Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions.

IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES
Julia I Bandini, Julia Rollison, Jason Etchegaray
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引用次数: 0

Abstract

Goal: This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems.

Methods: We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system.

Principal findings: Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic.

Practical applications: As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

了解与留住直接护理人员相关的多层面因素:在考虑创新干预措施时吸取经验教训。
目标:本文探讨了在医疗机构中为患者提供重要支持的直接护理工作者(DCW,即初级护理人员)的留任过程中,广泛的背景因素可能会产生怎样的影响。我们对三家医疗系统中主要受雇于医院环境的直接护理人员的留任情况进行了评估,并从中总结了多站点干预措施的经验教训:我们评估了一项针对初级护理人员的多层次计划,其中包括风险评估、为期 4 天的课程、后续课程以及三个医疗系统的劳动力辅导。作为评估的一部分,我们收集了三个医疗系统约 3000 名 DCW 的数据;信息包括每名新 DCW 的聘用日期、任何调动日期和任何终止日期,以及人口统计信息、职位特征、终止状态和终止原因。此外,我们还收集了有关组织特征的信息,包括人员编制和员工人数。我们还对三个医疗系统中实施留任计划的 56 名 DCW 和 21 名工作人员进行了访谈,并对每个系统的课程进行了远程虚拟观察:尽管我们评估的项目侧重于可能影响留任的个人层面因素,但我们的研究结果显示,社区保健工作者还面临着其他更广泛的、背景性的挑战,他们表示这些挑战会影响他们留任的意愿。这些挑战包括:(1)与工作相关的因素,包括有限的报酬、工作本身的方方面面以及无法在自己的岗位上晋升;(2)医疗系统的挑战,包括使命、政策、人员配备和组织文化;以及(3)外部因素,包括联邦政策和正在发生的 COVID-19 大流行病:随着直接护理人员队伍的不断壮大,提高留任率的干预措施应考虑这些多层面因素的相互关联性,而不仅仅是个人层面的因素。此外,还需要进一步开展研究,以严格评估任何可能的干预措施,并考虑这种方法如何能够针对医院环境中受多层次挑战影响最严重的直接护理工作者。最后,任何旨在提高留任率的干预措施都必须与确保公平相一致,尤其是在低工资的 DCW 群体中,其中许多人都是边缘化的女性和有色人种。
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来源期刊
Journal of Healthcare Management
Journal of Healthcare Management HEALTH POLICY & SERVICES-
CiteScore
2.00
自引率
5.60%
发文量
68
期刊介绍: The Journal of Healthcare Management is the official journal of the American College of Healthcare Executives. Six times per year, JHM offers timely healthcare management articles that inform and guide executives, managers, educators, and researchers. JHM also contains regular columns written by experts and practitioners in the field that discuss management-related topics and industry trends. Each issue presents an interview with a leading executive.
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