WORKFORCE PLANNING

June 2011

Amr FouadTraining & Research SectorMinistry of Health & Population

Presentation Outlines

Introduction

Overview on Workforce Planning Model

Model Applications: Examples for Model Results

Conclusions and next steps

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Human Resource in Egypt

Why Egypt?

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Human Resource Challenges in Egypt

Egypt’s Health reforms in hospitals and the Family Health Model require changes in staff skills and mix.

Workforce distribution poorly allocated: Between urban and rural areas Between primary, secondary, and tertiary care Among different specialties

New management skills due to increasing complexity of health systems.

The need for linking training programs to actual staffing needs.

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Development and Application of Workforce Planning Model

in Egypt

Objectives of our Work

Identify a good methodology to plan the number and type of staff needed

Build MOHP capacity in workforce planning

Develop Egyptian standards for Health Workforce

Develop a strategy report on long-term MOHP workforce plan

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What is the Workload Indicatorsof Staffing Need (WISN) Model?

The Health Systems 20/20 adapted the World Health Organization’s “ Workload Indicators of Staffing Need (WISN) methodology to the Egyptian context.

The method uses expert-generated activity standards and the observed volume of services at a hospital to estimate numbers of workers needed.

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Why the WISN Model?

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Traditional Methodsvs. WISN Model

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WISN Results in two Fifty-bed Hospitals

Source: S. Ozcan et al. 1998. Determining hospital workforce requirements: a case study. Human Resources for Health Development Journal (HRDJ) Vol. 3 No. 3

Workforce Planning Model

Determines staff requirements based on actual

Workload or Service Volume

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Expert Opinion PanelExpert Opinion Panel Local Labor/HR LawsLocal Labor/HR Laws Facility RecordsFacility Records

1. Clinical & nonclinical activities of heath workers(e.g., “Outpatient exam.,

admin., training”)

1. Clinical & nonclinical activities of heath workers(e.g., “Outpatient exam.,

admin., training”)

2. Activity standards(Time per activity)

2. Activity standards(Time per activity)

3. Total available working hours

3. Total available working hours

5. Actual workload or annual service volume

(e.g., ”no. of patients , surgeries, admission, ..”)

5. Actual workload or annual service volume

(e.g., ”no. of patients , surgeries, admission, ..”)

4. Standard workload4. Standard workload

6. Staffing Needs or

Number of Workers Required (R)6. Staffing Needs or

Number of Workers Required (R)

8. Workforce Ratio8. Workforce Ratio7. Workforce Gap7. Workforce Gap

Workforce Planning Model in Egypt

Activity Standards

What are Activity Standards?

Time it takes a trained and well-motivated staff member to perform the action to acceptable professional standards in the circumstances of the country.

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Activity Standards: ExampleActivity Standards for OB/GYN

I. PhysiciansACTIVITIES Unit Consultants Specialists Residents

OUTPATIENT ENCOUNTERS

Outpatient Encounters minutes/patient 10 15 15

INPATIENT VISITS

a. All other admissions minutes/patient 15 20 20

b. Normal vaginal deliveries minutes/patient 20 70 75

All (Average) minutes/patient 17.5 45 47.5

SURGERIES

a. Minor procedures minutes/patient 15 30 30

b. Major procedures minutes/patient 60 90 90

All (Average) minutes/patient 37.5 60 60

NON CLINICAL ACTIVITIES (% time on Non Clinical activities)

6% 5% 4%

AVAILABLE CLINICAL HOURS PER YEAR 1467 1487 2018

II. NursesACTIVITIES Unit Nurses

OUTPATIENT ENCOUNTERSOutpatient Encounters minutes/patient 20

NON CLINICAL ACTIVITIES (% time on Non Clinical activities)

7%

AVAILABLE CLINICAL HOURS PER YEAR 1937

INPATIENT ACTIVITIESMorning shift (6hrs) patients/nurse 6

Afternoon shift (6 hrs) patients/nurse 6

Evening shift (12 hrs) patients/nurse 6

NON CLINICAL ACTIVITIES (% time on Non Clinical activities)

17%

AVAILABLE CLINICAL HOURS PER YEAR 1728

Establish Standard Workloads

What are Standard workloads?

Amount of work (within one activity) that one person could do in a year,

e.g.; Full time Specialist in General Surgery performs:

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Example of Standard Workloads

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Specialties Outpatient Encounters Inpatient Days Surgeries

PEDIATRICS

Total 6,019 3,611

Minor 4,514

Major 3,010

NEONATOLOGY

Total 3,597

Minor 4,496

Major 2,998

INTERNAL MEDICINE

Total 6,925 6,925

Minor 8,656

Major 5,771

GENERAL SURGERY

Total 4,918 11,475

Minor 17,213 2,869

Medium 956

Major 8,607 717

STANDARD WORKLOAD FOR SPECIALISTS

Determine Required Staff

Actual Workload for activity

R =

Standard workload for activity

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What Does the Model Measure?

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What is WP Model can Do?

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User-friendly Access-based software was developed to estimate the gap between available and required staff, and quantify shortages and surpluses of workers.

Build MOHP Capacity in WP(Taskforce & Governorate Teams)

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Build MOHP Capacity (Hospital Teams)

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Build MOHP Capacity (Data Entry Training)

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Build MOHP Capacity(Data Verification OJT)

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Set Activity Standards

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Challenges with ROUTINE DATA

MOHP lacks personnel database

Patient registration and records are incomplete

Lack of activity standards for health services

Inconsistencies between reported and actual workload

Data on severity and case mix are absent or inaccurate

√ Necessary

to do:

Data collection

Special studies

Estimates

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Challenges with POLICIES & ORGANIZATION

Top-down assignment of staff Current policies

E.g. minimum staff required even if workload is zero! To maximize benefit of workforce planning need:

HR strategy Institutional home Steering committee to engage policy makers

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Results of Workforce Assessment in one of the Pilot Governorates

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Example of EgyptWorkforce Analysis Results

Current Staff Profile

Staff Composition Staff Composition

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Current Staff Profile

Hospital Hospital StaffStaff FlowFlow (Percent Gain and Loss) (Percent Gain and Loss)

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Current Staff Profile

Registered vs. Actually Working StaffRegistered vs. Actually Working Staff

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Current Staff Profile

Retirement: Staff Distribution by Age Retirement: Staff Distribution by Age

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Current Staff Profile

Years of Experience of Hospital StaffYears of Experience of Hospital Staff

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Least ExperienceLeast Experience

Workforce Gap Analysis Results

Current Required Gap Ratio Current Required Gap Ratio Current Required Gap Ratio Current Required Gap Ratio

PEDIATRICS 9 2 7 4.5 46 3 43 15.3 20 7 13 2.9 75 12 63 0.7

NEONATOLOGY 0 2 -2 0.0 0 2 -2 0.0 8 2 6 4.0 8 6 2 1.3

INTERNAL MED. 11 4 7 2.8 37 5 32 7.4 13 12 1 1.1 61 21 40 2.9

GEN SURG 16 5 11 3.2 27 6 21 4.5 8 7 1 1.1 51 18 33 2.8

OBGYN 14 5 9 2.8 68 6 62 11.3 26 6 20 4.3 108 17 91 6.4

RENAL DIALYSIS 0 0 0 0.0 1 2 -1 0.5 15 14 1 1.1 16 16 0 1.0

ICU 0 1 -1 0.0 0 2 -2 0.0 1 2 -1 0.5 1 5 -4 0.2

EMERGENCY 0 2 -2 0.0 0 12 -12 0.0 0 26 -26 0.0 0 40 -40 0.0

LAB 8 1 7 8.0 11 3 8 3.7 22 5 17 4.4 41 9 32 4.4

REHAB. 0 0 0 0.0 4 4 0 1.0 5 4 1 1.3 9 8 1 1.1

RADIOLOGY 2 3 -1 0.7 3 3 0 1.0 3 5 -2 0.6 8 11 -3 0.7

TROPICAL DISEASE 1 1 0 1.0 6 1 5 6.0 7 0 7 0.0 14 2 12 7.0

SKIN 5 2 3 2.5 32 2 30 16.0 25 5 20 5.0 62 9 53 6.9

PSYCHIATRY 0 1 -1 0.0 7 1 6 7.0 3 3 3 0.0 10 5 5 2.0

URO-SURGERY 6 5 1 1.2 11 5 6 2.2 2 6 -4 0.0 19 16 3 1.2

ORTHOPEDIC 7 6 1 1.2 10 7 3 1.4 18 10 8 1.8 35 23 12 1.5

ENT 3 4 -1 0.8 10 5 5 2.0 13 6 7 2.2 26 15 11 1.7

ANESTHESIA 6 5 1 1.2 15 6 9 2.5 7 9 -2 0.8 28 20 8 1.4

TOTAL 88 49 39 1.8 288 75 213 3.8 196 129 67 1.5 572 253 319 2.3

SPECIALISTS RESIDENTSCONSULTANTS SPECIALITIES

TOTAL

Gharbia hospitals have surplus in all staff types.

Gap between Current and Required Staff

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Physicians’ Gap Analysis

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Physicians Gap Analysis across Hospitals in Gharbia Governorate

Nurses’ Requirements by Specialty

Current Required Gap Ratio Current Required Gap Ratio Current Required Gap Ratio Current Required Gap Ratio

PEDIATRICS 90 61 29 1.5 41 34 7 1.2 15 4 11 3.6 146 99 47 1.5

NEONATAL 180 41 139 4.4 21 5 16 4.4 201 46 155 4.4

INTERNAL MEDICINE 146 51 95 2.9 60 40 20 1.5 24 5 19 4.8 230 96 134 2.4

GEN SURG 130 48 82 2.7 54 28 26 1.9 21 5 16 4.5 205 81 124 2.5

OBGYN 137 45 92 3.0 50 13 37 3.8 17 3 14 6.4 204 61 143 3.4

BURNS 42 6 36 7.0 57 11 46 5.2 99 17 82 5.8

RENAL DIALYSIS 166 61 105 2.7 12 11 1 1.1 178 72 106 2.5

ICU 152 31 121 4.9 22 15 8 1.5 174 46 129 3.8

EMERGENCY 217 127 90 1.7 -1 -10 9 0.1 216 117 99 1.8

DENTISTRY 82 27 55 3.0 8 -2 10 0.0 90 25 65 3.6

REHAB. 71 6 65 11.8 -16 -1 -15 0.0 55 5 50 11.0

CHEST 8 0 8 0.0 12 5 7 2.4 0 0 0 0.0 20 5 15 4.0

TROPICAL DISEASES 28 13 15 2.2 29 9 20 3.2 -14 -2 -13 9.3 43 21 23 2.1

SKIN 2 0 2 0.0 59 32 27 1.8 13 0 13 0.0 74 32 42 2.3

PSYCHIATRY 8 4 4 2.0 0 0 0 0.0 8 4 4 2.0

URO-SURGERY 71 24 47 3.0 23 12 11 1.9 2 -3 5 -0.8 96 34 63 2.9

ORTHOPEDIC 98 33 65 3.0 56 34 22 1.6 29 2 27 13.4 183 69 114 2.6

OPTHALMOLOGY 36 18 18 2.0 30 11 19 2.7 12 1 11 18.0 78 30 48 2.6

ENT 43 30 13 1.4 30 27 3 1.1 5 -2 7 -3.0 78 55 23 1.4

CARDIOLOGY 20 3 17 6.7 2 1 1 2.0 22 6 16 0.0 44 10 34 4.3

TOTAL 1183 404 779 2.9 990 471 519 2.1 249 48 201 5.2 2422 923 1499 2.6

TOTAL NURSESSPECIALTIES

IN-PATIENT NURSES OUT-PATIENT NURSES NURSE SUPERVISORS

Other Staff Requirements

Staff Type Current Required GAP Ratio

Dentists 92 45 47 2.0Pharmacists 287 117 170 2.5Admin Staff 1707 1128 579 1.5Medical Technicians

Dentistry 73 10 63 7.3Lab. 107 49 58 2.2Radiology 221 16 205 13.8

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Next Steps

Application in primary health care facilities (PHCs), other type of hospitals and other sectors.

Designing training programs in response to actual staffing needs.

Using results of workforce assessment as a basis for developing workforce plans.

The workforce standards should be officially adopted by the MOHP.

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Conclusions

An effective, valid workforce planning model was developed for the Egyptian context.

The model quantified the magnitude of staff imbalances by governorate, specialty, and staff category.

Implications

Policies are needed to close the gaps observed between the need for and supply of health workers for all levels of service provision.  

Thank you