Workload Analysis

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Workload Analysis

• WILFRED LABI ADDO
• CLINICAL CARE UNIT
• EASTERN REGIONAL HEALTH DIRECTORATE, KOFORIDUA

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GENERAL CONCERNS

• RISING WAGE BILL? ON WHAT BASIS ARE WE REWARDED.
• INCREASING NUMBER OF NEW STAFF
• INCREASING POOR OUTPUT
• POOR QUALITY OF CARE
• WHAT ARE THE EXPECTED OUTPUT OF A HEALTH
  PROFESSIONAL? NO EXISTING STANDARDS TO MEASURE
  OUTPUT.
• WHAT IS THE ROLE OF LEADERSHIP IN ENSURING
  STANDARDS, INCREASING QUALITY OUTPUT
• WHO IS RESPONSIBLE WHEN TARGETS ARE UNMET?

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Introduction

• THE CORE BUSINESS OF THE HOSPITALS IS TO PREVENT
  DEATH AND REDUCE DISABILITY
• The most difficult thing is the lack of interest
  in our staff and health managers in realizing
  this goal.
• Thus our activities do not zero in on this main
  objective. Activities are happening because the
  people must show up to work and are not measured
  in line with the core objective that caused their
  engagement.

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• The other major problem is the difficulty in
  getting reliable data from all facilities.
• This is due to the lack of understanding in the
  value data generated, providing credible leads
  towards improved performance and quality
• There are no serious data managers in the entire
  service
• Medical superintendents and DDHSs alike fail to
  provide the necessary guidance for improvement in
  this vital area. Hospital data is not used in
  decision making process of hospital management.

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Input output

• The system hangs loose with even the appointment
  of managers whose agenda are at variance with the
  spirit of the engagement. This is transferred to
  subordinates whose tasks are not quantified and
  the only expectation is for them to show up to
  work.
• demand on output provides avenue for enhanced
  skill and competency development which gives us
  the quality of care with positive outcome that
  are desirable.
• Such systems breed demanding staff whose output
  is far less in quantum and quality. They think
  that being around is equated to satisfactory
  output.

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Results

• The good and reliable ones burn out or become
  frustrated and get new ideas
• The smart ones have field days and do whatever
  that suits them
• Managers who are products of the system do not
  realize the value of challenging output with
  standards and
• Mediocrity, low output and non existing standards
  rewards generously the lazy and unchallenged.

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Out/In-Patients Analysis

• Using averages only the OPD time per doctor per
  day is 182 minutes or averagely 3hours.
• Giving an average ward management of 25 beds per
  doctor gives us total ward visit of 2hours.
• Average op/week is 3 which works out 4.5hrs or
  0.9hrs/day thus 1hr averagely.
• These are a few examples. However these are
  regional averages. The institution specific
  averages would tell different stories.
• Targets are then drawn and shared with staff and
  performing staff are rewarded in any form
  possible as a motivation to others.

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Output analysis

• The economic implications are obvious for those
  who meet targets or do better.
• The thinly manned facilities turn to be less
  aggitative than the overfilled (over employed)
  ones.
• These indicators and achievers of targets are
  important information to help managers and policy
  makers take important human resource decisions on
  distribution and their future development.
  Without that everything else is done the way we
  do things previously making the value the same.
  

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MEDICAL ASSISTANTS

• Medical assistants see an average of 39.2
  patients per day.
• The lowest consultation load is 10.6 with a high
  of 50.
• We are encouraging medical assistants to take up
  more than their transitional responsibilities
  particularly in smaller facilities with one or
  two doctors.

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MATERNITY

• Midwives do an average of 1.6 deliveries a week.
  
• The mission hospitals turn to have a higher
  figure above 2 per week.
• If we want to increase supervised delivery, with
  the type of access and competency levels we have,
  the value shall remain the same. The same can be
  deduced from the poor emergency care because we
  are always running away from them!!!!!

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TARGETS

• We have set ourselves to challenge the
  practitioners to upgrade their activities for
  2008.
• This is a process that would sharpen our
  clinical skills in a bid to improve quality care.
  
• A well tested practitioner is the one that is
  capable of managing emergencies efficiently
  because he has acquired the necessary skills to
  cope in crisis situations.
• This will go a long way in reducing our mortality
  outlook.
• The high fatality rates of prevalent easy to
  manage cases is certainly unacceptable.

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STANDARDS

• We need to set baseline standards for
  practitioners output over and above which they
  shall be deemed to have executed their
  responsibilities and therefore emoluments well
  deserved just as is done in other industries.
• It is the sole responsibility of management to
  ensure that adequate resources are made available
  and the atmosphere is enriched to ensure
  maintenance of targets.
• However we are experiencing the opposite in many
  institutions in achieving even the minimum as
  seen in the tables.

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Standards contd

• What our doctors can do largely determines the
  level of competency developed by other supporting
  health staff/technicians.
• Low quality and targets sets the stage for
  routine services only. Revenue is generally low.
  We are fortunate somebody who doesnt care about
  output pays everybody!!
• We are suggesting the use of EWS in general
  nursing care to improve quality and outcomes.

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STANDARDS
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• Life is an opportunity, benefit from it.
• Life is beauty, admire it.
• Life is bliss, taste it.
• Life is a dream, realize it.
• Life is a challenge, meet it.
• Life is a duty, complete it.
• Life is a game, play it.
• Life is a promise, fulfill it.
• Life is sorrow, overcome it.
• Life is a song, sing it.
• Life is a struggle, accept it.
• Life is a tragedy, confront it.
• Life is an adventure, dare it.
• Life is luck, make it.
• Life is too precious, do not destroy it.
• Life is life, fight for it.
• ---Mother Theresa

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