Workload Intens-o-meteR

Workload Intens-o-meteRValueBasedHealthcare_logo_kleur_RGB_HR_nomineeprize2016

Health care delivery has witnessed a lot of reform in the past decade and much of this has involved the revision of operational processes and care pathways within health care systems. Some interventions have been austere in nature and have posed risks to the quality and outcome of health care delivery. Despite the different outcomes of some of these measures however, the common objective has been to reduce hospital expenditures and improve the efficiency of health services.

As of the 1st of January 2015, the Atrium Medical Center Parkstad (Atrium MC) together with Orbis medical Center (OMC) in SIttard formed a new merger hospital called the Zuyderland Medical Center.  Until the 1st of January, the Atrium MC was one of the largest top clinical (non-university) teaching hospitals in the Netherlands and the department of pediatrics was one of the 33 clinical specialties in the hospital. Each year, approximately 2400 patients aged between 1 month and 18 years were admitted to the hospital’s wards for long-term care and 420 for shorter admissions. In January of 2012, the hospital management board of the AMC announced a comprehensive reallocation of resources as a measure to reduce its operational costs. This intervention was essential for the proposed merger with the OMC, which was based on the assumption that the merger between the two hospitals would  create a synergy of the hospitals’ separate human and medical resources and result in a potentially higher market value within a single hospital

For the department of pediatrics, these cut backs resulted in a reduction of 5 full time equivalent nursing staff and a reduction from 22 to 18 in-patient pediatric beds. Since there was no proportional reduction in the amount of patients being admitted, the cutbacks resulted in a high level of resentment and a perceived increase in the intensity of work among the nursing staff (workload).  Staff morale also fell in the wards, resulting in the urgent need for an intervention to address the problem. Anticipating that these concerns could affect the quality of care, we realized that a strategy was needed to 1) obtain objective (i.e. actual vs. perceived) assessments of nurses’ perceptions of their workload and 2) create a common language that could embrace the various perceptions of workload intensity, as prerequisite for the chance of all parties accepting any recommendations for improvement.

In this report, we describe how we responded to this need by developing and implementing an intervention (i.e. workload intens-o-meter) that could measure the intensity of nurses’ workload and also predict the adequacy of nurse staffing in a clinical ward. The product of this exercise was an innovative and intuitive web-based tool that we developed over a 3 year period. This care quality analytic tool represents an effective strategy used to improve the quality of healthcare by optimizing the operational process, improving efficiency and sustaining staff morale in our pediatric ward. The goals of the next stages of this project include refining the instrument so that it is more intuitive and easier to use and capable of generating extra information. It is our expectation that if used responsibly, the information generated can be effective in tailoring patient admissions to the number of nurses available to provide care.

Finally, as far as we know, this is the first “care quality analytic tool” that can measure workload intensity objectively, real-time and with the active involvement and leadership of frontline health care providers. ( A demonstration of this tool’s functionality and “ease of use” is recommended for a true appreciation of its capabilities.