Where, When and What? A Time Study of Surgeons' Work in Urology

Wolff, Jan; McCrone, Paul; Auber, Gerd; Fiedler, Petra; Patel, Anita; Wetterauer, Ulrich

doi:10.1371/journal.pone.0092979

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Understanding differences in resource use between groups of patients is vital for the efficient organisation of health care [ 1 ]. Respective data are required by health care providers for managerial decision-making, such as determining appropriate staffing levels and controlling of budgets [ 2 , 3 ]. Moreover, they inform policy makers considered with the efficient allocation of funds on a system level, for instance by the design of reimbursement schemes [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of length of stay in psychiatry: analyses of electronic medical records

et al. 2015

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BackgroundLength of stay is a straightforward measure of hospital costs and retrospective data are widely available. However, a prospective idea of a patient’s length of stay would be required to predetermine hospital reimbursement per case based on patient classifications. The aim of this study was to analyse the predictive power of patient characteristics in terms of length of stay in a psychiatric hospital setting. A further aim was to use patient characteristics to predict episodes with extreme length of stay.MethodsThe study included all inpatient episodes admitted in 2013 to a psychiatric hospital. Zero-truncated negative binomial regression was carried out to predict length of stay. Penalized maximum likelihood logistic regressions were carried out to predict episodes experiencing extreme length of stay. Independent variables were chosen on the basis of prior research and model fit was cross-validated.ResultsA total of 738 inpatient episodes were included. Seven patient characteristics showed significant effects on length of stay. The strongest increasing effects were found in the presence of affective disorders as main diagnosis, followed by severity of disease and chronicity of disease. The strongest decreasing effects were found in danger to others, followed by the presence of substance-related disorders as main diagnosis, the daily requirement of somatic care and male gender. The squared correlation between out-of-sample predictions and observed values was 0.14. The root-mean-square-error was 40 days.ConclusionProspectively defining reimbursement per case might not be feasible in mental health because length of stay cannot be predicted by patient characteristics. Per diem systems should be used.

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Section: Introductionmentioning

confidence: 99%

Predictors of length of stay in psychiatry: analyses of electronic medical records

et al. 2015

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“…Travel time to clients' homes, where doula visits often take place, was not included in this analysis, but doulas' travel time is important to consider. 19 Most time-use studies in healthcare use self-reported data 35,51 or observation [36][37][38]41 to track the time spent by providers on different activities; others approach time use from a per client perspective by tracking all activities related to a client over a specific period of time. 52,53 We did not include any observational methods, so all data are based on doulas' self-reports and potentially subject to self-report and social desirability biases.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“… 33 In healthcare settings, time-use studies are commonly used in the context of quality improvement and cost effectiveness. 34 Time-use studies with healthcare providers, 35 – 38 including community health workers, 39 – 41 exist, but we are not aware of any similar systematic efforts to track doulas’ time use.…”

Section: Introductionmentioning

confidence: 99%

What, when, and how long? Doula time use in a community doula program in San Francisco, California

Arcara

Cuentos²,

Abdallah

et al. 2023

Womens Health (Lond Engl)

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Objectives: Community doulas, who provide culturally concordant, nonclinical support during and after pregnancy, are increasingly promoted as an evidence-based intervention to advance birth equity. As valued members of their communities, community doulas often provide extensive physical and emotional pregnancy, birth, and postpartum support at low or no cost to clients. However, neither community doulas’ scope of work nor the distribution of time among their different work activities has been clearly defined or enumerated; therefore, this project sought to describe the work activities and time use of doulas in one community-based doula organization. Methods: In a quality improvement project, we reviewed case management system client data and collected 1 month of time diary data from eight doulas employed full-time at SisterWeb San Francisco Community Doula Network. We calculated descriptive statistics for activities community doulas reported in their time diaries and each visit/interaction logged in the case management system. Results: SisterWeb doulas spent about half of their time in direct client care. For every hour that doulas spent with a client in prenatal and postpartum visits, on average, they spent an additional 2.15 h communicating with and supporting their clients in other ways. Overall, we estimate that SisterWeb doulas spend an average of 32 h providing care for a client receiving the standard course of care, including intake, prenatal visits, support during childbirth, and postpartum visits. Conclusions: Results highlight the wide variety of work that SisterWeb community doulas do beyond direct client care. Acknowledgment of community doulas’ broad scope of work and appropriate compensation for all activities is necessary if doula care is to be advanced as a health equity intervention.

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“…In contrast, work-sampling uses snap-shots of subject’s activities, usually at random points of time, in order to estimate total work time distribution [ 15 ]. Work-sampling was found to produce results of similar validity in comparison to time-and-motion studies [ 16 ] and its efficient design allows incorporating large numbers of staff [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

A Time Study of Physicians’ Work in a German University Eye Hospital to Estimate Unit Costs

et al. 2015

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BackgroundTechnical efficiency of hospital services is debated since performance has been heterogeneous. Staff time represents the main resource in patient care and its inappropriate allocation has been identified as a key factor of inefficiency. The aim of this study was to analyse the utilisation of physicians’ work time stratified by staff groups, tasks and places of work. A further aim was to use these data to estimate resource use per unit of output.MethodsA self-reporting work-sampling study was carried during 14-days at a University Eye Hospital. Staff costs of physicians per unit of output were calculated at the wards, the operating rooms and the outpatient unit.ResultsForty per cent of total work time was spent in contact with the patient. Thirty per cent was spent with documentation tasks. Time spent with documentation tasks declined monotonically with increasing seniority of staff. Unit costs were 56 € per patient day at the wards, 77 € and 20 € per intervention at the operating rooms for inpatients and outpatients, respectively, and 33 € per contact at the outpatient unit. Substantial differences in resources directly dedicated to the patient were found between these locations.ConclusionThe presented data provide unprecedented units costs in inpatient Ophthalmology. Future research should focus on analysing factors that influence differences in time allocation, such as types of patients, organisation of care processes and composition of staff.

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Where, When and What? A Time Study of Surgeons' Work in Urology

Cited by 6 publications

References 13 publications

Predictors of length of stay in psychiatry: analyses of electronic medical records

Predictors of length of stay in psychiatry: analyses of electronic medical records

What, when, and how long? Doula time use in a community doula program in San Francisco, California

A Time Study of Physicians’ Work in a German University Eye Hospital to Estimate Unit Costs

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