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Making it Work:
Remote Rural Workforce
Stability Forum
January 15, 2019
Faculty/Presenter Disclosure
Speakers: Dr. Roger Strasser, Dr. Gwen Healey Akearok,
Dr. Catherine Cervin, Dr. Sarah Newbery, Jennifer Wakegijig, Ray Hunt,
Stephen Tuitt, Dr. Francois de Wet
International Partners: Niclas Forsling, Dr. Helen Brandstorp,
Dr. Birgit Abelsen, Dr. Sigurður Sigurðsson, Dr. David Heaney
• We have no conflict of interest to disclose.
Disclosure of Financial Support
• This session/program has received financial support from The
Northern Periphery and Arctic Programme in the form of a
funding grant.
Learning Objectives
1. Apply the concepts and implementation strategies of the Making it
Work, Summit North and Queensland Knowledge Share projects to
local Recruitment and Retention challenges.
2. Discuss the examples and priorities established in partner country's
to provide useful, plausible solutions for rural/remote populations in
Northern Ontario and within your own community.
3. Identify gaps and prioritize policy implications to Canadian
rural/remote strategies.
The Challenge of Remote Rural
Recruitment and Retention• Unique health service needs
• Transience impacts quality and continuity of care
• With high turnover, HR professionals often focus only on recruitment
• Organizations struggle to advance strategic priorities as constantly
orienting new personnel
NOSM’s Involvement with this
International Project• The European Union
– Northern Periphery Programme
• Recruit and Retain 2011-2014
– Northern Periphery and Arctic Programme
• Making it Work 2016-2019
Our Northern Periphery Partners
We have much in common.
NOSM’s Partnership with Nunavut• NOSM has had periodic residency placements in Nunavut
• NOSM reached out to the Minister and DM of Health in NU in 2015 to
explore potential partnerships and collaboration
• There was considerable interest in exploring
– Sharing the Ontario Health Careers Camp model with NU
– Potential additional residency placements
– Potential collaborative research in remote health services models
– Potential collaboration on CEPD for NU physicians
NOSM’s Partnership with Nunavut
• NPAP funding presented an opportunity to partner with NU on an
initiative with relevance to Northern Ontario
• A strong steering committee was established including the
Government of Nunavut, Nunavut’s Inuit organization (Nunavut
Tunngavik Inc) and now Nunavut’s Inuit training organization –
Makigiaqta
• Additional partners engaged with us for some projects, including
Nunavut Arctic College
Nunavut ᓄᓇᕗᑦ• Geography: Arctic region, 2 million km2
• Population Demographics:
• 25 communities
• 35,000 people, 85% Inuit
• 4 official languages: English, Inuktitut,
Inuinnaqtun, French
• Health Demographics:
• Nunavut has the highest birth rate in
Canada.
• Median age is 25.
Health Care Delivery Model
• Based on remote nursing station model -
1950s
• 3 distinct health service regions with
associated tertiary care centres
(Qikiqtaaluk, Kivalliq, and Kitikmeot)
• 22 community health centres
• 2 ‘super’ regional health centres (Rankin
Inlet and Cambridge Bay)
• 1 hospital (Iqaluit)
Health Care Delivery Model
• Community health centres are staffed by:
• Community health nurses (CHNs)
• Community health representatives (CHRs)
• Mental health nurses (some, not all)
• Interpreter translators
• Other important support staff, such as x-ray
technicians, telehealth technician, a few
nurse practitioners, and other project-
specific staff
Health Care Delivery Model
• Tertiary services are
available via visiting
specialists
• Fewer specialized
services available than
a typical urban hospital
in southern Canada.
• Large number of
referrals and
emergency medical
evacuations to large
urban hospitals
• Yellowknife
• Edmonton
• Winnipeg
• Ottawa
Grise Fiord Health
Centre
Most northerly health
centre in Canada
West wing of the
Qikiqtani General
Hospital in Iqaluit
Regional Health Centres in Cambridge Bay and Rankin Inlet, Nunavut
How has involvement in this work
benefitted Northern Ontario?
• Many similarities NU and Northern Ontario
• Through transnational collaboration, research and learning, a
framework has been produced with universal application to remote
rural challenges
International Case Study
Presentations
Sweden Case Study
Presentation
Making it Work Final Forum
15th January 2019
The Swedish partnership, will
highlight two cases from our
region:
1. Rural Stream of Medical Education
Students, Centre for Rural Medicine
2. Relocation Coordination Officer,
Storuman Municipality
Rural Stream; Medical Education Students
to rural areas, transforming Medical School
curriculum to increase the number of clinical practice
days at rural primary care units.
Peter Berggren
Medical programme
Storuman-Umeå: 3.5 h by bus Lycksele-Umeå: 1.5 h by bus
The curriculum 5.5 Y
Selection of campusFrom 6th semester, about 30 students move to 3
other campuses in the northern region:
• Sunderbyn (Norrbotten)
• Östersund (Jämtland)
• Sundsvall (Västernorrland)
2014 2015 2016 2017
Visionary document
Region Västerbotten’s objective: Support recruitment of health care professionals to rural areas by increased clinical training in rural environments
2014 2015 2016 2017
Umeå university: Medical school programs in
Sweden may be extended from 5,5 years to 6
years. Can we increase the clinical training in
primary health care?
The Rural Stream/Track
Features of the pilot• Two students/semester
• A 4-10 fold increase in rural medicine exposure
• Intra-curricular (same learningoutcomes and assessment tasks)
• Repeated shorter periods over 4 years
• Peer-learning
• Interprofessional learning
• Video conference (seminars, lectures)
Lycksele
Storuman
Semester Course Days in Storuman Days in Lycksele
5 Family medicine 5
KLUM 5
6 Internal medicine 10 8
7 Surgery 5 15
Oncology 5*
8 Family medicine 10
9 Psychiatry 5
10 Research project at
GMC Storuman?
?
11 Family medicine 8
Gyn/Obstetrics 5 5
Pediatrics 5 5
58 days + 38 days
The Swedish partnership, will
highlight two cases from our
region:
1. Rural Stream of Medical Education
Students, Centre for Rural Medicine
2. Relocation Coordination Officer,
Storuman Municipality
Relocation Coordination Officer,
to facilitate community engagement and
improve impact.
Tina Kerro
Relocation Co-ordinator
Relocation Service
S T O R U M A N S K O M M U N • W W W . S T O R U M A N . S E • + 4 6 ( 0 ) 9 5 1 - 1 4 0 0 0
What happens when
words become action?
S T O R U M A N S K O M M U N • W W W . S T O R U M A N . S E • + 4 6 ( 0 ) 9 5 1 - 1 4 0 0 0
A postcard to those
who moved out turns
into an invitation to
move back in?
S T O R U M A N S K O M M U N • W W W . S T O R U M A N . S E • + 4 6 ( 0 ) 9 5 1 - 1 4 0 0 0
Sofia
S T O R U M A N S K O M M U N • W W W . S T O R U M A N . S E • + 4 6 ( 0 ) 9 5 1 - 1 4 0 0 0
Together
Scotland Case Study
Presentation
Making it Work Final Forum
15th January 2019
Scottish Forum Today• Making It Work Team (Anne Mason and Claire Savage)
• Remote and Rural Healthcare Alliance (Pam Nicol)
• Scottish Rural Medicine Collaborative (Martine Scott)
• NHS Orkney (Charlie Siderfin)
• Scottish Government (Fiona Duff)
• NHS Shetland (Lorraine Hall)
• Scottish Rural Health Partnership (Karen O’Hanlon)
• Workshops: Community Engagement and Multi-professional Education
Scottish Forum Today• An experiment: all online, no-one but some of the
speakers in the room. There is no centre - the periphery has equal status.
• 100 delegates, from a wide range of disciplines, places.
• Widened our audience, saved time and travel
• Its recorded! You will be able to go watch it
• All the materials are available use or adaptation
Scottish Activities
Conditions for success: Working with HR to strengthen recruitment processes
Community Engagement: Working with communities to develop local
information and support for new recruits and their families
Professional information sharing: Working with recruitment teams to develop authentic and innovative
advertising
Professional development / team cohesion: Working with educators and trainers to develop accessible learning and support for rural and remote staff
Recruitment and retention activities
Interviews (34) with HR, staff, and public
Robust Advertising
Authentic professional
and community information
A welcoming community
Contractual information
Getting the recruitment process
right, helps to retain staff• Rural and remote posts are not standard.
• The demands on the post holder often not captured in job descriptions.
• more flexibility in job contracts, more clarity in job descriptions and more transparency regards relocation packages and car allowances.
• Use technology to update knowledge
• The need for support and being part of a team was crucial to lone workers
• A buddying system for newly appointed staff – to feel connected and supported.
Emphasize information sharing
Professional Brochure developed with Rural support Team (a multi-disciplinary team developed to align service delivery with population need, and to counter vacancies in general practice)
• includes blogs and short videos
• What it is like living and working in West Highland
• What sort of person the team needs
• Who they will be working with, where they will be working
• What the work is like – explained by team members
• Stories and experiences of team members
• What Professional development and training is available
Community EngagementLiterature review
• local knowledge can help recruitment planning
• Community ownership can improve conditions
• Communities can offer local appeal
• Calibre of partnership
Westray
• 100% recruitment success
• In depth understanding of recruitment/retention
• Strong sense of ownership and healthy working relationship
with primary care team and mutual investment
Co- produced community brochure in Ullapool
Professional Development
Sharing existing resources, breaking down
professional barriers, knowledge sharing.
Piloted joint training with Rural Fellows
programme & RAPs
Piloted E book to aid access to evidence
based information without digital connection
Team Cohesion
• Rural Support Team reported strength & empowerment within team through working on brochure
• Buddy framework for remote practitioners–to provide increased personal support
• Small Isles education platform
Training Future Professionals
• Developing a Rural Career Pathway for
new roles - Advanced Practitioners
• International Remote and Rural Passport
Scottish Rural Medicine CollaborativeProject 1:
Rural GP recruitment good
practice guidelines
Project 2:
Rural GP Recruitment Yearly Wheel
Project 3:
Rural GP Marketing resources
Project 4:
Valuing Rural GPs
Project 5:
Rural GP Recruitment and Retention Toolkit
Project 6:
Rural GP Recruitment
Support
Scottish Resources• Scottish Rural Medicine Collaborative: Recruitment good practice guide
https://www.recruitmentsupport.scot.nhs.uk/ , rural GP bureau, education support, www.gpjobs.scot
• NHS Orkney and NHS Shetland: good marketing https://www.shetland.org/live community engagement, friendship scheme, attracting experienced general practitioners -Rediscover the Joy of Holistic General Practice
• Remote and Rural Healthcare Alliance : education platform https://learn.nes.nhs.scot/786/rrheal
• Scottish Rural Health Partnership : housing MIW products and co-ordinating rural health activities https://www.uhi.ac.uk/en/research-enterprise/res-themes/school-of-health-social-care-and-life-sciences/srhp/
• Scottish Government : The short life Remote and Rural General Practice Working Group is working to support rural areas to deliver the first phase of the Scottish General Medical Services Contract.
Sustainability
• In Scotland, it’s over to our partners, there
is a lot going on!
• Secondly, can we find a way to continue to
work transnationally?
Faculty/Presenter Disclosure
Speaker Names: Dr. Roger Strasser, Dr. Gwen Healey Akearok,
Dr. Catherine Cervin, Dr. Sarah Newbery, Jennifer Wakegijig,
Ray Hunt, Stephen Tuitt, Dr. Francois de Wet
International Partners: Niclas Forsling, Dr. Helen Brandstorp,
Dr. Birgit Abelsen, Dr. Sigurður Sigurðsson, Dr. David Heaney
• We have no conflict of interest to disclose.
Disclosure of Financial Support
• This session/program has received financial support from The
Northern Periphery and Arctic Programme in the form of a
funding grant.
The Norwegian Case Study
Dr. Birgit Abelsen and Dr. Helen Brandstorp
National Centre of Rural Medicine (NCRM)
Tromsø
Many rural municipalities in Norway
are struggling to recruit and retain GPs• … and has done that for years
• National level policies to attract
GPs to rural areas are lacking
• Municipalities are limited by
budgets and creativity –
equipped with few tools
• Some succeed using different
economic and non-economic
incentives
Main aims of the Norwegian Case Study
• to improve the recruitment and
stability of regular GPs in three
case municipalities
• to identify successful strategies
• to disseminate these strategies
to other municipalities
MELØY ÅRDAL ODDA NORWAY
Population 1.1.2018 6 346 5 277 6 835 4 672
(median
pop.)
% pop. Change
last 10 years
- 4.4 % - 5.8 % - 3.1 % + 5,3 %
(median
pop.)
% population > 67 years 18.5 % 20.2 % 19.9 % 14.9 %
% change in pop. > 67 years
last 10 years
+2.9 % +3.1 % +0.5 % + 2 %
Three case municipalities
Meløy Årdal Odda
2016
2017
2018
2019
Case-municipalitiesand NCRM
Other org.and NCRM
R&R Making it Workan NCRM
Local meetings
1. WorkshopLocal projects
2. Workshop
Sum up meetings
Final conference
Workshops (4)andvideo-confrences
• Framework• National
reports• R&R-MIW
reportsC
O M
U N
I C
A T
I O
N
C O
M U
N I
C A
T I
O N
*ALIS-Vest
*State funding
**ALIS-Nord
**State funding
*ALIS-Vest expansion
Local outcomes
Based on the Making it Work platform, all three case-municipalities had been able to:
- establish a local regular GP recruitment and retention project
- that was anchored, understood, and strongly supported at the top municipal administrative and political level.
“Participating in the project meant that we got higher up in the system. They were a little more interested, and understood a little more.
The mayor, the chief municipal executive, and the municipal health manager are all in the steering group. When you get such anchoring, something positive can come out of the project. It’s not just hanging in the air.”
MELØY ÅRDAL ODDA
2015 2018 2015 2018 2015 2018
Number of regular GP positions 7 8 5 6 7 8
Number of vacant regular GP positions 3 1 3 0 2 0
Number of regular GP positions served
by a locum
3 1 2 3 5 0
Developments in the regular GP situation
in the three case municipalities
Meløy people Årdal people Odda and NCRM people
Lessons learned
1. The process and the results are equally important
2. In order to retain GPs, a flexible approach to GP
working conditions is important.
3. It is easier to recruit than to retain regular GPs
Making it work in......
Akureyri-IcelandSigurður E Sigurðsson
Akureyri Hospital
Population 350.000
Læknaskortur (shortage of physicians)
ÞINGSÁLYKT
UN
um
ráðstafanir
vegna
læknaskorts.
1961
ALVARLEGUR LÆKNASKORTUR
BLASIR VIÐ
03. október, 2014 - 09:12 Þröstur
Ernir Viðarsson
Yfirvofandi læknaskortur er staðreynd - segir Þorbjörn
Jónsson
Goal
• During project 7 new recruits
• Next five years 11 new recruits
Participating in educational
programs of physicians in the
specialist training has given the
Akureyri Hospital opportunity to be
more recognized in its target groups
of physicians.
An understanding of professional
isolation and measures to
counteract is an important factor in
retention.
Regular visits to medical schools in Iceland
and abroad has opened up channels to
larger numbers of possible candidates.
An engagement from the
municipality to underline
the importance of the
social aspect of
recruitment is important
especially to foreigners as
well as Icelanders.
Regular visits to Icelandic
physicians abroad have been
greatly appreciated.
Advertise nationally and internationally
Engaging society
We saw an opportunity in engaging the municipality
– to enhance the cooperation between the hospital and the
Akureyri municipality by delegating personal contact
people to supporting the integration of physicians and their
families in the community and mentorship for the physician
within the hospital.
– To provide information about how to work AND live the life
in this town
So far ....
Interviews Qualitative study in April and December 2018
Semi-standardised questionnaire
Participants Eight doctors, 4 women and 4 men, from different countries
The purpose was to identify:a) the satisfaction among doctors coming from abroad with the
welcoming program and the information provided at the start of their recruitment at SAk.
b) motivational and demotivational factors affecting their further stay and work in Akureyri.
Why Iceland/Akureyri?
Gain more quality of life
Experience new things
Find balance between family and work
Gain international experience
Some comments
• “Here we can balance family and work”.
• .... “the people,” they are warm and polite and for
instance during Christmas I got many invitations”.
• .... “impressed that they experienced no hierarchy at the
hospital at least none in comparison with their home
country.”
Conclusion locally• The doctors are in general happy with their life and work in Akureyri,
Iceland.
• It is important to maintain the quality of services and information provided regarding personal and professional matters about life and work in Akureyri => to continue the welcoming program at the City Council and the support provided by coworkers and bosses at the arrival to SAk
• It should be considered to organize the Icelandic language courses better
• to find ways to increase child care services
• to establish some kind of “social net program”
Conclusion project
• Research and information sharing
• Networking
• Should be continued
• Spread the word
The Nunavut Physician
Recruitment and Retention
Project
Making it Work in Canada
Nunavut ᓄᓇᕗᑦ• Geography: Arctic region, 2 million square km
• Population Demographics:
– 25 communities
– 35,000 people, 85% Inuit
– 4 official languages: English, Inuktitut, Inuinnaqtun, French
• Health Demographics:
– Nunavut has the highest birth rate in Canada.
– Median age is 25.
Health Care Delivery Model• Based on remote nursing station
model - 1950s
• 3 distinct health service regions with
associated tertiary care centres
(Qikiqtaaluk, Kivalliq, & Kitikmeot)
– 22 community health centres
– 2 ‘super’ regional health centres
(Rankin Inlet and Cambridge Bay)
– 1 hospital (Iqaluit)
• High number of physician providers
• Short-term visits
• Strong (but not appropriate)
physician service
• Lack of continuity
• Patients negatively impacted
NU MD Recruitment | Past Practice
• Physician retention initiatives not supported
• Focus on locating and employing service providers
• MD Retention negatively affected by previous
contracting model
NU MD Retention | Past Practice
Lack of continuity increases
• Risk for patients being under-treated, over-
treated and/or medical conditions missed
• Increased likelihood of poor handover and poor
patient follow-up practices
• Patient Frustration
NU MD Results | Past Practice
High rate of physician turnover caused
• High travel & administrative costs
• Reduced efficiency of administrative staff
NU MD Results | Past Practice
Focus was entirely on physician coverage
metrics and did not consider how to
support, improve conditions and retain
physicians “on the ground”.
The NU Physician
Recruitment & Retention Project• Key collaborators:
– Government of Nunavut Department of Health
– Northern Ontario School of Medicine
– Nunavut Tunngavik Incorporated
– Qaujigiartiit Health Research Network– *Nunavut Arctic College, Qikiqtani Regional Hospital, GN
Department of Education*
Identified Initiatives
Plan Recruit
• Refresh Recruitment Website
• Contract Model Innovation
• QHRC Cultural Orientation App
Retain and Train
• Continuing Education Events
• Youth Health Careers Camp
Recruit
Continuing Education Events• Professional development relevant to rural
remote practice
• Practice environment innovation
• Peer to peer learning
• Social connections
Training Future Professionals
Additional Impacts
• Strengthened partnerships creating
new opportunities
• New pediatrics residency position
in Nunavut
NU MD Recruitment & Retention
2017 - Present• A time of transition
• Shifting from fixed to flexible contract models
We surveyed and listened to what
physicians wanted.
• Increased focus on offering local CEPD events for physicians.
• Participating/Hosting Intra & Inter Territorial Events.
NU MD Recruitment & Retention
New Initiatives
Focus on digital platforms
• All-new physician website: www.NUphysicians.ca
• New “NU Health” mobile App for iOS
and Android platforms
NU MD Recruitment & Retention
New Initiatives
• Emphasis & funding
allocated to Medical
learners.
• Increased placements
for Medical Residents
from more disciplines.
NU MD Recruitment & Retention New Initiatives
Predictability, Continuity of Care
and Sustainability of the
Workforce are on the horizon!
Making it Work:
Q&A
Making it Work:
Thank you!
