Workload Measurement by keara

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									Workload Measurement
What is WLM?
               About WLM
   The Ministry of Health & Long Term Care of
    Ontario (1997) developed a standardized data
    collection & reporting system which meets the
    information needs of healthcare policy makers,
    administrators, practitioners and researchers
   Nursing WLM is the determination of the total
    amount of nursing time, which includes both
    indirect & direct nursing services
   A nursing WLM system is a complex, dynamic
    process designed to aid in determining and
    allocating nursing resources, by assisting in staff
    allocation and budget planning
           Need for WLM
   Nurses as healthcare providers, must
    provide leadership to bring both cost and
    quality into focus

   Nurses must identify the right activity,
    right time, right person and right process
    for delivery of nursing care which provides
    maximum benefit to patient outcomes at
    an affordable cost
  How is WLM Nursing
WLM combines nursing science, computer
 science, and information science to assist
   in the management and processing of
 nursing data, information, and knowledge
   to support the practice of nursing and
          delivery of nursing care.
Implementation of WLM
            WLM Tools
WLM Systems     Total         Percentage
GRASP                    96          44%
NISS                     42          19%
Medicus                  25          12%
Other Systems            11                5
Unknown                   7                3
None                     35            17
Total                   216           100
Data Collection
            Data Collection
   Data is collected through computer-based tools
    and grouped into 2 categories
      Pt Care Activities             Non Pt Care Activities

   Assessment                       Functional Centre
   Therapeutic Interventions       Organizational Activities

   Consultation/Collaboration      Teaching/In-service

                                    Research
                              Patient Care Activities

       Assessment             Therapeutic Interventions    Consultation/Collaboration

Physical Health Assessment      Treatment Procedures         Professional Consultation
Diagnostic Tests & Measures    Medication Administration        Case Conferences
   Cognitive Assessment           Coping Assistance                   Report
   Clinical Documentation        Discharge Planning               Team Meetings
                                              Non-Patient Care Activities

Functional Centre Activities
                                Professional Activities          Teaching/In-service      Research
   Program Management
                               Board/Committee Functions                 Students          Studies
    Employee Meetings
                                    Public Relations                    Academic           Projects
                                         Travel                    In-service Education     Travel
   Caseload Management
Patient Care
Non Patient Care
Monitoring WLM
            Validity of WLM
   In order for workload measurement data to be deemed
    accurate and useful, the workload measurement system
    from which it was generated must be valid
   Workload measurement systems should be reviewed
    annually to ensure that they are valid
   Validity reflects whether the system measures what it is
    supposed to measure
              The system must reflect the current activities to the
              The system must reflect the times assigned to activities in
               accordance with the national system when an average
               methodology is used
              The system must reflect current reality when a standard time
               methodology is used
         Reliability of WLM
   Reliability of WLM tools is the degree of consistency with
    which it measures the attribute it is supposed to be
   A reliable system shows consistent data
   Factors that influence reliability of workload information
              Characteristics of the tool (user friendly)
              Language used
              Length of the tool (time to complete it)
              Person completing the tool
              Time of completion (close to time of intervention)
              Motivation of the person classifying (reduced if information is
               not shared, not relevant, not valued, not used)
              Staffing levels (often left undone if understaffed)
What if Validity and Reliability
  Do Not Meet Standards?

   The number of audits should be increased
    until the problem is identified and changed
   Audits should be random
   Teaching on proper use of the tool to
    users should be implemented
   Changes must be made to the tool to
    ensure it is user friendly
Impact on the Nursing
The nursing profession must not act as
victims of healthcare cuts, but leaders in
 assuring that quality and access do not
suffer. Nurses must take control to work
  smarter, not harder. Nursing resource
   consumption data can facilitate this
Benefits of WLM to the
  Nursing Profession
    Identify and make changes to non patient- value
     added activities
    Incorporate an appropriate skill mix into patient care
    Helps in solving the staffing requirements
    Appropriate staff mix increases nurses time with
     patient which in return improves patient care
    Enhances patient safety
    Increase job satisfaction
    Appropriate allocation of staffing based on acuity and
     fair distribution reduces workload and stress on staff
      Findings From WLM
   Understaffing (20% below recommended) is
    associated with 30% increase in patient
   There has been a decrease of 0.8 days in
    hospitalization throughout the last five years
   Reduced length of stay as well as more
    sophisticated technology has increased the time
    nurses spend with their patients
   Those hospitals with a higher RN to RPN ration
    have lower adjusted mortality rates
The analysis of nursing workload data is complex due to the complexity
                             of nursing care.
   Workload measurement tools are intended to quantify nursing
    resources available, but cannot identify the quality of care provided
   Workload measurement tools do not provide conclusive evidence
    about the type of staff mix which is best at meeting the needs of
    the patient
   Nursing is greater than the sum of its parts, and complexity of the
    nurse/patient relationship cannot be characterized
   Workload measurement tools are insufficient in understanding the
    intensity of patient care
   Nurses fill in WLM tools under their specific user name and
    password, therefore there is a concern that they will be penalized if
    data indicates a lack of patient care
    The Future of
Workload Management
In the future, workload measurement tools should be able to:

   Serve as a benchmark for the development of workload standards
   Demonstrate how the workload for two patients with the same diagnosis can vary
   Compare nursing resources across all health care environments
   Determine appropriate skill mix
   Identify and delete and non-value activities
   Develop appropriate staffing schedules
   Provide historical trend analysis
   Link outcomes to nursing care

For any of these goals to become reality nurses need to:

   Understand how nursing data fits into the GRASP system
   Ensure that the data is reliable and appropriately reported
   Understand factors which drive the consumption of nursing resources
Do You GRASP it?
Joint Policy and Planning Committee. (1997). MIS: Nursing Resource
    Consumption. Ontario: Canada. Government Printing Office.

Canadian Nursing Association. (2003). Measuring nurses workload. Nursing
   Now, 15(1). Retrieved November 2, 2007, from http://www.cna-

Grasp Systems International. (2006). Uniting the business of healthcare with
   priority of patient care. Retrieved November 2, 2007, from

Pellerin, R. Personal Communication, October 8, 2007.

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