Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce.

BACKGROUND: Recruiting and retaining a skilled health workforce is a common challenge for remote and rural communities worldwide, negatively impacting access to services, and in turn peoples' health. The research literature highlights different factors facilitating or hindering recruitment and retention of healthcare workers to remote and rural areas; however, there are few practical tools to guide local healthcare organizations in their recruitment and retention struggles. The purpose of this paper is to describe the development process, the contents, and the suggested use of The Framework for Remote Rural Workforce Stability. The Framework is a strategy designed for rural and remote healthcare organizations to ensure the recruitment and retention of vital healthcare personnel. METHOD: The Framework is the result of a 7-year, five-country (Sweden, Norway, Canada, Iceland, and Scotland) international collaboration combining literature reviews, practical experience, and national case studies in two different projects. RESULT: The Framework consists of nine key strategic elements, grouped into three main tasks (plan, recruit, retain). Plan: activities to ensure that the population's needs are periodically assessed, that the right service model is in place, and that the right recruits are targeted. Recruit: activities to ensure that the right recruits and their families have the information and support needed to relocate and integrate in the local community. Retain: activities to support team cohesion, train current and future professionals for rural and remote health careers, and assure the attractiveness of these careers. Five conditions for success are recognition of unique issues; targeted investment; a regular cycle of activities involving key agencies; monitoring, evaluating, and adjusting; and active community participation. CONCLUSION: The Framework can be implemented in any local context as a holistic, integrated set of interventions. It is also possible to implement selected components among the nine strategic elements in order to gain recruitment and/or retention improvements.

Primary care emergency team training in situ means learning in real context.

OBJECTIVE: The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. DESIGN, SETTING AND SUBJECTS: As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants' understanding of team training. RESULTS: In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants' own sense of responsibility. CONCLUSION: Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants' own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. KEY POINTS Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning. The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions. Providing room for the participants' own priorities and sense of responsibility allows for improvement on several levels. The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves.

Duration of general practitioner contracts.

BACKGROUND: The regular GP scheme is intended to promote continuity in the relationship between doctor and patient. The duration of GP contracts is therefore a key factor in the success of the scheme. This study examines how long the GP contracts last and whether their duration varies according to doctors' gender and age, municipality size and list size. MATERIAL AND METHOD: The study encompasses 7,359 GP contracts throughout Norway, entered into between municipalities and doctors in the period 1 May 2001 - 1 May 2014. Duration is measured as the time from which the contract was signed until its expiry or the end of the study period. The material was analysed with measures of central tendencies and dispersion, Kaplan-Meier survival curve analysis and Cox proportional hazards regression. RESULTS: Median duration of a GP contract at the time of the study was 5.91 years. It varied between 2.75 years in the smallest municipalities and 8.37 years in the largest ones. The duration of a GP contract increased significantly if the doctor was a woman, or with the doctor's age at the start of the contract, increased municipality size and increased list size. INTERPRETATION: If it is assumed that continuity in the doctor-patient relationship provides a qualitatively better GP service, the results indicate that patients in small municipalities are generally offered a lower-quality service than patients in large municipalities.

Rural general practice patients' coping with hazards and harm: an interview study.

OBJECTIVE: The aim of this study is to identify and analyse rural general practice patients' experiences of hazards and harm that comprise adverse events, and their strategies for coping with them. DESIGN: Interview study using systematic text condensation and coping strategy theory in an abductive analysis process. SETTING: Nine rural general practice clinics in Norway. PARTICIPANTS: Twenty participants, aged 21-79 years, all presenting with recent onset of somatic and/or psychiatric complaints. RESULTS: Participating rural general practice patients described their experiences of a variety of hazards and harms. Their three most discussed cognitive and behavioural coping strategies were: (1) to accept the events; (2) to confront them and (3) to engage in planful problem-solving. While the participants demonstrated a tendency toward accepting hazards and harm that their regular general practitioner created, they were often willing to confront those that locum (ie, substitute) general practitioners created. Participants used planful problem-solving in situations they deemed hazardous, such as breaches of confidentiality or not being taken seriously, as well as during potential/actual emergencies. CONCLUSIONS: Patients at rural general practice clinics actively identify and respond to hazards and harm, applying three coping strategies. Thus, patients themselves may serve as an important safety barrier against hazards and harm; their potential contributions to improving patient safety must be appreciated accordingly and reflected in future research as well as in everyday clinical practice.

[Training in multiprofessional emergency medicine in primary health care]. / Tverrfaglig akuttmedisinsk teamtrening i kommunehelsetjenesten.

BACKGROUND: Most Norwegian hospitals have systematically trained trauma teams in cooperation with the BEST Foundation: Better & systematic trauma care. A group of general practitioners, ambulance personnel and primary care nurses have modified this training concept for use in general practise, with the aim to strengthen acute medical competence within Norwegian primary health care. This study describes experience gained with a training method for dealing with receival and stabilisation of victims of injury in multiprofessional teams in primary health care. MATERIAL AND METHODS: Multiprofessional training courses were held in 10 municipalities in Finnmark county in northern Norway. The course consisted of two hours of lectures on handling of critically injured patients in the primary care setting, followed by practical training with simulated patients. Communication, leadership and cooperation was emphasised during the training. The simulation sessions with dolls were video recorded and evaluated after each session. Individual questionnaires were distributed before and after training. RESULTS: Most municipalities that we contacted responded positively. Training was arranged for 22 teams and 145 participants completed questionnaires. The participants reported a significantly improved confidence in their own role and the correct order of necessary procedures. 91% would recommend the course to a colleague. INTERPRETATION: This group of different health professionals reported a great need for training and a high outcome after the intervention. The findings support further dissemination of this training method in Norwegian primary health care.