How to Determine the Optimal Target Manpower for Your Hospital

There are many methods used by Operation Management Experts to determine the number of employees needed by an organization. The two common ones are the Full Time Equivalent (FTE) method and the Takt time Method. In my Training Sessions with Hospital Entrepreneurs, Doctors and Managers, I tend to favor the Takt time method. Though slightly more technical, it can be used in combination with deductive reasoning. This makes it suitable for use in the hospital setting. Physicians are generally not fans of calculations, so I will explain it as clearly as I can.

 Firstly, I will define the following terms-Labor Content, Demand, Takt Time and Target Manpower.

Labor content is the total amount of time that a flow unit (e.g. a patient) spends within a process. It is determined by calculating the sum of the individual time each resource/employee spent with the patient. For example, if a patient spends 5 mins at registration, 30 mins at consultation and 30 mins at the pharmacy before leaving the hospital, the labor content will be (5 mins+30 mins+30 mins) 65 mins.

The demand is the total number of flow units per given period. E.g. we can speak of a demand of 10 patients/hour.

The takt time defines the ideal amount of time that a flow unit should spend with each resource/employee/work station. Takt is a German word that means “the beat of the music”. Literally, it signifies that workers should dance to the beat of the music of demand. That is, if the demand increases, the pace of the work should also increase. If the demand reduces, then the work pace should equally drop. The formula for Takt time is:

Takt Time= 1/Demand

           Or

Takt Time/hour= 60 mins/Demand per hour

 The target manpower is the approximate number of resources you need to employ in order to achieve the takt time. It is calculated as follows:

Target Manpower = Labor Content/Takt time

For better understanding, let’s consider the problem below:

Dr. Johnson is a Hospital Entrepreneur who owns a modest hospital, New-life Hospital (a general practice facility) located in a small town. He runs consultation services Mon-Fri (8 am-4 pm) and also admits the occasional patient into the ward. Thus the hospital is open 24 hours a day, 365 days a year.

He has on his payroll, 1 resident doctor, 9 nurses who rotate on an 8 hourly basis. (3 nurses on morning shift, 2 on afternoon, and 2 on night duty and 2 off duty). He also employs 1 pharmacist-technician, 1 laboratory scientist, and 1 receptionist/records staff to help him during clinic hours (8 am-4 pm). His total number of employees is 13.

His workers are idle most of the time except on Wednesdays (ANC days) when the demand is overwhelming (40 patients on average). During ANC days, the workers usually work overtime. The ANC process is as follows: 5 mins (registration), 10 mins (vital signs), 15 mins (doctor) 30 mins (laboratory) and 20 mins (pharmacy).

On other days, New-life hospital attends to an average of 16 patients in the Out-Patient Clinic.

What should be his optimal target manpower for Non-ANC days and for ANC days? (Assume a labor content of 40mins during non-ANC days.)

Solution:-

To calculate the target manpower for non-ANC days ,

Labor content =40 mins (given above)

Demand/hour = 16 patients/8 hours

                         = 2 patients/hour

 (Note that there are 8 working hours every clinic day and a total of 16 patients every clinic day)

Takt Time/hour = 60/Demand per hour

= 60/2= 30 mins (i.e. a patient should spend 30 minutes at each work station)

Target Manpower = Labor Content/Takt Time

                                 =40/30= 1.3   (approx. 2 workers)

N.B: In practice, a patient will not spend an equal amount of time at each work station. The 30 minutes above is therefore a theoretical guide that gives the maximum duration a patient should spend with each resource at New-Life Hospital.

Let’s calculate these same values for ANC days

Labor Content = 5 mins+10 mins+15 mins+30 mins+20 mins

                          = 80 minutes

Demand/hour = 40/8

                          = 5patients/hour

Takt Time/hour = 60/5

= 12 mins (i.e. a patient can spend 12 minutes at each work station)

Target Manpower = 80/12

                                = 6.7 (approx. 7 workers)

Deductions:

1.     For non-ANC days, the target manpower is actually 1.3 workers. However, we rounded it up to 2 workers because we can’t have 0.3 of a person. But having only 2 workers in a clinic is hardly practicable (unless, Dr. Johnson wants to run a village health outpost).

Dr Johnson feels that to effectively run a clinic, there must be a minimum of a doctor, a nurse, a pharmacist-technician and a laboratory scientist. That makes a total of at least 4 workers. Dr. Johnson currently has 9 nurses, 1 doctor, 1 pharmacist-technician, 1 laboratory scientist and 1 record staff making a total of 13 workers.

To determine his optimal target manpower for Non-ANC days, I will assume here that the number of patients visiting the OPD daily determines the number of patients on admission. If only 2 patients come every hour, the chances are that the admission rate will be low, therefore the nurses on afternoon and night shifts will not have much to do.

With that in mind, Dr. Johnson doesn’t need a resident doctor on non-ANC days. He alone can cope with the work load until his clientele increases. He also doesn’t need a records staff, 1 of his nurses can perform that role currently. Also, he doesn’t need 9 nurses. 5 nurses should suffice i.e. 2 on morning shift, 1 on afternoon, 1 at night and 1 on off duty per time.

 The optimal target manpower for non-ANC days will now consist of 5 nurses, 1 laboratory scientist, and 1 pharmacist-technician = 7 workers.

(We arrived at this number through a combination of scientific calculations and deductive reasoning.)

2.     On ANC days, the demand increases to 5 patients/hour and the calculated target manpower is 7 workers (not 6.7 because you can’t have 0.7 of a person). This corresponds with the optimal target manpower for non-ANC days.

However, because of the increased work load on ANC days, Dr Johnson may need to employ a Doctor on a part time basis and also bring in an extra nurse. This will bring the optimal target manpower on ANC days to 9.

3.       Finally, from calculations and deductive reasoning, Dr Johnson should employ 7 full time employees and 2 part-time employees. This brings his total number of employees to 9 instead of 12.  This 9 should consist of 5 full-time nurses, 1 full-time laboratory scientist, 1 full-time pharmacist-technician, 1 part-time nurse and 1 part-time doctor. 

Do You Have Oxygen?

Today, I will like to share two stories with you. Please read on:

Courtesy: Wikipedia

1.

On Wednesday June 24^th, I was called out of a church service by a well respected High Court Judge. He wanted me to help take a look at a little girl. Diane (not her real name) was a sweet looking two-year old. What struck me when I first saw her was how frail she was. She clearly had growth retardation and was about half her expected weight. She was in severe respiratory distress, cyanosed and febrile. Her parents said she had being admitted about 5 different times since birth for ‘pneumonia’. I didn’t have a stethoscope to listen to her heart. But, I immediately thought of a congenital heart disease.

I placed a call to a very good friend who is a Pediatric Resident and sent Diane to him for evaluation and management. After examination at the hospital where he works, he confirmed my fears. She had a Congenital Heart Disease. He promptly proceeded to admit her into the ward prior to investigations and further review. But alas, the oxygen cylinder in the ward was empty! And there was no oxygen in the entire hospital. Since her condition required oxygen as part of the immediate management, Diane was referred to another hospital. She died as soon as she got to the entrance of the emergency pediatric unit of the second hospital!

2.

About two years ago, a very close relative suffered a CVA and was admitted into the medical ward of a hospital. He was comatose for about a week and in that period, he needed oxygen to remain alive. The hospital didn’t have enough to go round all the patients. I wanted to keep him alive long enough so all his children could come visit him before his imminent death. As a result, I had to ‘borrow’ oxygen from several private hospitals in town to supplement what the hospital could spare for him.

The stories above are not fictional. They are real stories that involved real people who needed something as basic as oxygen. I am sure similar scenarios play out daily in hospitals and clinics all over the developing world. I have seen so-called emergency ambulances used to convey critically ill patients that lacked oxygen canisters/cylinders! Sadly, what Physicians in developed countries take for granted is now a luxury in many developing countries like mine. There is an urgent need to restructure and revamp the healthcare system in developing countries. We must put in place an organized system to prevent the absence or shortage of vital materials and equipment.

Oxygen alone certainly cannot treat all illnesses and diseases. Diane probably would have died even if she had received oxygen. My close relative also died despite my best efforts to provide oxygen. But that is beside the point.

The simple question is: Do you have oxygen and other basic live-saving equipment in your hospital?

It could mean the difference between life and death. If you currently lack oxygen and other basic life-saving equipment in your hospital, the time to get it is NOW! You would be saving lives.

Cheers!

BUILDING RELATIONSHIPS: A Customer Service Skill

In previous posts, I defined who your customer really is and explained the most basic need of customers. As a follow up, it is important you know that there are certain skills required by management and employees that will enable you render excellent customer service.

Much like a surgeon needs the right skills and tools to perform a successful surgery, every hospital employee will need to acquire the necessary skills to satisfy the customer. One of such skills is the ability to build relationships; with co-workers and patients.

Courtesy: Lucas

I had stated in another previous post that one of the elements of  medical services is ‘inseparability’. That means you cannot render service without coming into personal contact with the patient (at least in most cases). As a result, medical employees need to learn, acquire, or develop the skills necessary for building relationships.

Building relationships means getting to know your patients as people; seeing them as real people and not just as medical cases. The better you get to know them, the better you can help them. Developing relationships builds patients trust in you. Here are a few tips:

1.     Be Nice and Friendly

The first step to building relationships is to be nice to patients and their relatives. This begins with knowing the names of your patients. Patients have names and it is always nice if you call them by their names instead of referring to them as “madam” or “the man with the red cap”. In addition, learn to correctly pronounce their names. Their name is the sweetest sound to them when correctly pronounced. Knowing their name gives them a feeling of importance and makes them know that you genuinely care enough to know them.  

2.     Smile Always

It is also important that you always have a smile on your face when dealing with patients. A friendly smile is often reassuring and relaxing to patients. When they are relaxed, it becomes easier to get information from them.

3.     Listen

The next key to building relationships is listening. Listening is a skill on its own. Please resist the temptation to dismiss the patient before they even get to the kernel of their complaint. I know how difficult it is to listen to a patient blabbing away when you have a busy clinic. But you should do all in your power to steer the patient towards the important facts while maintaining a listening ear. Things to do while listening are making eye contact when patients are speaking, nodding to encourage them to speak more, asking questions to clarify certain points and repeating certain aspects of their conversation. (I hope to write extensively on how to be a good listener in a future post).

4.     Pay Compliments

We all want to hear how nice we are, how lovely our dress is and how smart we work. It is the same with patients. Learn to give honest and sincere compliments like “You are doing a good job with your diet plan” or “thanks for coming promptly for your appointment”. Don’t criticize, condemn or complain about them.

5.     Small Talk

During downtime, indulge in small talk with patients, their relatives and friends. Let them see your ‘human’ side, your ‘informal’ side. Avoid being serious and business-like all the time. When you talk, talk in the terms of the other person’s interest. Let it be clear that you genuinely care.

6.     Bedside Manner

Finally, adopt a congenial bedside manner. This means being pleasant and responsive to the needs of your patients.

In conclusion, building relationships with patients will ultimately affect your profit margin, positively.

 See you soon….

What do Patients Need?

Many physicians have asked this question countless times in exasperation. What do patients need?! It seems when you’re nice to patients, they take you for granted and call you at odd hours for the most trivial of issues. Conversely, when you are not so nice, they call you a snob.

What do patients really need? Can you ever please them? Do they need treatment in the form of drugs, counseling, surgery, physiotherapy, or a combination of all these? Or is there something deeper that they need?

I usually tell physicians that the most basic need of any customer/patient is EMPATHETIC HELP! You certainly cannot cater to their every want but you will do well to offer them emphatic help.

Image Courtesy: www.fotosearch.com

Usually, patients cannot do much for themselves. When they come to the hospital, they often feel like crap and cannot make themselves better. This helplessness may be physical, mental or emotional. My little daughter’s dictionary says to help is ‘to make it easier for someone to do something, by doing part of their work or by giving them advice or an object they need’.

Empathy means the ability to identify with and understand somebody else’s feelings or difficulties.

Empathetic help therefore means the ability to do something, give something or give advice from a point of understanding to a patient. For example, when a patient comes in vomiting all over the couch, empathetic help means providing relief and cleaning up without being rude or impolite. It also means a woman who is in labor is not screamed at or slapped on the laps. Rather counseling and some form of acceptable pain relief is offered. In addition, empathetic help means putting yourself in the patient’s shoes and giving the treatment and attention you would expect to receive if you were a patient.

The components of empathetic help are:

—  Friendliness:

The act of being nice to patients and being receptive to their queries

—  Understanding:

This is having the right attitude towards patients based on your ability to interpret or infer their feelings.

—  Fairness:

This means providing a balanced and impartial service to patients regardless of their gender, color, creed, ethnicity, religion or political leaning.

—  Confidentiality:

This means not divulging the patient’s medical history or condition to unauthorized persons.

—  Information:

This involves providing facts and data about the patient’s condition in terms they can understand so that they can make informed choices.

—  Control:

This is allowing patients or their guardians to make informed decisions at each point in their treatment process.

—  Options & Alternatives:

This implies providing equally beneficial treatment choices to patients as well as directing patients to another service provider when you cannot manage their specific health issues.

Beyond the aesthetics and facilities of your hospital, empathetic help is a culture that your hospital must imbibe. To remain competitive, you should learn it and train your staff to give it.

So, when next you get exasperated by your patients and wonder what they actually need, read through this article. That way you can keep on providing quality healthcare with a smile.

Cheers!

Who Are Your Customers?

There are two basic questions I always ask in my Customer Care Training Workshops. The first is “who are your customers”? I get various responses like; “my customers are my patients”, or “customers are those who buy services from us”. Then I ask the next question, “who is a consumer”? At this stage, a lot of people get stumped and ask “aren’t they the same”? Well, not really.

Your customer is someone who purchases a product (a service or a good) from you. The customer may not necessarily purchase the product for personal use or satisfaction.  A customer is also a person with whom you have dealings. A consumer on the other hand, is a person who actually uses your product and derives personal satisfaction from it.

In this context, a customer could be a Medical Insurance Company or a Health Management Organization (HMO) that purchases health insurance for a group of employees. The employees are the consumers. A customer could also be a parent who pays the dentist to do scaling and polishing for his daughter. In this case, the daughter is the consumer and the parent is the customer. A person who presents in the ER and pays for his treatment is both a customer and a consumer.

You must ensure you identify both the customer and the consumer in each case and provide the service that each needs. The consumer needs good health, while the customer expects value for money. Satisfying both is always a delicate balancing act. This is especially true with regard to Medical Insurance Companies and HMOs. Excellent service involves satisfying both the customer and the consumer.  However, the ultimate person is the consumer, who is the patient.

To satisfy the consumer, you need to understand the concept of the customer chain. But first, let us consider the various classes of customers encountered in a typical hospital:

• —  External Customers
• Internal Customers
• Corporate Customers
• Regulatory Customers

The external customers come from outside the hospital environment. They are the most important component in the customer chain. The external customer includes the patient, his/her relatives and friends. They require the services of the hospital. External customers can be both customers (purchase the service) and consumers (derive personal satisfaction from using the service).

The internal customers come from within the hospital environment. They include doctors, pharmacists, hospital administrators etc. They require the service of another service provider to perform their own duties. Internal customers are mainly consumers. They use/consume the services of others.

Corporate customers are also from the external environment. They differ from external customers because they do not consume hospital services. Rather, they provide service to the hospital. Examples are suppliers, pharmaceutical company sales reps, waste disposal companies etc. Without your corporate customers, you may not be able to meet the needs of your external customers.

Finally, the regulatory bodies monitor the activities of the hospital to ensure minimum standards of healthcare quality are met.

The Customer Chain

These different types of customers form a chain called the customer chain. The chain begins when the corporate customers supply drugs, consumables and other services to the hospital. The quality of service received from the corporate customers influences the quality of service the hospital will provide to its other classes of customers.

The customer chain continues when the external customer/consumer/patient requires treatment and presents at the hospital. The internal customers then ‘processes’ the patient through the hospital system.

For example, the front desk provides a service to the doctor by pulling out the relevant documents pertaining to the particular patient. The doctor also requires the service of the laboratory scientist to aid the diagnosis. He in turn provides service to the laboratory by requesting for the right investigation. The nurse is expected to carry out the instructions of the doctors.

The regulators ensure that all that takes place is acceptable and legal. The chain goes on to the last point of service the patient comes across before exiting the hospital.

If one person in this chain does a shoddy job, the customer leaves with an unsatisfactory service. A break in this chain leads to poor service. Shoddiness can result from misdiagnosis, wrong tests results, expired drugs, poorly filled prescriptions e.t.c.

Excellent customer service therefore begins from identifying your customers and consumers; ensuring each member of the medical team understands the customer chain and their position in it; and encouraging everyone to give their best at their respective work stations.

See you soon…..

Beyond Aesthetics: Campus Sheraton

I initially planned to title this post “Does Your Hospital Have Aesthetic Value?”. But after some careful thought I decided to title it “Beyond Aesthetics”. This is because I have discovered that a lot of hospitals are stepping up their look in terms of modern designs and buildings. This is especially so in the urban areas. Many though, in rural and semi-urban areas are still living in the past, providing services from dilapidated structures and unkempt premises.

I have always believed that a hospital building should be trendy (forgive me, I am still under 45), have wide corridors, neat and air-conditioned rooms, shiny floors, sparkling clean bathrooms, a pleasant fragrance, comfortable furniture, adequate lighting, spectacular landscape, an imposing signpost, functional ambulances, smartly dressed staff, state of the art facilities etc. This sounds like a five-star hotel. Well, I think the modern hospital should be a five star hotel and even more.

Back in school, we had a cafeteria complex that catered to the culinary needs of the entire campus. There were about 12 separate canteens called ‘Buka’ 1- ‘Buka’ 12. Sometime in my 4^th or 5^th year, Buka 1 was taken-over and became known as ‘Campus Sheraton’. The new management transformed the dingy lit canteen to a five-star hotspot. The furniture was changed to a more comfortable one; the exterior was re-designed, the interior was re-decorated and air-conditioned. But most importantly, the menu and service were drastically changed from what the other cafeterias were providing. The management employed waitresses who were smartly dressed, friendly and courteous. My wife and I still reminisce on those good old days as students when we went ‘tearing’ turkey wings, eating fried rice and drinking chilled coke at Campus Sheraton; all at the expense of our parents! The place sure wasn't cheap but the service and food was spectacular.

That is what ‘Beyond Aesthetics’ means; going beyond mere external beauty to provide profitable quality. While it is necessary to improve the outlook of our facilities, the focus should be more on provision of quality service at all times. The aim of every infrastructural project should be to enhance the experience of the patient and improve patient outcome. A beautiful building will attract patients but only consistent quality service will keep the patients.

There are several dimensions of quality which must be regularly assessed to determine how well you are doing on the quality scale. These are:

• ·        Timeliness
• ·        Completion
• ·        Courtesy
• ·        Accuracy
• ·        Mistakes

The time dimension of quality emphasizes promptness of service to patients. Patients should not be delayed unduly and adequate measures should be put in place to reduce patients waiting time to the barest minimum.

 Quality also means each task in the hospital process is properly completed. An incomplete or poorly performed task could affect the performance of the next task in the sequence.

Another quality dimension that must be regularly assessed is courtesy. Measures and standards of behavior should be set for hospital employees at employment, induction and at regular intervals during the period of their employment. It is unacceptable for hospital workers to be rude to patients whose basic need is emphatic help.

Accuracy is a dimension of quality that relates with hitting the mark in patient care. The incidences of misdiagnosis should be rare and far between.

Finally, mistakes should be avoided. Hospital managers should design measures to prevent mistakes e.g. use of checklists, adequate planning of duty rosters, putting name bands and marking surgical sites on patients going for surgery e.t.c.

These measures will improve quality and reduce litigation. In addition, ensuring quality service helps you move beyond aesthetics to actual profitability.

See you soon…..