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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