How best to measure health workforce turnover and retention: five key metrics

Objective. This article identifies, critically appraises and illustrates the use of five key workforce turnover and retention metrics that are well suited for use by Australian rural health workforce planners. These are crude turnover (separation) rates, stability rates, survival probabilities, median survival and Cox proportional hazard ratios. Examples of their calculation are presented using actual data obtained from payroll records in Australian rural and remote health services. Conclusion. The use of this small number of metrics as a 'workforce measurement package' can help overcome many of the limitations evident when a single measure is reported in isolation, by providing a more comprehensive picture of turnover and retention patterns. We suggest that health services themselves can calculate the simplest measures, whereas regional and centralised health authorities with higher levels of expertise undertake survival analysis and comparisons of compiled data. Implications. These key metrics can be used routinely to measure baseline levels of health worker turnover and retention, to quantify important determinants of turnover and retention, and importantly, to make valid comparisons. This enables areas for improvement to be better targeted using appropriate retention strategies, and changes resulting from retention interventions to be evaluated effectively. What is known about the topic? A vast array of turnover and retention metrics has been described in the literature. However, which of these are likely to be most useful for measuring Australian rural and remote health workforce turnover and retention is not well understood. What does this paper add? In recognition of the shortcomings of using single measures in isolation, this article identifies, critically appraises and illustrates the use of five key workforce turnover and retention metrics, recommending their use as a 'package'. What are the implications for practitioners? Regular use of the identified metrics can enable health workforce planners to recognise which areas to target for improvement, devise appropriate retention strategies and evaluate changes occurring as a result of retention incentives or interventions.