A Comparison of Four Approaches for Measuring Clinician Time Use

Abstract

Concern about rapid growth in demand for reproductive health services in developing countries has created interest in productivity and costs of existing programmes. Staff costs usually constitute the largest share of total service costs, meriting special effort to ensure that they are measured accurately. Several techniques have been used in the literature to analyze staff activity, but these techniques have not been validated. This paper reports on a study conducted in three Ecuadoran clinics. The study uses an observational time-motion (TM) technique as a benchmark, and compares results from three other techniques to those obtained using TM. None of the alternative techniques produces estimates that agreed with TM estimates; deviations from TM are particularly large for non-contact time, defined as clinician activities carried out when clients are not present. Implications of these findings for productivity and cost studies are discussed, and possible avenues for future research are proposed.

Physician Activities During Time Out of the Examination Room

“…These results are consistent with those obtained by Bratt et al 15 Out-of-examination room medical care activities, averaged over the number of patients seen in the offi ce that day, would increase the time spent on each patient encountered by approximately 7 minutes (from 17 to 24 minutes, approximately) or 2 hours a day in medical care provided by the physician. The total time spent on medical care is 40% more than the length of the offi ce visit inside of the examination room, and this time does not include additional, considerable responsibilities that physicians perform outside of the offi ce.…”

“…7,8 A number of published studies have described the content of patient visits. [9][10][11][12][13][14] Stange et al 14 used direct observation, the most accurate method for studying physician activities, 15 to describe the complexity of a physician-patient primary care offi ce visit. Outside of the examination room, physicians perform many undocumented responsibilities and activities, including but not limited to charting, dictating, reviewing reports, consulting medical resources, consulting colleagues, and communicating with patients.…”

“…These activities have a direct bearing not only on patient well-being and outcomes, but also on physicians' abilities to manage their practices. In an Ecuadorian study of physician time use, Bratt et al 15 found that 40% of offi ce time was spent outside of direct patient contact, and that nearly one half of this time was spent on activities integrally related in 4 Brian A. Selius, DO 5 Michael Cowher, MD 6 Rishi Maheshwary, MD 6 Falguni Patel, MD 7 Ami Shah, MD 8 Bonny Tsai, MD 9 Mia Zaharna, MD 10 PHYSICIAN ACTIVITIES some way to medical care. The present study is a systematic investigation of community-based physicians' offi ce-based activities outside of the examination room.…”

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health‐care settings

“…Time and motion studies rely upon trained observers to measure the duration of each activity and, for brief activities, are probably more accurate than using self-report [12]. Although there are no published time and motion studies for screening and brief intervention for harmful substance use or behavioral health interventions similar to SBIRT, this methodology has been used to study other health-care deliveries [12][13][14][15][16].…”

“…Although there are no published time and motion studies for screening and brief intervention for harmful substance use or behavioral health interventions similar to SBIRT, this methodology has been used to study other health-care deliveries [12][13][14][15][16].…”