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 Informatics? 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 Activities 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 Monitoring/Evaluation 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 Travel In-service Education Travel Caseload Management Patient Care Activities Non Patient Care Activities 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 organization 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 measuring A reliable system shows consistent data Factors that influence reliability of workload information include: 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 Profession 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 process. 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 nurses Findings From WLM Understaffing (20% below recommended) is associated with 30% increase in patient complications 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 Concerns 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? References 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- nurses.ca/CNA/documents/pdf/publications/NN_NursesWorkloadmarch2003 _e.pdf Grasp Systems International. (2006). Uniting the business of healthcare with priority of patient care. Retrieved November 2, 2007, from http://www.graspinc.com/methodology/faq.htm Pellerin, R. Personal Communication, October 8, 2007.
Pages to are hidden for
"Workload Measurement"Please download to view full document