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Mak S, Thomas A, Razack S, Root K, Hunt M. Unraveling attrition and retention: A qualitative study with rehabilitation professionals. Work 2024:WOR230531. [PMID: 38669505 DOI: 10.3233/wor-230531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Health human resources are scarce worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. OBJECTIVE To investigate the phenomena of attrition and retention with OTs, PTs and S-LPs who stayed in, or left their profession. METHODS Cultural-historical activity theory provided the theoretical scaffolding for this interpretive description study. We used purposeful sampling (maximum variation approach) to recruit OTs, PTs, and S-LPs from Quebec, Canada. Individual interviews were conducted with 51 OTs, PTs, and S-LPs from Quebec, Canada, in English or French (2019-2020). Inductive and deductive approaches, and constant comparative techniques were used for data analysis. RESULTS Six themes were developed: 1) characteristics of work that made it meaningful; 2) aspects of work that practitioners appreciate; 3) factors of daily work that weigh on a practitioner; 4) factors that contribute to managing work; 5) relationships with different stakeholders that shape daily work; and 6) perceptions of the profession. Meaningfulness was tied to participants' sense that their values were reflected in their work. Factors outside work shaped participants' work experiences. Recurrent negative experiences led some to leave their profession. CONCLUSION Findings underscore a critical need to address contributing factors to attrition and retention which are essential to ensuring the availability of OTs, PTs and SLPs for present and future rehabilitation needs.
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Affiliation(s)
- Susanne Mak
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
| | - Saleem Razack
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship, University of British Columbia, P. A. Woodward Instructional Resources Centre (IRC), Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Kelly Root
- School of Communication Sciences and Disorders, Dalhousie University, College Street, Halifax, Nova Scotia, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
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Cahill PT, Ferro MA, Ng S, Turkstra LS, Campbell WN. Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework. BMC Health Serv Res 2024; 24:347. [PMID: 38491356 PMCID: PMC10943816 DOI: 10.1186/s12913-024-10821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context. METHODS Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately. RESULTS We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve. CONCLUSIONS The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
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Lewis AK, Taylor NF, Carney PW, Bryson A, Sethi M, Ooi S, Tse GT, Harding KE. Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic. Heliyon 2024; 10:e23346. [PMID: 38169770 PMCID: PMC10758808 DOI: 10.1016/j.heliyon.2023.e23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Delays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented. Methods This observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods. Results Two years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52-51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45-57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582). Conclusion The STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.
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Affiliation(s)
- Annie K. Lewis
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Nicholas F. Taylor
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Patrick W. Carney
- Eastern Health, Melbourne, Australia
- Monash University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Alexander Bryson
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Moksh Sethi
- Eastern Health, Melbourne, Australia
- Northern Health, Melbourne, Australia
| | - Suyi Ooi
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Harding KE, Lewis AK, Dennett A, Hughes K, Clarke M, Taylor NF. An evidence-based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial. Child Care Health Dev 2024; 50:e13154. [PMID: 37487607 DOI: 10.1111/cch.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/21/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Waiting lists for community-based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. AIMS To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. METHODS Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal-Wallis test. Employee satisfaction and perception of the model were explored using surveys. RESULTS Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre-intervention (median 57 days) to the post-intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery. CONCLUSION Waiting lists are a major challenge across the health system. STAT provides a practical, low-cost, data-driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale.
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Affiliation(s)
- Katherine E Harding
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Annie K Lewis
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Amy Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Kylie Hughes
- Department of Families, Fairness and Housing, Government of Victoria, Melbourne, Australia
| | - Michelle Clarke
- Department of Health, Government of Victoria, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
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