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

In Canada, healthcare reforms typically aim to improve the quality of care and access while making healthcare systems more efficient. These reforms have led to a 2-level healthcare system consisting of provincial and regional health authorities (RHAs). RHAs are responsible for providing and administering health services within specific territories. One of the 2 language-based RHAs in New Brunswick (NB) operates in French-speaking rural minority communities. This study explored key factors affecting the retention of nurses and physicians within a RHA operating in a language minority context. This descriptive qualitative study explored how macro-level decisions are experienced on the frontlines. Data were collected through semi-structured interviews with 21 physicians and 37 registered nurses, as well as 2 focus groups involving 20 key informants in managerial roles. Thematic analysis was used to identify key themes. Three main factors emerged: organizational accountability and frustration, local autonomy and contextual responsiveness, and a culture of openness and perceived loss of control. These factors are associated with policy changes that affect operational settings and resource distribution within the RHA and influence the retention of nurses and physicians. Stakeholders in health system reforms, including governments and RHAs, must recognize that policy adjustments can have direct implications on everyday care. Participants expressed a growing disconnect from decision-making hierarchies and a perceived loss of control. Both are seen as barriers to delivering quality care. Ensuring adequate support and resources for implementing system-level changes is key to fostering professional engagement and enhancing job satisfaction.