Human resource assessment of a district hospital applying WISN method : Role of laboratory technicians Context : The Workload Indicators

Context: The Workload Indicators of Staffi ng Need (WISN) human resource planning and management tool, developed by Shipp (1998) and popularized by the World Health Organization (WHO), gives health managers a way to analyze and calculate correct staffi ng levels in health facilities. In present study, WISN tool was used to assess a District Hospital in terms of staffi ng of laboratory technicians to understand the staffi ng need against the existing workload of health system. Aims: To assess the staffi ng needs of laboratory technicians in District Hospital using WISN method. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: The present study is a cross-sectional survey involving observation, record review, and personal interview. Study was performed in a District Hospital of Madhya Pradesh. There were six laboratory technicians in the District Hospital and all of them were included in the study. The staffi ng pattern and need of laboratory technicians in District Hospital was estimated and WISN indicators calculated. Statistical Analysis Used: Rate ratio and proportions were calculated using Microsoft Excel 2007. Results: WISN calculation showed that District Hospital in which the study was done requires 16 laboratory technicians in order to provide the volume of health services in its annual statistics in accordance with the professional standards (activity standards) for these services, thus having a shortage of 10 technicians. Conclusion: The laboratory technicians in the District Hospital where study was conducted are constantly under pressure to match the existing workload due to shortage of manpower. Appropriate human resources management and planning can contribute greatly to the improvement of effi ciency of their work by ensuring optimum workload.


INTRODUCTION
Workload Indicators of Staffi ng Need (WISN) is a method of setting the correct staffi ng levels in health facilities.This method has been developed by Shipp (1998) and popularized by the World Health Organization (WHO). [1]In the late 1990s, the World Health Organization developed WISN to bring planning principles long used in business and industry to the health sector.Following fi eld testing, the WISN approach was immediately used in a variety of countries.Since then, a large amount of experience has been gathered to help measure the adequacy of staffi ng levels in terms of the work to be done and the number of staff available to perform the many necessary tasks.
In the context of public health, there has been a need for rational method of setting the correct staffi ng levels in health facility.There is fi xed pattern of staff for health posts, health centers, district hospitals, etc., in India which does not take into account the demand-supply dynamics of health services.With this background in mind, we undertook this study with the objective of human resource assessment of laboratory technicians in a District Hospital of Madhya Pradesh applying WISN method.
the study.Study design was cross-sectional using Key Informant Interview of Lab Technician, WISN, secondary sources/record review of annual hospital statistics.
To conduct the research study in selected hospital, formal written permission was obtained from the concerned authority before data collection.The investigator introduced her and the purpose of the study was explained to the subjects and informed consent was obtained.Structured interview questionnaires were given.The time taken to complete questionnaire was 20-30 min.Annual hospital statistics were collected by record review.The study was conducted between January and July 2012.

Development of Tool
The tools were developed by: • Review of literature which provided adequate content area and information.• Discussion and consultation with Chief Medical Offi cer of the District Hospital.

Ethical considerations
Ethical approval of study protocol was obtained from Institutional Ethics Committee, Indian Institute of Public Health (IIPH), Delhi.
Informed consent was taken from participants before the interview.

WISN Method
The WISN method is based on the work which is actually undertaken by health staff.Every health facility has its own pattern of workload which may include inpatients, surgical operations, deliveries, outpatients, clinics of various types, health education, home visits, outreach activities, inspection visits, etc.Each type of workload calls for effort (i.e., time) from specifi c health staff categories.For each type of workload (inpatient, outpatient, Medical Center Health (MCH) clinic, etc.) we can set an activity standard.This is a unit time for each staff category-how much time on average a case, a prescription, etc., should take each staff category which is involved in it, working to acceptable professional standards.This activity standard, an activity time or a rate of working (either can be used), can now be converted into the equivalent annual workload, that is, how much of this type of work could be done by one person in a year working to these professional standards and also making due allowance for time spent on vacation, holidays, training, sickness absence, etc.This equivalent annual workload is called the standard workload.
The amount of each type of work done in a health facility in a year is reported in its annual statistics.Thus, applying the standard workloads (annual work rates) to these annual statistics will show how many staff in each category is required in order to accomplish this workload to acceptable professional standards.The details of calculating these indicators can be obtained from http://whqlibdoc.who.int/publications/2010/9789241500197_users_eng.pdf.

RESULTS
The present study used WISN calculations to study staffi ng needs of laboratory technicians in a District Hospital.To calculate the workload indicators, fi rst the estimated available working time of laboratory technicians was calculated.The same is shown in Table 1.
As seen from the above table, average available working time per month for these staff categories is: 264 days/year/12 = 22 days/ month.
The result of calculating the average available working time per year for staff categories can be used directly to calculate the staffi ng requirements of posts which must be manned according to a fi xed than according to a fi xed time pattern rather than according to workload.
To calculate the workload of laboratory technicians, annual hospital statistics were scanned from the hospital records and total number of tests performed by laboratory technicians during the previous year was noted, as seen in Table 2.
The WISN method uses currently available service statistics, rather than calling for a special data collection.Workload data for WISN calculations were obtained mainly from the Health Management Information System Records in District Hospital.At times, it was necessary to visit the individual health units when data were missing.
A checklist was prepared to facilitate data collection.
The workload of laboratory technicians was also categorized into main health service activities, support activities, and other additional Based on the information gathered above, WISN method was used to calculate standard workload and staff requirement for laboratory technicians.Calculations are shown in Table 4.
Table 4 shows how to determine number of health workers you require in total to cope with all the different components of the current workload of your WISN staff category in District Hospital.
For this, we fi rst need the health facility's annual service statistics for the previous year.Divide the annual workload of each main service activity by its respective standard workload.This gives us the health workers required for that activity.The requirements of all activities together are added to get the total staff requirement for all main service activities.
The actual staffi ng levels and the calculated staffi ng levels and the calculated staffi ng requirements in one health facility denotes the shortage of staff in the facility according to the actual workloads and professional standards.The ratio between actual and calculated staffi ng level (WISN) shows whether these staff are working under pressure there is on them, that is, to what extent the professional standards can be upheld in the facility.
Table 5 shows the WISN ratio calculation for laboratory technicians in District Hospital.

DISCUSSION
WISN calculation shows that the District Hospital in which the study was done requires 16 laboratory technicians in order to provide the volume of health services in its annual statistics in accordance with the professional standards (activity standards) for these services.The WISN method is a very objective way of establishing staffi ng levels, but requires a dedicated team with adequate expertise to make the raw data meaningful for calculations.
The results of the assessment revealed a real shortage of laboratory technicians.Appropriate human resources management and planning can contribute greatly to the improvement of effi ciency in the health sector.[4][5] This study was restricted to a select category of    health staff in a single hospital.However, large scale studies in this regard, will provide evidence for rationale human resource planning in health sector which is need of the hour.

CONCLUSION
The present study highlights the acute shortage of manpower and urgent need to address human resource management issues in a health center in India.Further studies on a larger scale will help to understand the situation better and suggest suitable recommendations to improve human resources in health.

Table 2 : Total number of tests performed by laboratory technicians in district hospital in the previous year
activities, as per WISN method.Table3shows the activities under each of the categories performed by the laboratory technicians.Main health service activities are carried out by all members of the health worker category.Regular statistics are collected on them.Important support activities are carried out by all members of the health worker category.Regular statistics are not collected on them.Other activities are carried out by certain (but not all) members of the health worker category.Regular statistics are not collected them.
International Journal of Medicine and Public Health | Oct-Dec 2013 | Vol 3 | Issue 4

Table 5 : WISN calculation for laboratory technicians in district hospital
Pandey AA, Chandel S. Human resource assessment of a district hospital applying WISN method: Role of laboratory technicians.Int J Med Public Health 2013;3:267-70.
WISN = Workload indicators of staffi ng need How to cite this article: Source of Support: Nil, Confl ict of Interest: None declared.