. Evidence suggests that retention of Indigenous health professionals will be improved through building supportive and culturally safe workplaces; clearly documenting and communicating roles, scope of practice and responsibilities; and ensuring that employees are appropriately supported and remunerated. The absence of intervention studies highlights the need for deliberative interventions that rigorously evaluate all aspects of implementation of relevant workforce, health service policy, and practice change.

Addressing provider turnover to improve health outcomes in Nunavut

“…38 Based on the data presented in this paper, in Nunavut specifically, it is retaining medical personnel that has been challenging, rather than recruiting them. We know much about factors that contribute to provider turnover and have access to a number of ideas and strategies to address it, but we need more evaluative evidence on the initiatives as well as the effectiveness of specific strategies (examples can be found in the conclusions of some of these reviews 35,39 ). We hope to encourage researchers and professionals to report on various initiatives and their evaluation findings.…”

Promoting perceived insider status of indigenous employees

“…However, it is important 622 CCSM 26,4 not to overcharge employees so that they can have free time to engage in innovative behavior (Wang et al, 2017) and to achieve objectives (Guillaume et al, 2014). Indeed, work overload can cause stress, exhaustion and lead to resignation (Lai et al, 2018). The attribution of clear, adequately defined, realistic and attainable objectives favors psychological health and well-being (Lai et al, 2018;Trompf, 1996;Whiteside et al, 2006).…”

“…are respectful of the environment, given indigenous employees' connectedness to the landHaley and Fisher (2014),Kunz et al (2000),Lawrence (2005),Loxton et al (2012), McRae-Williams and Gerritsen (2010),Pearson and Daff (2013) andRuwhiu and Elkin (2016) Maintaining good work relationships Ban racist behaviors, as indigenous employees would rather not work than be victims of inappropriate behaviorsBiddle et al (2013) andO'Faircheallaigh (2006) Implement mandatory cultural awareness programs for all employees; develop contents of cultural awareness programs with communitiesBrereton and Parmenter (2008),Burgess and Dyer (2009),Chesley (2016),Crawley and Sinclair (2003),Day et al (2004),Ewing et al (2017),Ferdinand et al (2014),Haley and Fisher (2014),Jose (2013),Lai et al (2018),Lawrence (2005),Mills and Clarke (2009),Parmenter and Trigger (2018),Rerden and Guerin (2015) andRussell (2013) Organize activities unrelated to work and focusing on indigenous cultures…”

“…Day et al (2004),Haley and Fisher (2014),Lai et al (2018),Loxton et al (2012),McRae- Williams and Gerritsen (2010) andRerden and Guerin (2015) Fostering support from community Encourage family support, promote Indigenous models and success storiesBrereton and Parmenter (2008),Burgess and Dyer (2009), Maru and Davies (2011), McRae-Williams and Gerritsen (2010), Rerden and Guerin (2015) and Rodon and Lévesque (2015) Organize awareness-raising activities regarding the benefits of Indigenous involvement in the labor market Burgess and Dyer (2009), Haar et al (2012), Haley and Fisher (2014), Jose (2013), Lawrence (2005), Loxton et al (2012), Maru and Davies (2011), Parmenter and Trigger (2018), Pearson (2000) and Russell (2013) Contribute to the economy of indigenous communities by buying local goods and services, donating to non-profit organizations and sponsoring events Haley and Fisher (2014) Monitoring of practices Develop and implement employment policies and practices in collaboration with indigenous communities, taking into account that cultures are dynamic and that needs evolve Brougham and Haar (2012), Day et al (2004), Ewing et al (2017), Haley and Fisher (2014), Jose (2013),Kuntz et al (2014) andRerden and Guerin (2015) …”

Working Well: Strategies to Strengthen the Workforce of the Indigenous Primary Healthcare Sector

“…However, many Indigenous PHC services struggle to implement these priorities [7]. A systematic review found that barriers to Indigenous health workforce retention include systemic factors such as limited organisational funding and inadequate remuneration and limited career pathways; organisational factors such as heavy workloads and demands, lack of support from management and lack of mentoring, and professional development opportunities; and proximity to community on the individual level [8]. Factors that affect the engagement of Indigenous people with education, training and employment included racism, family and community responsibilities, stress, isolation and poor secondary education [9].…”