An assessment of existing surge capacity of tertiary healthcare system of Khyber Pakhtunkhwa Province of Pakistan using workload indicators for staffing need method

Abstract

Background Globally the occurrence of disasters has increased more than fourfold during the last three decades. The main concern for the healthcare system responding to a disaster is its ability to deal with the sudden influx of patients and maintaining a certain level of surge capacity. Health workers are considered to be the major driving force behind any health system. Their role gets even more prominent during disasters or public health emergencies. With the lack of information on the health workforce in the tertiary healthcare system of Khyber Pakhtunkhwa, where most of the disaster surge is diverted, it is difficult to plan and respond to accommodate the sudden surge of patients. Methods This was a mixed method cross-sectional survey conducted in all the tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan to assess the current staffing situation and surge capacity based on the current workload. Annual service statistics of 2018 were collected from all the tertiary care hospitals of the province. WISN was piloted with only one healthcare staff category, i.e., for doctors in Ayub Teaching Hospital before assessment in all the tertiary care hospitals was undertaken. Results Overall, there were 1215 surplus doctors in medical and allied specialties and 861 doctors in surgical and allied specialties in the tertiary healthcare system. The health care system has an acute shortage of 565 emergency department doctors. The tertiary healthcare system of KP has an overall shortage of 1099 nurses. Based on the WISN generated numbers for doctors, the tertiary care system of KP has a combined healthcare staff (doctors and nurses) that can manage an additional surge of 6.3% of patients with the current patient workload. Conclusion The tertiary health care system of the Khyber Pakhtunkhwa Province of Pakistan does not possess the required ≥ 20% HR surge capacity indicating that the tertiary healthcare system is poorly prepared for disasters or public health emergencies. The lack of nursing staff, more than the doctors, is the major reason behind the lack of HR surge capacity of the tertiary health care system.

Workload Indicators of Staffing Need (WISN) Method for Health Workforce Planning at Health Facility: A scoping review

“…WISN strengthens primary health care team by clearly assigning job description for each cadre of the health facility [29]. The health facilities use WISN to assess the surge capacity and resulting disaster preparedness [35]; to understand the level of workload pressure, the cause of shortage or surplus and reassign staff or change facility status [31,33].…”

“…Limitations of WISN method during health workforce planning WISN method of health workforce planning has some limitations according to the reviewed articles. The limitations include use of last year health service performance data to forecast this year sta ng requirement, no clear consideration of frequent service interruption during workload analysis, differences in the severity of illness for which patients sought consultation time was not considered, activity standards did not consider individual professional variations in performing an activity, sudden surge of patients was not assumed, lack of standards for certain activities, on-call time workers were not considered and weekend and holiday workers were not considered during workload calculation [25,26,30,34,35,38,42,50].…”

A Delphi consensus study to determine the workload components and activity standards of dietitians in South Africa’s central and tertiary public hospitals

“…This technique has been widely used in various disciplines due to its cost-effectiveness and convenience when dealing with incomplete knowledge [ 17 , 18 ]. Using a panel of experts, an online platform for questionnaire distribution, sequential questionnaires, and guaranteed anonymity for participant responses, the Delphi method enhances the rigor of studies and provides a quick and simple way to obtain data and guide group opinion towards consensus [ 16 , 17 , 19 ].…”

“…To determine the specific daily work activities of dietitians, we relied on the job descriptions (JDs) of dietitians as an appropriate source document. This helped establish an initial baseline and provided a focused framework for the Delphi consensus exercise [ 4 , 17 , 19 ]. The purpose of this paper is to describe the process followed in gathering expert opinions from dietitians and identifying consensus regarding the proposed dietetic WISN-based workload components and activity standards [ 6 , 20 ] for central and tertiary public hospitals.…”

Skilled Nursing Facilities: The Missing Pillars of the Health Care System in Pakistan

“…Consequently, tertiary hospitals always have a shortage of beds for acute conditions because it takes patients from one end and is not able to release patients at a similar rate. 2 The major reason for this is a missing pillar called "skilled nursing facility or "nursing homes. A skilled nursing facility can accommodate patients who are in transition of care and do not require hospitalization as well as are not able to be shifted to homes safely.…”