Strategic Management in Healthcare: Retention of Skilled Professionals in Rural Settings

This article discusses the challenges faced by healthcare organizations in retaining skilled professionals in rural settings. It highlights the drivers and consequences of high turnover rates and justifies the need for strategic management and leadership to address the issue.

Running head: STRATEGIC MANAGEMENT
STRATEGIC MANAGEMENT
Name of the Student:
Name of University:
Author Note:

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Introduction
The health care sector, especially the hospital industry is a service sector and relies on
the medical technologies and the availability of the trained medical professionals in different
fields of health care. One of the important challenges that the health care industry has been
facing is the high turnover the skilled health care professionals.
Describing the strategic issue and its strategic nature
One of the health care issue that has been identified in the first assignment that has
been noticed in the concerned health care organisation is the problem regarding the retention
of the highly skilled professionals in the remote rural settings. The main reason that has been
identified for this issue is the lack of health force motivation among the health care
professionals that can be due to several factors like remuneration issues, or lack of motivation
or lack of infrastructure (Bhattacharya and Ramachandran, 2015).
In the organisational level the increased turnover of the health care professional leads
to decreased productivity, decreased reputation of the organisation, medical errors,
deteriorating level of care in the organisation (Bhattacharya and Ramachandran, 2015).
According to WHO, the health performance of an organisation solely depends upon the
quality, composition and the distribution of the health care workers, globally it has been
noticed that about half of the global population residing in the rural areas are faced with
several difficulties in accessing the quality health care (WHO. 2014). Organisation with high
turnover of the health care professionals generally face with medical malpractices, near
misses, falls and less infection control. This can bring about several adverse effect to the
patient admitted and can hamper the reputation of the organisation. High training cost is an
important negative outcome of turnover of the skilled health care professionals as new and

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the inexperienced health care professionals have to go through robust training procedures,
that against increases the training cost.
According to Mbemba et al. (2016), geographical maldistribution of the health care
professionals is a global issue that can be linked with the increased turnover of the health care
staffs. As per the 2013 Review of Australian Government Health Workforce Programs, it has
been found that the primary health care issue regarding the primary care workforce is the
distribution of the health care workers. Addressing the inequalities regarding the
misdistribution of the health care providers needs workforce planners to have a good insight
of the health care professional transitions into and out of the rural areas (Mbemba et al.
2016). The high turnover the health care professionals are leading to a global shortage of the
nearly about 7.2 millions of health care professionals that is expected to cross 12.9 million by
the year 2035 (Mbemba et al. 2016). The shortage of the skilled health care professionals are
leading to suboptimal levels of patient care, increased mortality and morbidity in patients ,
increased rate of medical errors. Furthermore, it has to be remembered that people residing in
rural areas are more prone to medical errors as they have a low level of health literacy. As per
the Joint initiative learning report of the Human resource for health, Australia should triple
their current number of the skilled health care professionals by the addition of about one
million workers through recruitment, training and retention of the old workers (Russell et al.
2017).
For this reason it is essential for the health care organisation to carry out strategic
planning for the retention of the health care professionals. Retention strategies should include
good facilities to the health care professionals, providing then with the strategies of the
professional growth. However retention and attracting the health care professionals in rural
health care is an acknowledged problem in most of the countries and the hence it is crucial to
identify the reasons behind the turnover of the health care staffs and recognise the important

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factors for recruiting and retaining of the trained staffs of our organisation setting (Friedberg
2013).
Justification/critical argument around the strategic issue (its drivers and consequences)
There are several factors behind the increased turnover of the health care staffs.
Competent health care professionals are required in the rural primary care settings. Ray et al.
(2013) have reported several factors like better job remuneration, high stress levels, increased
workload and burnout, better working conditions in private settings or other countries and
lessened job satisfaction are some of the important factors responsible for the high turnover
of the skilled health care professionals.
Considering the current global health care scenario, huge investments in the private
health care sectors and big pharmaceutical companies, and the corporate health care sectors
are providing better opportunities to the health care professionals due to which the public
health care sector is lagging behind. Furthermore, professional support networks, professional
autonomy, peer recognition are some of the highlighted factors. Some of the other
professional factors that has been identified are lack of sense of belonging in the community,
rapid and safe transport to the cities have also been found to having an influence on the
retention policies (Bryant and Allen 2013).
As mentioned in the previous assignment, lack of motivation among the health care
professionals is an important factor behind then transition of the health care professionals. As
stated by Wakerman, Pashen, and Buykx (2017) health care workers are motivated by several
intrinsic factors that has to be looked upon by the managers. Stimpfel et al. (2013) have stated
that wages, salaries, incentives, facilities increases the morale for reaching the optimal
performance.

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In an organisational setting, the professional needs of the health care professionals
often remain unaddressed. According to the Maslow's Need Hierarchy Theory, people are
generally motivated by the five basic needs like physiological needs, need for safety, need to
belong, the need for self-esteem and the need for self-actualisation. It is these basic needs that
often remain addressed while dealing with the employees (Maslow 2013). Management is
one of the important factors contributing to voluntary turnover of the clinicians. Regular
recognition of the performances or obtaining feedback from the health care workers are often
not practiced in the organisations, in the management level. Management should have
included performance feedbacks, career discussion. This makes the employees to feel valued
and supported. Shortage of staff increases the workload on the remaining health professionals
and is an important cause of burnout, which can be another reason behind staff turnover
(Mosadeghrad 2013). Recruitments are often not done as per the requirement causes shortage
of staffs. Lack of attractive appraisals and incentives in comparison to the private health care
leads to loss of employees. Occupational safety is another issue faced by the rural health care
professionals, as in many cases they do not get access to safe transport to cities of get access
to the basic amenities in rural settings (Mosadeghrad 2013). Lack of communication channels
and the unavailability of the scopes for providing feedback generates resentment among the
working health professionals. The health care professionals should be included in
management decision making process, which can again be related to Maslow’s need for self-
esteem.
Lack of a senior leadership is another important reason behind the staff turnover.
Senior leadership encompasses a varied range of perceptions regarding the low levels of the
leadership in the organisation. Senior leaders should practice a transformational leadership
style in order to explore the retention strategies (Duffield et al., 2014). The key proposition
behind the transformational leadership are- the inspirational motivation, the idealised

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influences, intellectual stimulation and individual considerations. It is the transformation
leadership that increase the performance of the health care professional by motivating them to
achieve the goals of the organisation and at the same time raise their professional standard.
These are the probable drivers of the turnover of the health care staffs. If these issues
remain unaddressed, then problems related to equal access of health care by the ethnic
minorities and the vulnerable group would still persist. Furthermore the direct replacement
cost for the employee turnover can reach as high as 50 -60 % of the annual salary of an
employee and the total cost associated with the turnover would range up to 90- 200 percent of
the annual salary (Li and Jones 2013). It would also lead to loss of productivity and industry
specific error and loss of customer reliability. In a health care sector this can lead to high
error rates, illness. The most significant part is that the company or the organisation will lose
an appreciating assets.
Conclusion
In conclusion it can be said that poor management skills, lack of motivation,
remuneration issues and high workload, discrimination, lack of health and safety, conflicts
and emotional unrest can lead to increased employee turnover. Globally employee turnover
have been found to be associated with increased training cost, loss of productivity, loss of
company’s asset and increased medical error. Hence strategic management and proper
strategic leadership in each and every organisation is necessary for the retention of the
workforce.

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References
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