From Policy to Practice: A Qualitative Study on Reforms and Frontline Retention in Healthcare

Area of Science:

• Health Services Research
• Rural Health
• Minority Language Health Systems

Background:

• Canadian healthcare reforms created a 2-level system with provincial and regional health authorities (RHAs).
• One RHA in New Brunswick serves French-speaking rural minority communities, facing unique challenges.
• Understanding factors influencing healthcare professional retention in such contexts is crucial.

Purpose of the Study:

• To explore key factors affecting the retention of nurses and physicians within a RHA operating in a language minority context.
• To examine how macro-level healthcare policy decisions are experienced at the frontline of healthcare delivery.

Main Methods:

• A descriptive qualitative study design was employed.
• Data collection involved semi-structured interviews with 21 physicians and 37 registered nurses.
• Focus groups with 20 key informants and thematic analysis were used to identify key themes.

Main Results:

• Three primary factors emerged: organizational accountability and frustration, local autonomy and contextual responsiveness, and a culture of openness versus perceived loss of control.
• These factors are linked to policy changes affecting operational settings and resource distribution.
• A disconnect from decision-making hierarchies and a perceived loss of control were identified as barriers to quality care.

Conclusions:

• Policy adjustments in healthcare systems have direct implications on frontline care delivery and professional retention.
• Supporting adequate resources and fostering professional engagement are essential for successful system-level changes.
• Enhancing job satisfaction and addressing concerns about control are vital for retaining nurses and physicians in minority contexts.