Digital technologies
Recruitment and retention of qualified physicians and other clinical staff have long challenged rural communities. The effects of information and communication technologies on recruitment and retention of healthcare professionals, is proven to have a positive effect.
ImplementabilityRelatively difficult to implement.
Health systems may be motivated to invest in tele emergency technology not only to improve access to care, but also to improve recruitment and retention of the primary care physicians that sustain their systems.
Although small rural facilities are tasked with managing mainly minor injury and illness, they also treat patients with complex and time critical problems. These facilities are generally staffed by nurses alone, or by junior doctors, general practitioners or rural generalists. Rural doctors often have specific training for rural emergency medicine, but what they lack is immediate access to onsite specialist advice.
Telehealth can be a cost effective, real-time and convenient alternative to the more traditional face-to-face way of providing healthcare, professional advice and education. It can help to remove many of the barriers currently experienced by health consumers and professionals, such as distance, time and cost, which can prevent or delay the delivery of timely and appropriate healthcare services and educational support.
The objectives of using telehealth are to:
- improve patient outcomes
- drive greater efficiency in the way health care is delivered
- support the delivery of the quality health care across the state and
- make telehealth a viable alternate to the way some health care is traditionally delivered.
Success factors
Telemedicine improves access to care not otherwise available in rural settings. Previous studies have found that telemedicine also has positive effects on the work environment, suggesting that telemedicine may improve rural physician recruitment and retention, although few have specifically examined this. Dolea et al. identified telehealth technology as a possibly effective retention strategy in their global review of recruitment and retention of rural healthcare professional. The telemedicine literature indirectly suggests that tele-emergency services may improve the workplace for rural clinicians.
Telemedicine and the implementation of digital technologies can;
- Reduce professional isolation and workload.
- Facilitate distance learning
- Avoid patient transfer
- Facilitate professional networking and establishment of professional relationships
Telehealth is also perceived to decrease workload, by allowing on-call duties to be done from home or shared on a regional basis. This allows the coverage of specialties to be shared by specialists from several hospitals rather than those of a single hospital.
telehealth could support the organization of joint training programs between several rural and remote locations. Such programs could also give exposure to the regions and their medical teams.
Challenges
Tele-emergency may adversely affect the relationship between the local caregiver and patient, as they may not have complete trust/confidence in the caregiver. Assuming sole responsibility for the full spectrum of care required by community members can be professionally and personally taxing. Tele-emergency helped relieve pressure for some rural physicians. Many used the phrase ‘second pair of eyes’ to describe their relationship with the emergency medicine specialists in the hub.
- The cost of the technology can be a significant factor, particularly for smaller centres.
- Could give the image of a poorly equipped hospital.
- Risk of malpractice.
- Insurance companies – will they cover the cost of the consult via telemedicine
- Regulations, guidelines and legislation.
- You can’t get a physical exam (if required) so may not suit all
Doctor
Nurse
How can we be sure that our service model best meets the needs of our population, provides the most cost-effective solutions, and leverages advances in technology? The service model must best meet the needs of the population, and metrics are required to monitor the effectiveness of the service model. In addition to understanding the population’s
service needs, a strong body of evidence suggests that, especially in rural and remote environments, the most successful health-service models are explicitly tailored to the local environment.
Delivery of safe and effective healthcare in remote and rural areas requires a specific additional skill set including ongoing skills maintenance and continuing education. In addition to ensuring there are appropriately tailored education and training opportunities that are accessible to remote and rural practitioners, there is a need to ensure recruits are learning-focused and have the ability to develop the remote and rural skill set that is required. This Framework challenges this perception and encourages organizations to seriously consider the characteristics of the person you would like to hire. Management may find that the promotion and advertising materials used may be targeting the wrong person.
Supporting your professional teams to access professional development that is relevant to their rural and remote work environment can be a significant factor in enhancing the quality of services in your community and in retention of employees. A mixture of well designed “at distance or “technology enhanced” education programmes together with some “face-to-face” education and training should be offered.
Developing an academic/training mandate for an organization, and potentially seeking funds to allow professional teams to dedicate time to training the professionals of the future will lead to a strong return on investment. There is a clear and substantial body of evidence which confirms that offering health professional training in rural and remote environments leads to increased retention of those professionals. Furthermore, training and rural and remote environments ensures that professionals have the unique skills that are needed for rural practice.
Potter AJ, Mueller KJ, Mackinney AC, Ward MM. Effect of tele-emergency services on recruitment and retention of US rural physicians. Rural and Remote Health(Internet) 2014; 14: 2787. Available: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2787
Dolea C, Stormont L, Braichet JM. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of the World Health Organization 2010; 88: 379385.
https://www.mja.com.au/journal/2015/203/7/providing-lifeline-rural-doctors
College of Family Physicians of Canada, Canadian Medical Association, Royal College of Physician and Surgeons of Canada: National Physician Survey (NPS): Workforce, satisfaction and demographic statistics concerning current and future physicians in Canada. [http://www.nationalphysiciansurvey.ca/nps/home-e.asp]
Romanow RJ: Building on Values: The Future of Health Care in Canada - Final Report. 2002, Ottawa , Commission on the Future of Health Care in Canada
Watanabe M, Jennett P, Watson M: The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture. Journal of Telemedicine and Telecare. 1999, 5 (Suppl 2): S11-19. 10.1258/1357633991933477.
https://www2.health.vic.gov.au/hospitals-and-health-services/rural-health/telehealth