Productivity Prepared by Dr. Manal Moussa

Definition of Productivity Productivity is the relationship between the output of an organization and the resources (input) required to produce that output. Inputs are the resources such as materials, and equipment used in the production of services. Output is the product produced by an organization.

Health Care Inputs:- The measurements of some inputs are not as simple as it appear. e.g. Nursing Personnel, are not a homogeneous group, nurses vary in their level of education, experience, and skill.

Health Care Outputs:- In the past, hospital output was most frequently defined as patient day that is the total number of days all patients were hospitalized (LOS) in a facility over a period of time. Then it was realized that some patient days required the use of many more resources than others.

Newer concepts of hospital output are more specific than patient days. Case mix is a method of clustering patients into groups that are homogeneous with respect to the use of resources. Case mix measures have refined how output quantity is measured, but they do not address the question of quality.

Effectiveness:- Health care output is increasingly defined in terms of quality as well as quantity of services. Measuring effectiveness is difficult because the ultimate outcome of many occurrence of illness care or treatment meet is not known for some time after the care finish. The alternative to measuring effectiveness is evaluation of the care process itself or quality of output.

Efficiency:- Health care organizations are facing severe financial constraints in the future delivery of care. Efficiency is the relationship between achieving objectives and consumption of resources. This emphasis on the financial aspects of care has led to an increased interest in the efficiency of providing care and care deliverers.

What is nursing Productivity: Productivity in nursing is related both to how efficiently clinical nurses deliver nursing care and to how effective that care is relative to its quality and appropriateness.

Factors affecting staff productivity: Fundamental questions remain about what should be considered an input and how output should be measured? 1- The primary inputs 2- The primary outputs

Staff characteristics include the level, mix, qualifications, and experience of staff members. Patient characteristics include the number of patients to be cared for and their ages, diagnoses and treatments. Unit characteristics refer to the unit's size design, and location as well as the equipment and services available on the unit.

2- The primary outputs include acuity adjusted patients days, improved patient health, patient satisfaction with service, medical records, patient education & nurses satisfaction.

Measurement of nursing productivity: 1-Traditionally approach to productivity measurement (The Scientific Management approach, 1920) which focused on the question, how can we design processes and procedures to produce the product most efficiently? Productivity is the ratio of work output to work input over a specified time period. Total productivity= total outputs unit/total inputs unit. It should be noted that there is no correct result for these ratios.

2- Open System Model ( Jordan, 1994) This model shows the relationship between inputs, processes, and outputs. This also includes interactions with the environment. Inputs include the number and type of nursing personnel, equipment, and supplies used, and the capital costs incurred in providing care.

Processes include all of the activities and resources required to convert inputs into output. Outputs represent the product resulting from the application of processes and inputs. The environment is everything external to the organization over which the nurse manager has little control, such as labor laws, health care financing policies, and personnel licensing laws.

Improving nursing productivity: Changes in use of inputs Little attention has been given to the"raw material" of nursing services because it is uncommon to think of patients and clients as raw material. Nurses have little control over the type of patients presented to them.

1- Matching supply with demand: The greatest productivity gains can be achieved by careful selection and use of personnel, the key to efficient resource use is to match the required and available staff.

2- Making staff substitutions: To reduce personnel costs it is logical to employ more nonprofessional staff, who receives lower salaries. Increasing the number of licensed practitioner nurses and unlicensed assistive personnel in relation to the number of registered nurses would result in an increase in available hours of personnel time per patient day with no increase in cost.

Tasks would be assigned to the least costly personnel category capable of doing the task. The most qualified individuals would be assigned only those tasks requiring their special expertise.

3- Controlling the use of supplies and equipment: Input costs also can be controlled by the wise use of supplies and equipment, selecting products that have the desired qualities at the lowest cost.

Nurse Managers receive monthly reports that note variances between actual charges received from the unit and items charged to the unit's supply. Any discrepancies are investigated and corrected.

Changes in the process of care: It allows nurses and nurse managers to use their creativity to the fullest. Changes in direct care process may lead to improvements in the quantity and quality of care delivered.

Experiments with new approaches to common clinical problems may be productive. Investigating alternative modes of nursing care delivery, such as primary nursing, case management, differentiated practice, or other restructuring methods may be needed.

1- Documenting changes: It is essential that nurse manager's measure and evaluates the changes and their consequences. Without careful documentation, it may be impossible to influence others that the innovations introduced are safe, effective, and efficient.

2- Calculating costs: Costs can be calculated using one of two approaches. Estimate only the direct costs of the change.

Estimate costs of an occurrence of care (a home visit, clinic appointment, hospital admission). To identify cost savings, the average costs before introduction of the innovation can be compared to costs after its introduction.

3- Measuring outcome: The nursing staff will need to design its own outcome evaluation method by asking, what is the outcome that should be measured. The answer lies in the innovation is intended to do, what the possible unfavorable consequences could be, and what the organization can afford to measure.