Clinician Workload Determinants at Paediatric Wards of Selected Private and Public Hospitals in Nairobi City County, Kenya
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Date
2020
Authors
Kiura, Daniel Munyi
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Human Resources for Health is a key pillar of healthcare provision necessitating prudent
staffing norms to meet workload demands of health facilities. Uniform staffing norms
across health systems based solely on policy guidelines can no longer be used at facility
level without adjusting for facility specific trends of workload determinants such as
occupancy the omission of which results in poor outcomes or wasted resources due to
inadequate staffing mix. The study utilized a cross sectional design & sought to confirm
or disapprove the correlation between bed occupancy and patient care activity time with
clinician workload at paediatric wards of selected public & private hospitals in Nairobi
County, Kenya and drive for determinant informed application of staffing norms in the
different settings of the health sector. A validated staffing standardization model was used
to estimate Clinician Workload. The different types of activities that clinicians carry out
in their daily work were determined through key informant interviews. Results of the
interviews helped design a work sampling data collection tool through which observations
were made on the frequency of patient care activities carried out by the clinicians and thus
established activity times. Activity time data collected from the survey was analyzed using
Statistical Package for Social Sciences (SPSS) version 22 and factored into the validated
model so as to derive workload and the corresponding clinician staffing level. Multivariate
linear regression analysis was used to correlate the various independent variables and
clinician workload followed by test of significance for each variable. A sample of 6188
observations were made among 115 clinicians with a distribution of 4,890 (79.0 %)
observations for direct patient care activities, 771(12.5 %) observations for indirect patient
care activities and 527(8.5%) observations on allowance activities. Differences were
observed between public & private facilities in average bed occupancy (2= -0.505, df=
53, p = 0.000) and proportion of time spent by clinicians in direct patient care activities
(2= -10.995, df=53 p = < 0.05) but no significant difference in workload required (t=-
1.415, df=53, p= 0.163). There was varied but significant correlation between various
variables and workload including direct patient activities (r=.743, P< .000), indirect
patient activities (r=-.311, P< .021) and bed occupancy (r=.314, P< .020). The study
concluded that workload increases by one unit with every 8.8% change in direct patient
care activities volume, every 5% change in indirect patient care activities and 14.3%
change in bed occupancy with the three factors accounting for 54.4%, 9.7%, and 9.8% of
the determinants of workload respectively. Multivariate regression of the combined
factors of patient care activities, allowance activity, ward occupancy and facility owner
found these factors to account for 85.9% of the variation in clinician workload (p-value
<0.001). The study recommends that the magnitude of direct patient care activities should
be considered when determining clinician workload, that strategies of reducing the effect
of indirect patient care activities on clinician workload should be devised and that bed
occupancy trends should be studied and factored into workload determination derivation of
staffing norms.
Description
A Research Thesis Submitted in Fulfillment of the Requirements for the Award of the Degree of Master of Science (Health Management) in the School of Public Health and Applied Human Sciences of Kenyatta University, April 2020.
Keywords
Clinician Workload Determinants, Paediatric Wards, Private hospitals, Public hospitals