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Background An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs’ working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention. Methods Thirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi-structured topic guide. Interview transcripts were analysed using thematic content analysis. Results Interviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management. Conclusions The findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.

Child welfare workers typically face strict deadlines, limited training periods, high caseloads, and understaffing. These high-demand positions often coupled with few organizational or supervisory supports contribute to decreased worker well-being and low retention. Informed by the Job Demands-Resources model, we examined common demand-resource sub-groups among recently-hired child welfare workers and how sub-group membership contributed to agency retention. This study used data from the Florida Study of Professionals for Safe Families (FSPSF), a four-year, longitudinal cohort study of child welfare workers hired in 2015–16 (n = 912). We used a three-step Latent Profile Analysis (LPA) with logistic regression to identify profiles of workers based on demand and support levels at 6 months to predict agency retention 12 months later. Findings resulted in five profiles: floundering, surviving through supervisor, surviving through role, surviving through supports, and thriving. Profile distributions indicated both demands and supports were independently important for retention. Each profile had higher odds of staying at the agency compared to the floundering profile, those floundering in role and support (ORs = 2.08–7.68). Those in the thriving profile, thriving in role and support, had higher odds of staying when compared to each other profile (ORs = 2.12–7.68). Findings identify that demands and supports operate in an additive way to promote retention and suggest that agencies can address individual aspects of workers’ role and support challenges to improve retention without requiring a single approach to combat workload and environment simultaneously.

Background Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middle-income countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war . This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. Methods A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical officers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. Results Most of the respondents were females (62.90%), married (84.62%), with certificate level (55.74%), and nurses as qualification (36.60%) as well as attached to Health Center 3 level (61.28%). Significant individual factors associated with retention included having a certificate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staff, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. Conclusion The study established that indeed several individual and social demographics, health system and career-related factors are significantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.

Purpose The engagement and retention of older workers is a major concern for organisations and has been an increasing focus for human resource scholars internationally. Drawing on social exchange theory (SET), the purpose of this paper is to examine the conditions under which retention and engagement of older workers could be enhanced, together with the potential for perceptions of age discrimination to negatively influence these outcomes. Design/methodology/approach The study surveyed a large sample of New Zealand workers aged 55 years and over from across 28 New Zealand organisations of varying size and from a wide range of industrial sectors. A moderated-mediation model was proposed to examine the relationship between perceived organisational support (POS) and intention to leave, the mediating effect of job engagement in this relationship, and the moderating influence of perceived age discrimination on this mediation. Findings While POS was negatively related to workers’ intention to quit, job engagement partially mediated this relationship. Age discrimination moderated this mediation. As perceived age discrimination increased, the mediation of job engagement was weakened as POS had less influence on the job engagement of older workers. Research limitations/implications Implications for human resource management practice include the importance of providing organisational support for older workers along with protections from age bias and discrimination. Originality/value The study is one of the first to apply SET to the context of older workers, and has extended the SET literature through its examination of the role of employee engagement as a mediator of this relationship, and how perceived age discrimination, as a negative aspect of the work environment, can negatively impact these relationships.

Background The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors. Method This paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland’s failure to retain doctors and makes recommendations for retention policy and practice. Results Interviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration. Discussion Understanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards future-proofing the medical workforce and is essential to achieving medical workforce self-sufficiency.

Surge capacity—the ability to acquire additional workers and resources during unexpected increases in service demand—is often perceived as a luxury. However, the COVID-19 pandemic necessitated an urgent expansion of surge capacity within health systems globally. Health systems in Bangladesh, Nepal, and Sri Lanka managed to scale up their capacities despite severely limited budgets. This study employs a mixed-methods approach, integrating qualitative interviews with quantitative data analysis, to propose a comprehensive framework for understanding Human Resources for Health (HRH) surge capacity from 2018 to 2021, termed ARRAS: Anticipate, Recruit, Retain, Adapt, Sustain. We present national-level data to demonstrate how each country was able to maintain their per capita health care workforce during the crisis. Interviews with key informants from each country reinforce the ARRAS framework. Quantitative data revealed ongoing increases in doctors and nurses pre- and post-pandemic, but no country could rapidly expand its health workforce during the crisis. Qualitative findings highlighted critical strategies such as pre-crisis planning, financial incentives, telemedicine, and re-skilling the workforce. Despite adaptive measures, challenges included inadequate funding, poor data systems, and coordination issues. This study underscores the necessity for robust, long-term strategies to enhance surge capacity and better prepare health systems for future crises.

PurposeSince the subject matters of human resources activities on knowledge intensive firms have been changed by coronavirus disease 2019 (COVID-19) pandemic, this study aims to analyze the impact of stock options on talent retention (knowledge worker retention) and knowledge productivity (innovation) in terms of patents, which directly affect the financial performance of knowledge intensive firms.Design/methodology/approachDrawing on agency and contingency theory to design the causality model, this study analyzes the data obtained from 227 publicly traded knowledge intensive firms in information technology (IT) and healthcare sectors. Panel data analysis is used to determine the long run causal relationship between firm innovation, knowledge worker retention and financial performance, in addition to ANOVA for evaluating firm size as a lurking variable on the effect of stock options.FindingsThe results of this study demonstrate that, when firm size is taken into account, (1) stock options significantly affect knowledge worker retention and firms' financial performance, and this impact is stronger in a during-pandemic situation than in a pre-pandemic situation (2) firm innovation significantly affects firms' financial performance and this impact is stronger in a during-pandemic situation than in a pre-pandemic situation; (3) knowledge worker retention doesn't have a significant impact on firm innovation and firms' financial performance. Moreover, random effect regression analysis for long-term relationships also depicts the same results: knowledge worker retention has non-significant impact on firm innovation and financial performance, but firm innovation significantly affects financial performance.Originality/valueTo the best of the authors' knowledge, the authors are the first to compare the effects of stock options, knowledge worker retention and firm innovation in both pre- and during-pandemic scenarios where firm size is taken into consideration.

Purpose: Globally, countries with both developed and developing economies are struggling to secure sufficient participation in vocational education to generate the range and quantum of skills required for their communities and realising national social and economic goals. In an era of high aspiration, vocational education and the occupations it serves are increasingly seen as being a less than desirable outcome by young people and their parents. Hence, there is a need to identify means by which to inform and engage young people in considering vocational education and the occupations it serves. The case study discussed in this paper is contextualised within the Australian state of Queensland, which, like many other countries is struggling to have a workforce sufficient to meet communities' healthcare needs as its population both grows and ages. Methods: The study data were collected from 1) interviews with healthcare-related stakeholders including health industry representatives, teachers or practitioners, and healthcare providers, 2) focus groups with senior secondary students, and 3) surveys with these participant groups. It provides a descriptive analysis of efforts to secure greater participation by young people in allied health roles, and, in particular, young Australian Indigenous people. Findings: The study participants included those from regional and metropolitan centres and from state and independent schools, and in all of which the focus on engagement was central. Findings indicated that engagement was necessary to advise young people about these occupations, the effective preparation for them, and likely retention in the workforce. Conclusion: This study highlights the need for intentional strategies to engage young people, their parents/guardians and with those efforts likely needing to be organised and enacted at the local level. This requires collaboration and engagement from education, industry, and local communities. Essentially, a systemic approach is required, specifying roles for government, employers, educational systems, and teachers and parents who engage directly with young people. In all, engagement, advice and opportunities locally are all emphasised in the study reported here.

Background There is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital. Case presentation We perform a descriptive case study of clinical and non-clinical services offered at Bayalpata Hospital prior to and following the initiation of GP-level services in 2013. Bayalpata is a district-level public hospital managed through a public private partnership by the nonprofit healthcare organization Possible . We found that after general practitioners were hired, additional clinical services included continuous emergency obstetric care, major orthopedic surgeries, appendectomy, tubal ligation, and vasectomy. This time period was associated with increased emergency department visits, inpatient admissions, and institutional birth rate in the hospital’s catchment area. Non-clinical contributions included the development of a continuing medical education curriculum and implementation of a series of quality improvement initiatives. Conclusions GPs have potential to bring significant value to rural district hospitals in Nepal. Clinical impact may include expanded access to surgical and emergency obstetric services, which would more fully align with local health needs, and could further reduce Nepal’s maternal mortality rate. Task-shifting and structured training programs would be required to increase orthopedic surgery capacity, but this would contribute to meeting local healthcare needs. Non-clinical impact may include supervision of health workers and leadership in continuing medical education and quality improvement initiatives. These changes can lead to improved health worker recruitment and retention in rural posts. Limitations include generalizability of our results to other district hospitals in Nepal and lack of data from control hospitals. This analysis provides an additional perspective on the potential value GPs can add in rural Nepal, through provision of a wide range of clinical and non-clinical services. It supports the expansion of GPs to additional district hospitals in Nepal’s public sector.

Background Information and communication technologies have become a vital infrastructural asset for use in the retention of rural health workers. However, little is known about the potential influence of ICT use, perceptions of health workers on ICT in healthcare delivery, and contribution of ICT to health care providers’ retention in rural and remote areas in rural post-war and conflict situations of northern Uganda. Methods Data from interviews were transcribed, coded and thematically analysed. Results Participants generally exhibited low confidence, knowledge and low ICT skills. Majority of participants, however, perceived ICT as beneficial in relation to job performance and health care provider retention in rural areas. Common barriers for the implementation and use of ICT in health centres were inadequate ICT knowledge and skills, poor Internet networks, inadequate computers, inadequate power supply, lack of Internet Modems and expensive access to outside computer centres. Conclusions This qualitative study showed low confidence, poor knowledge and skills in ICT usage but positive perceptions about the benefits and contributions of ICT. These findings suggest the need for specific investment in ICT infrastructural development for health care providers in remote rural areas of northern Uganda.