4.3.1 Review of the achievement of Program objectives

All UDRHs are currently meeting their objectives as required in their contractual arrangements with the Commonwealth; regular three-year funding agreements and their corresponding reporting mechanisms
have ensured that key performance indicators (KPIs) are monitored.

The challenge to the UDRHs is vast. The national rural health workforce shortage was described by one participant as a 'wicked' problem (Camillus, 2008), i.e. one which is multi-dimensional, changes shape or form as potential solutions are implemented, and which is embedded in a larger organisational system and culture. The establishment of the university infrastructure for the UDRHs and the implementation of research, training, and support programs have begun to create a national network of rural health clinicians, academics, students and health service administrators which should in time increase the effectiveness of the rural health workforce. This is a long-term strategy and one which cannot be measured by a single long-term objective such as the increase to the rural health workforce. Other objectives will be required to measure outcomes achieved in the course of reaching the long-term goal. These outcomes include the academic infrastructure (defined as the physical presence of the university as well as the availability of information technology and remote access to academic resources), the creation of an intellectually stimulating network of academics and clinicians, access for rural and remote clinicians to opportunities to teach as well as to access professional development opportunities themselves, and increases in rural health research and publications.

At the inception of the Program the UDRHs had very broad objectives and no identified key performance indicators (KPIs). Following the lapsing program evaluation in 2003, the UDRHs in consultation with the Department developed a series of KPIs on which to evaluate their performance. The KPIs support the key result areas of the Program (the objectives named in section 4.2). The key result areas and the KPIs are monitored through bi-annual reports from the individual UDRHs to the Department. These indicators provide a quantified measure of the activities by which UDRHs are providing rural training for future clinicians as well as research and collaborative activities which are supporting the current health workforce.

Table 5 below summarises the extent to which the collective UDRHs are addressing their key result areas, and shows selected performance indicators. The table provides a snapshot of the level of activity undertaken by the UDRHs and the increase in volume of activity over the years 2004-2007.

Table 5 - UDRH KPI summary data6

Key Result Area

Selected performance indicators

2004

2005

2006

2007

1. Increase and improve rural experiences for health science students

No. students (undergraduate, postgraduate) undertaking placements
3,5297
3,817
3,856
4,398
Total no. student weeks
14,427
16,675
18,451
17,663

2. Expand educational opportunities that are relevant for rural and remote practice8

Vocational units or courses: total no. of enrolments
390
768
723
1,198
Undergraduate units or courses: total no. of enrolments
2,422
2,080
1,623
4,021
Postgraduate units or courses: total no. of enrolments
830
672
1,105
661

3. Undertake research and related activities in rural and remote issues

No. of new research and development projects
106
97
109
122
Value to UDRH ($)9
2,652,308
9,685,272
7,871,614
9,237,275
Total value (4)11
33,655,902
18,963,441
16,678,457
14,624,572
Total no. publications, reports and articles
202
303
349
453

4. Support for rural health professionals, consumers and communities

Total no. participants in development activities
9,75512
13,04513
13,92414
14,53715

5. Contribute to innovation in education, research and service development through collaborations

Total no. collaborations in which UDRHs were actively engaged during the July to December reporting period of a given year16
396
399
500
464

6. Embrace a strong public or population health focus; and contribute to the development of innovative service delivery models in rural and remote health

Please refer to Section 4.4 for examples
NA
NA
NA
NA

7. Endeavour to progress the rural health agenda within the medical and other health sciences faculties or departments

Please refer to Section 4.4 for examples
NA
NA
NA
NA
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4.3.2 Issues arising in the achievement of Program objectives

The major constraints on UDRHs in their achievement of the Program's objectives are discussed later in this chapter. In summary, these are:
  • funding levels;
  • challenges in recruiting academic and clinical staff;
  • distance and the challenges of providing either placements for students in more remote towns or providing support to clinicians and communities in more remote locations; and
  • workforce pressures on those within the current rural health workforce which constrain the ability to act as supervisors or teachers.
In spite (or because) of these limitations, UDRHs have sought to access additional sources of revenue through grant applications and research consultancies (up to half their annual revenue for some UDRHs), have been innovative in developing joint appointments with local health services, have developed significant IT and other support networks with remote and isolated clinicians, and have provided training and professional development opportunities for clinicians who supervise students.

Some informants believed that the broad nature of the objectives meant that 'it was left up to us' to determine the priorities and strategies for establishing the local UDRH. Most UDRH staff considered this to be a benefit, on balance, contributing to the individual character and culture of each UDRH.

4.3.3 Contribution to national rural health workforce priorities

The UDRHs are widely believed to be doing innovative and exciting work, facilitating networking and support for a beleaguered rural health workforce, acting as a catalyst for innovation in service delivery, and fostering a culture of research and evidence-based clinical practice. As one informant observed (and many others agreed over the course of the evaluation) 'the evidence is thin but the program works'.

According to many informants, the presence of the university within rural towns has enabled local health professionals to remain in clinical practice when they might otherwise have moved to an urban setting. The opportunity to reduce one's clinical load and take on an academic role has in some instances kept clinicians approaching retirement in 'circulation' rather than losing them from the health system altogether. Academic research and teaching opportunities, professional and social networking, and access to continuing education have been some of the contributions named by stakeholders which the UDRHs have provided. These have contributed in some instances to retaining clinicians in rural practice.

'You can't say we alone are increasing retention, but you can say that it makes it easier to agree to stay.' (UDRH nursing academic)
In addition, the university infrastructure in a rural location is itself an attraction and has led to at least some health professionals choosing to practice in the country because of the opportunity to combine clinical practice with academic teaching and research alongside a rural lifestyle. Retention, and the support provided by UDRHs to rural practitioners, are discussed in sections 4.4.1 and 4.4.2.

The UDRH research capacity building strategies, while still evolving, have begun to bear fruit in terms of grants won and opportunities available to individual clinicians seeking to research areas of interest or local need. A number of UDRHs have appointed a research director, and in some cases research staff, and all have undertaken research projects and produced publications. Research and capacity building are discussed in greater detail in section 4.4.3.

The increasing number of student placements which UDRHs organise has anecdotally led to some students choosing to return to country areas. While this is difficult to quantify across the nation, there is evidence both that students increasingly are perceiving rural placements as a positive addition to their education and that an increasing number are expressing an intention to spend time in rural practice at some point in their career. UDRHs have begun to publish their own studies on rural intentions and the effects of placements, from Playford, Larson and Wheatland's (2006) early article on allied health students in Western Australia to Dalton, Routley and Peek's (2008) recent survey of Tasmanian health science students. These studies are indicating that placements are contributing to student's positive perceptions of rural practice and encouraging students' inclinations to undertake rural practice after graduation. Student placements are discussed in section 4.4.1.

The following section outlines in detail the ways in which the UDRHs are implementing their objectives and contributing to national rural health workforce priorities, as well as some of the issues or challenges which attend these activities.

6 Please see section 2.6
7 This figure includes postgraduate placements for July to December 2004 only. January-June figures are unavailable
8 Figures represent unique instances of participation. Note that a single participant may be involved in more than one activity
9 "Value to UDRH" for some projects is unavailable
10 "Value to UDRH" data is unavailable for January to June 2004
11 "Total value" for some projects is unavailable
12 This figure includes 1830 participants in a health promotion tour conducted by CUCRH. Grand Rounds participants are excluded from this figure - approximately 1200 participants.
13 This figure includes 800 participants in a sporting activity assisted by SGUDRH UDRH and 2000 participants of promotion
activities conducted by SGUDRH at Croc Fest. Grand Rounds participants are excluded from this figure - approximately 4800 participants.
14 This figure includes 2600 participants in National Rural Health Education Forums conducted by Northern NSW UDRH, 386 and 750 participants at career days attended by MICRRH and CUCRH respectively. Grand Rounds participants are excluded from this figure - approximately 1700 participants.
15 This figure includes 2000 participants in a National Rural Health Education Forum conducted by Northern NSW UDRH. Grand Rounds participants are excluded from this figure - approximately 3000 participants.
16 Figures are derived from July-December data only, as collaborations listed in January to June reports may overlap with these. A single collaboration may be listed by more than one UDRH. Therefore figures are approximate only.