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Health services research
Research
Costs and effects of higher turnover of nurses and Aboriginal health practitioners and higher use of short-term nurses in remote Australian primary care services: an observational cohort study
  1. Yuejen Zhao1,
  2. Deborah Jane Russell2,
  3. Steven Guthridge3,
  4. Mark Ramjan4,
  5. Michael P Jones5,
  6. John S Humphreys6,
  7. John Wakerman2,7
  1. 1 NT Department of Health, Innovation and Research, Darwin, Northern Territory, Australia
  2. 2 College of Medicine and Public Health, Flinders Northern Territory, Alice Springs, Northern Territory, Australia
  3. 3 Child Development, Population Health and Policy, Menzies School of Health Research, Casuarina, Northern Territory, Australia
  4. 4 Primary Health Care, NT Department of Health, Darwin, NT, Australia
  5. 5 Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia
  6. 6 Monash Rural Health, Monash University, Bendigo, Victoria, Australia
  7. 7 Centre for Remote Health, Alice Springs, Northern Territory, Australia
  1. Correspondence to Dr Deborah Jane Russell; deb.russell{at}flinders.edu.au

Abstract

Objectives To compare the costs and effects of higher turnover of resident nurses and Aboriginal health practitioners and higher use of agency-employed nurses in remote primary care (PC) services and quantify associations between staffing patterns and health outcomes in remote PC clinics in the Northern Territory (NT) of Australia.

Design Observational cohort study, using hospital admission, financial and payroll data for the period 2013–2015.

Setting 53 NT Government run PC clinics in remote communities.

Outcome measures Incremental cost-effectiveness ratios were calculated for higher compared with lower turnover and higher compared with lower use of agency-employed nurses. Costs comprised PC, travel and hospitalisation costs. Effect measures were total hospitalisations and years of life lost per 1000 person-months. Multiple regression was performed to investigate associations between overall health costs and turnover rates and use of agency-employed nurses, after adjusting for key confounders.

Results Higher turnover was associated with significantly higher hospitalisation rates (p<0.001) and higher average health costs (p=0.002) than lower turnover. Lower turnover was always more cost-effective. Average costs were significantly (p<0.001) higher when higher proportions of agency-employed nurses were employed. The probability that lower use of agency-employed nurses was more cost-effective was 0.84. Halving turnover and reducing use of a short-term workforce have the potential to save $32 million annually in the NT.

Conclusion High turnover of health staff is costly and associated with poorer health outcomes for Aboriginal peoples living in remote communities. High reliance on agency nurses is also very likely to be cost-ineffective. Investment in a coordinated range of workforce strategies that support recruitment and retention of resident nurses and Aboriginal health practitioners in remote clinics is needed to stabilise the workforce, minimise the risks of high staff turnover and over-reliance on agency nurses and thereby significantly reduce expenditure and improve health outcomes.

  • Health Economics
  • Health Economics
  • Health Policy
  • Human Resource Management

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023906

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors YZ contributed to the design of the study and led analysis and drafting of the paper. JW conceived and contributed to design of the overarching study and assisted with drafting the paper. JSH contributed to the conceptualisation and design of the study and assisted with drafting the manuscript. MPJ, SG, MR and DJR contributed to the design of the study, particularly the quantitative component, and provided comments on the manuscript. All authors read and approved the final manuscript.

    • Funding This work was supported by the Australian Research Council’s Discovery Projects funding scheme (project number DP150102227). The funder had no input in to the design, conduct and reporting of this analysis.

    • Competing interests None declared.

    • Ethics approval Ethics approval was received from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (2015-2363).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The datasets generated and analysed during the current study are not publicly available due to identifiability of remote primary care providers and the need to protect their privacy.

    • Author note Original protocol for the study: The original protocol for the study is published and available (open access): Wakerman J, Humphreys JS, Bourke L, Dunbar T, Jones M, Carey T, et al. Assessing the impact and cost of short-term health workforce in remote Indigenous communities in Australia: a mixed methods study protocol. JMIR research protocols. 2016;5(4):e135.