University of Twente Student Theses

WORK ACTIVITY EVALUATED:IMPROVING THE WAY CONSULTATION HOUR ASSISTANTS SUPPORT MEDICAL SPECIALISTS IN THE CURRENT AND FUTURE ORGANIZATION OF THE CONSULTATION DEPARTMENT AT THE NKI-AVL

Bruin, M.B. de (2010) WORK ACTIVITY EVALUATED:IMPROVING THE WAY CONSULTATION HOUR ASSISTANTS SUPPORT MEDICAL SPECIALISTS IN THE CURRENT AND FUTURE ORGANIZATION OF THE CONSULTATION DEPARTMENT AT THE NKI-AVL.

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Abstract:	The demand for medical services in the Netherlands is growing due to technological and demographic developments. The change in the prevalence of care, an increase in the consuming behaviour of people and regulated market forces are supporting this trend for the coming years. Next to this, an increase in productivity is stimulated by the current system of hospital output prices. This system is based on diagnosis and treatment combinations. As a result of these market developments, the Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI-AVL) started to explore the possibilities for expanded growth. Up to the year 2020 a sustained growth of 45% is planned, from which 15% should be established by a more efficient use of existing resources. This study aims to improve the way consultation hour assistants (CHAs) support medical specialists in the current and future organization of the Consultation Department at the NKI-AVL. First, the content of the job of CHA is established. Second, a measurement tool is chosen and a procedure is defined to determine how CHAs spend their working time. This measurement procedure, which is worksampling, is applied into practice and the resulting data are analysed. Results following the analysis are discussed and verified. Next, the most influential areas for improvement are identified. Suitable strategies to improve the way CHAs support medical specialists at the CD are then developed, and corresponding effects within the current and future organization are explored. Finally, theory about behavioural change, which can be linked with organizational change, is used to create some practical insights about how the chance of success can be increased with respect to change initiatives. Results show that 80% of the activity of CHAs during an average working day is found in the following 5 categories: · Non-productive working time (25,7%) · Making appointments with patients (17,9%) · Taking care of the availability of patient records (17,7%) · Registering patients upon arrival (8,6%) · Providing telephonic support (8,5%) Improvement scenarios focussing on these areas will have the highest impact on the support delivered by CHAs at the CD. First, we conclude that the amount of non-productive working time of CHAs is too high in the current situation. Maintaining a non-productivity (NP) level of 25,7% is not advised. We would rather advise to aim for a NP-level of 10%. When the CHA FTEs are reduced to achieve this level, savings are estimated at €131.464 for the year 2010. The management of the CD should be aware of the major impact this change will have on CHAs and that resistance can be expected. Second, we conclude that digitalizing the medical records and nursing records, which are currently available on paper, will result in a substantive drop in work activity at the side of the CHAs. If the digital records are introduced and the CHA FTEs are reduced to match the new demand for their support, estimated savings approach €2.000.000 over the next 10 years. The introduction of the digital patient record is expected to receive a warm welcome from CHAs, since the current paper record is a source of frustration for them. Third, existing technology makes it possible that the (purely administrative) check-in procedure of a patient is fully automated. If the check-in procedure is automated and the CHA FTEs are reduced to match the new demand for their support, estimated savings approach €1.000.000 over the next 10 years. Since automating the check-in procedure will result in less personal contact between CHAs and the patients, this change initiative can be seen as a threat by CHAs. Fourth, we conclude that if the non-productivity is reduced to 10%, the digital patient record is introduced, the patient check-in is automated and other work activities remain unchanged, the expected demand for the year 2020 can be fulfilled by only 15 FTE of CHAs (considering a 45% growth of demand up to 2020). If nothing changes up to 2020, we estimate that 28.1 FTE will be needed at that time. In comparison, 19.4 FTE is on average at work in the current situation. Note that the mentioned FTE numbers represent net employment and do not account for sick leave and holiday leave. The mentioned improvement strategies result in a reduction of CHA FTEs needed on a daily basis. Alternatively these FTEs could be redeployed to provide more medical technical support to medical specialists during the consultations when this is considered to be beneficial. In the current situation a minor amount of time is spent on this activity. To illustrate the idea, we show within this report that increased support delivered by CHAs to anaesthesiologists during the Pre-operative Screening (POS) can result in an increase of POS-capacity by 33%. The corresponding work activity for CHAs, based on the current number of screenings, is estimated at an average of 180 minutes on a daily basis. While considering these and other change initiatives to improve the support delivered by CHAs to medical specialist during the consultation hours at the CD, insights gained from research within the field of behavioural science can be of valuable help to change leaders. The five stages of behavioural change defined by Prochaska and Di Clemente (1983) can be used as a practical tool to reduce resistance to change and to increase participation of employees. Change leaders should monitor the different stakeholders and their progress of behavioural change, and introduce individualized stage-matched interventions to prepare them well. The more people are prepared to take action, the higher the chance of success of a change initiative.
Item Type:	Essay (Master)
Clients:	NKI-AVL
Faculty:	BMS: Behavioural, Management and Social Sciences
Subject:	85 business administration, organizational science
Programme:	Industrial Engineering and Management MSc (60029)
Link to this item:	https://purl.utwente.nl/essays/60811
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