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De Vries N, Lavreysen O, Boone A, Bouman J, Szemik S, Baranski K, Godderis L, De Winter P. Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace. Healthcare (Basel) 2023; 11:1887. [PMID: 37444721 DOI: 10.3390/healthcare11131887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital's mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.
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Affiliation(s)
- Neeltje De Vries
- Department of Internal Medicine, Spaarne Gasthuis, P.O. Box 417, 2000 AK Haarlem and Hoofddorp, The Netherlands
- Spaarne Gasthuis Academy, P.O. Box 417, 2000 AK Haarlem and Hoofdorp, The Netherlands
| | - Olivia Lavreysen
- Centre for Environment and Health, University of Leuven (KU Leuven), P.O. Box 952, 3000 Leuven, Belgium
| | - Anke Boone
- Centre for Environment and Health, University of Leuven (KU Leuven), P.O. Box 952, 3000 Leuven, Belgium
| | - José Bouman
- Spaarne Gasthuis Academy, P.O. Box 417, 2000 AK Haarlem and Hoofdorp, The Netherlands
| | - Szymon Szemik
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Kamil Baranski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Lode Godderis
- Centre for Environment and Health, University of Leuven (KU Leuven), P.O. Box 952, 3000 Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, 3000 Leuven, Belgium
| | - Peter De Winter
- Spaarne Gasthuis Academy, P.O. Box 417, 2000 AK Haarlem and Hoofdorp, The Netherlands
- Department of Paediatrics, Spaarne Gasthuis, P.O. Box 417, 2000 AK Haarlem and Hoofddorp, The Netherlands
- Leuven Child and Health Institute, University of Leuven (KU Leuven), P.O. Box 3717, 3000 Leuven, Belgium
- Department of Development and Regeneration, University of Leuven (KU Leuven), P.O. Box 611, 3000 Leuven, Belgium
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Carter BJ, Siddiqi AD, Chen TA, Britton M, Martinez Leal I, Correa-Fernández V, Rogova A, Kyburz B, Williams T, Casey K, Reitzel LR. Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4013. [PMID: 36901024 PMCID: PMC10001967 DOI: 10.3390/ijerph20054013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Tobacco use is the leading preventable cause of death in America and is elevated among patients with non-tobacco substance use disorders. Substance use treatment centers (SUTCs) do not commonly address their patients' tobacco use. Lack of knowledge on treating tobacco use with counseling and medication may be a barrier that underlies this inaction. A multi-component tobacco-free workplace program implemented in Texas SUTCs educated providers on treating tobacco use with evidence-based medication (or referral) and counseling. This study examined how center-level changes in knowledge from pre- to post-implementation (i.e., over time) affected center-level behavioral changes in providers' provision of tobacco use treatment over time. Providers from 15 SUTCs completed pre- and post-implementation surveys (pre N = 259; post N = 194) assessing (1) perceived barriers to treating tobacco use, specifically, a lack of knowledge on treating tobacco use with counseling or medication; (2) receipt of past-year education on treating tobacco use with counseling or medication; and (3) their intervention practices, specifically, the self-reported regular use of (a) counseling or (b) medication intervention or referral with patients who use tobacco. Generalized linear mixed models explored associations between provider-reported knowledge barriers, education receipt, and intervention practices over time. Overall, recent counseling education receipt was endorsed by 32.00% versus 70.21% of providers from pre- to post-implementation; the regular use of counseling to treat tobacco use was endorsed by 19.31% versus 28.87% from pre- to post-implementation. Recent medication education receipt was endorsed by 20.46% versus 71.88% of providers from pre- to post-implementation; the regular use of medication to treat tobacco use was endorsed by 31.66% versus 55.15% from pre- to post-implementation. All changes were statistically significant (ps < 0.05). High versus low reductions in the provider-reported barrier of "lack of knowledge on pharmacotherapy treatment" over time were a significant moderator of effects, such that SUTCs with high reductions in this barrier were more likely to report greater increases in both medication education receipt and medication treatment/referral for patients who use tobacco over time. In conclusion, a tobacco-free workplace program implementation strategy that included SUTC provider education improved knowledge and resulted in increased delivery of evidence-based treatment of tobacco use at SUTCs; however, treatment provision rates-in particular, offering tobacco cessation counseling-remained less than desirable, suggesting that barriers beyond lack of knowledge may be important to address to improve tobacco use care in SUTCs. Moderation results suggest (1) differences in the mechanisms underlying uptake of counseling education versus medication education and (2) that the relative difficulty of providing counseling versus providing medication persists regardless of knowledge gains.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
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Pascoe KM, Petrescu-Prahova M, Steinman L, Bacci J, Mahorter S, Belza B, Weiner B. Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211034581. [PMID: 37090007 PMCID: PMC9981891 DOI: 10.1177/26334895211034581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Kelley M Pascoe
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Miruna Petrescu-Prahova
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
| | - Lesley Steinman
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
| | - Jennifer Bacci
- School of Pharmacy, University of Washington, Seattle, USA
| | - Siobhan Mahorter
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Basia Belza
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
- School of Nursing, University of Washington, Seattle, USA
| | - Bryan Weiner
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Department of Global Health, University of Washington, Seattle, USA
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Brabson LA, Herschell AD, Snider MDH, Jackson CB, Schaffner KF, Scudder AT, Kolko DJ, Mrozowski SJ. Understanding the Effectiveness of the Cascading Model to Implement Parent-Child Interaction Therapy. J Behav Health Serv Res 2020; 48:427-445. [DOI: 10.1007/s11414-020-09732-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramos-Vidal I, Palacio J, Villamil I, Uribe A. Examining the effect of the individual characteristics of implementers and the interaction of multiple relationships on the structure of psychosocial intervention teams. Implement Sci 2020; 15:69. [PMID: 32859225 PMCID: PMC7456066 DOI: 10.1186/s13012-020-01032-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Teams' structure may undergo modifications due to the individual attributes of actors and collective-level variables. This research aims to understand the effect of extensive experience working in the program and the simultaneous interaction among different relationships in the network structure of a team of implementers. The Psychosocial Care Program for Victims of Conflict is implemented by psychologists, social workers, and community advocates. METHODS A cross-sectional study was carried out. Multivariate analysis, quadratic assignment procedures, and graphic visualization are used to (a) determine how seniority affects the professionals' level of centrality in the program and (b) clarify how the interaction among professionals favors new relationships. RESULTS Longer-lasting professionals in the program report stronger network bonding, predisposition to work, and information exchange. The nonparametric permutation test indicates an intense association between the information requests submitted and received and between the predisposition to work network and the network of received information requests. The results are discussed to optimize the teams implementing the intervention programs. CONCLUSIONS Network analysis is a powerfull tool to evaluate program implementation processes. Analyzing the interactions among multiples relationships that emerge between members of multidisciplinary teams allows knowing how certain relationships (e.g., information exchange) triggering other kind of relationships (e.g., users referral). The implementers who have been collaborating in the program for a long time are key informants who can facilitate the process of adaptation of newly incorporated professionals.
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Affiliation(s)
- Ignacio Ramos-Vidal
- Department of Social Psychology, University of Seville, Seville, Spain
- Research Group CAVIDA, Universidad Pontificia Bolivariana, Montería, Colombia
| | - Jorge Palacio
- Faculty of Psychology, Universidad del Norte, Barranquilla, Colombia
| | - Ilse Villamil
- Research Group CAVIDA, Universidad Pontificia Bolivariana, Montería, Colombia
| | - Alicia Uribe
- Research Group CAVIDA, Universidad Pontificia Bolivariana, Montería, Colombia
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Herschell AD, Kolko DJ, Hart JA, Brabson LA, Gavin JG. Mixed method study of workforce turnover and evidence-based treatment implementation in community behavioral health care settings. CHILD ABUSE & NEGLECT 2020; 102:104419. [PMID: 32088538 PMCID: PMC8699177 DOI: 10.1016/j.chiabu.2020.104419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/16/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Practitioner turnover in behavioral health settings is high and hinders the implementation of new interventions. OBJECTIVE This study examined practitioner and organizational characteristics that contribute to high staff turnover in community behavioral health settings. PARTICIPANTS AND SETTING Clinicians in nine community-based agencies participated. Included agencies treated a high volume of families referred from child welfare. METHODS This study was part of a larger trial testing the effectiveness of a Cognitive Behavior Therapy for family conflict. Authors assessed predictors of turnover quantitatively and qualitatively. Quantitative data was collected prospectively (n = 169) on practitioner and organizational-level variables (e.g., demographics, professional practice, job satisfaction, emotional exhaustion, organizational commitment). Semi-structured interviews with practitioners who left their agencies (n = 40) provided qualitative data retrospectively. RESULTS Forth-five percent of practitioners left their agencies over three years. Two predictors of final survival status (lower age and lower job satisfaction) were associated with leaving the agency at the p < .05 level; however, they accounted for very little variance. Qualitative themes highlighted the importance of job characteristics, compensation, productivity requirements, advancement opportunities, and co-worker relationships as influential in the decision to leave. CONCLUSIONS This study highlights the value of a mixed-method approach given that themes emerged from the qualitative interviews that were not accounted for in the quantitative results. Additional research is needed to better understand workforce turnover so that strategies can be developed to stabilize the behavioral health workforce.
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Affiliation(s)
- Amy D Herschell
- University of Pittsburgh School of Medicine; Community Care Behavioral Health Organization, UPMC Insurance Services Division
| | | | | | | | - James G Gavin
- Community Care Behavioral Health Organization, UPMC Insurance Services Division
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Frey AJ, Kuklinski MR, Bills K, Small JW, Forness SR, Walker HM, Feil EG, Seeley JR. Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior Disorder: Using Real-World Intervention Data to Estimate Costs at Scale. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1219-1232. [PMID: 31313053 DOI: 10.1007/s11121-019-01035-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.
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Affiliation(s)
- Andy J Frey
- Kent School of Social Work, University of Louisville, Patterson Hall, Louisville, KY, 40292, USA.
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, Box #358734, 9725 Third Ave. NE, Suite 401, Seattle, WA, 981115, USA
| | - Kiersten Bills
- Kent School of Social Work, University of Louisville, Patterson Hall, Louisville, KY, 40292, USA
| | - Jason W Small
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR, 97403-1983, USA
| | - Steven R Forness
- University of California, 11901 Sunset Blvd., Apt. #216, Los Angeles, CA, 90049, USA
| | - Hill M Walker
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR, 97403-1983, USA.,College of Education, University of Oregon, Eugene, OR, 97403, USA
| | - Edward G Feil
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR, 97403-1983, USA
| | - John R Seeley
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR, 97403-1983, USA.,College of Education, University of Oregon, Eugene, OR, 97403, USA
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