1. www.postersession.com INTRODUCTIN The department of pediatrics is a 89 Beds unit. The department runs its own indoor and outdoor clinic. Besides It is also equipped with separate pediatric and neonatal Intensive care units. The number of doctors serving this department is 23 with following details ;one Professor, Associate Prof,Assistant Prof; & Consultant Pediatrician each. In addition 16 Post graduate Trainees in higher studies for Pediatrics along with 6 Medical Officers & 13 House officers also work with great zeal & zest to serve the ailed General Public. Only 3 P.G Trainee Doctors are deployed at OPD. Workload Indicators of Staffing Needs (WISN) of P.G. Doctors working in Out Patient Section Pediatrics Department Benazir Bhutto Hospital Rawalpindi Dr Muhammad Arshad Arain, QMU Student Id: 12009307-NM-252 PG Certificate Human Resource in Health (HRH), Queen Margaret University, Edinburgh. FRIDAY, April 04, 2014 In charge OPD has defined the main workload components and set activity standards for a staff category. The staff of OPD section work for averagely 5.6 hours a day (08:00 – 14:00). Available working hours in a week and year were determined. Similarly allowance standards for support and additional activities were calculated. METHODS A cross sectional study was conducted to see the Postgraduate doctors at OPD of Benazir Bhutto Hospital as the highest priority and WISN human resource management tool was used to determine the workload. Meetings were held with the Head of OPD, who defined the main workload components and set activities standards. Result The P.G Trainee doctors at OPD of Pediatrics Department of Benazir Bhutto Hospital Rawalpindi work for 244 days in a year and a six days a week. The staff avail 52 Sundays while 69 days of leave of different nature i.e. public, casual, annual and other leaves. The total working hours in a year was calculated 1366 hours. After applying WISN technique, it was found that the present doctors are highly overloaded with work & are three times short. Conclusion By comparing the difference between the current and required staffing level, it was found that the P.G Trainee Doctors are three times short to cope up their workload. The workload pressure calculated was 68 percent positive. References 1.WISN User’s manual (WHO, 2010) 2.Annual Statistics Benazir Bhutto Hospital, Rawalpindi. Table 1: WORK LOAD COMPONENT Staff Category: Postgraduate Trainee Doctors Work Load groupWork Load component Main Health Activities Detailed history & presenting complaints, Prescription writing in duplicate. Counseling for medication / diet, Dos & not.Record keeping for DHIS. Support Activities Investigation request in duplicate. Referral / counseling for referral to consultant. Detailed examination for Academic clinical cases. Review of investigation. Maintaining track for Notifiable diseases. Advocacy for Breast milk feeding & methods. Meeting with seniors. Additional Activities Presentation of Long Cases in Morning conference. Continued Medical Education Classes for Undergraduate students. Roster preparation for House Officers. Table 2: SERVICE STANDARDS Main Activities: Unit time or Rate of working Detailed history & presenting complaints, Prescription writing in duplicate. Counseling for medication / diet, Dos & not.Record keeping for DHIS. 02 minutes 01 minute Support Activities: Investigation request in duplicate. Detailed examination for Academic clinical cases. Review of investigation. Maintaining track for Notifiable diseases. Advocacy for Breast milk feeding & methods. Meeting with seniors. 01 min, 50/day 02 min, 10/ day 01 min, 30/day 02 min, 14/day 02 min, 20/day 60 min, 2/month Presentation of Long Cases in Morning conference. Continued Medical Education Classes for Undergraduate students. Roster preparation for House Officers. 60 min, 2/month 120 min,3/week 60 min, 2/month Table 5: CATEGORY ALLOWNCE STANDARDS (CAS) Variable “B” Average available working hours in a day = 5.6 hrs Available working days in a week = 6 days Available working hours in a week = 6 x 5.6 = 33.6 hrs Available working days in a year = 365 _121 = 244 days Available working hours in a year = 244 x 5.6 = 1366 hrs Work load groupWork load componentCAS (Actual working time) CAS % (working time %age) Support activities of P.G Trainee doctors Investigation request in duplicate. 30/60 = 0.5 hrs0.5/5.6 x100 = 8.9 % Referral / counseling for referral to consultant. 25/60 = 0.41 hrs0.41/ 5.6 x100 = 7.4 % Detailed examination for Academic clinical cases. 20/60 = 0.33 hrs0.33 /5.6 x 100 = 6.0 % Review of investigation.30/60 = 0.5 hrs0.5 / 5.6 x 100 = 8.9 % Maintaining track for Notifiable diseases. 28 / 60 = 0.46 hr0.46 / 5.6 x 100 = 8.3 % Advocacy & methods for Breast milk feeding. 40 / 60 = 0.66 hr0.66 / 5.6 x 100 =11.78 % Meeting with seniors.120/60= 2.0 hr24 /1366 x 100= 1.75 % Total CAS% =53.03 % B. (CAF): [1/[1- (total CAS percentage/100)]] 53.03/100=0.531—0.53=0.47VARIABLE “C” 1/0.47= 2.12 Table 6: INDIVIDUAL ALLOWNCE STANDARDS (IAS) = (IAF) -VARIABLE C Work load groupWork load component Number of staff performing work Actual working time per person (IAS) Annual IAS (for all staff performing activities) Additional Activities of P.G. Trainee Doctors Academic classes for medical students Two24 hours/ month288 hours Presenting long cases for Evaluation One2 hours/ week24 hours Total IAS in a year312 hrs Total IAF in a year ;Annual Total IAS/AWT 312/1366 = 0.2280.28 Table 3 : STANDARD WORKLOAD Staff Category: Postgraduate Trainee Doctors AWT in a year: 6x 5.6=33.6 hrs VARIABLE “A” Main ActivitiesUnit time or rate of working Standard work load (AWT/Unit time) Workforce Required Detailed history & presenting complaints02 minutes02/60=0.03, 1366 / 0.03= 1.52 Prescription writing in duplicate.01 minute01/60=0.016, 1366 /0.016= 0.8 Counseling for medication / diet, Dos & not.Record keeping for DHIS. 01 minute01/60=0.016, 1366 /0.016 = 0.8 Record keeping for DHIS.01 minute01/60=0.016, 1366 /0.016= 0.8 STAFF REQUIREMENT BASED ON WISN for MAIN ACTIVITIES 3.92 Table 4 : STAFF REQUIREMENT For MAIN ACTIVITIES; BASED ON WISN VARIABLE “A” Main Activities Work load componentAnnual work load (actual last yr activity/statistics) Standard work load Required number of staff members Detailed history & presenting complaints 69511 455331.52 Prescription writing in duplicate. 69511 853750.8 Counseling for medication / diet, Dos & not. 69511 85375 0.8 Record keeping for DHIS. 69511 85375 0.8 Variable AA. Total Staff required for main activity3.92 Table 7 : ANALYSIS OF WISN RESULT Staff Category: P.G. Trainee doctors Cadre of staff Current No. of staff Req. No. based on WISN Shortage or Excess Work force problem WISN ratio Work force pressure P.G Trainee Doctors 033.92x2.12=8.3 8.31+0.28= 8.59= 9.00 -6Shortage0.33High Workload pressure = 1- WISN ratio x 1001 – 0.33 x 100 = 68