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It is disconcerting to learn that productivity, the ratio between the volume of resources going into hospitals (inputs) and the quantity of healthcare provided by hospitals (outputs), is down in NHS hospital trusts (1). Importantly however, the data is not adjusted for quality of care. While useful, hospital workers may find these reports of productivity and activity slightly abstract, referring as they do to the often summated activity of several hospital workers over several days or weeks. We wonder whether activity measured on smaller temporal scales would feel more accessible and meaningful to staff. Such a measurement is difficult because of the lack of quantifiable outcomes. In an environment as sprawling and dynamic as a hospital, where the nature of each employee’s job can vary widely, it is difficult to find any common behaviour that could act as a global index of how busy the workforce is during any given moment of the day.
Ironically perhaps, a device often criticised for hindering productivity while generating needless activity (2,3), may help. The hospital pager can provide useful data regarding the general activity of a diverse workforce that is highly mobile around the hospital and otherwise lacking in common measurable behaviours. We recently analysed the 37,865 pages made during a two week period at a London teaching hospital (2,577 per day) finding a peak in activity at 14:30hrs and a variation in paging frequency that closely correlated that of reported “pager incidents”, hospital incident reports pertaining to pagers. A similar peak in incidents was found between 14:00hrs and 17:00 hrs, 26% of which were found to have caused some degree of harm to patients (4).
If the frequency of paging can be regarded as a crude index of general activity within the hospital workforce – albeit one that some might suspect is inversely proportional to productivity– it would appear that workers are busiest after lunchtime. It would also appear that this is the most likely time for pager communication to breakdown with ensuing repercussions to patient care.
Whether this finding is attributable to the timing of ward rounds, a backlog of work after a lunch-break, or indeed an effect of lunch consumption per se remains unclear. While such an analysis says little about productivity, at least it might resonate more with hospital workers by shedding some light on issues of quality of care, rather than the economics of inputs versus outputs.
[ Please see attached high resolution image, Figure 1]
References
1. Charlesworth A, Jones NM.The anatomy of health spending 2011-12. Mar 2013. www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305_anatomy....
2. Blum NJ, Lieu TA. Interrupted care. The effects of paging on pediatric resident activities. Am J Dis Child. 1992 Jul;146(7):806-8.
3. Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study BMJ 1998;316:67
4. National Patient Safety Agency. Patient safety incident reports in the NHS: National Reporting and Learning System Data Summary. Issue 8: 1 January 2007 to 31 March 2008.
Re: England’s NHS is struggling to boost productivity despite drive for efficiency, finds analysis
It is disconcerting to learn that productivity, the ratio between the volume of resources going into hospitals (inputs) and the quantity of healthcare provided by hospitals (outputs), is down in NHS hospital trusts (1). Importantly however, the data is not adjusted for quality of care. While useful, hospital workers may find these reports of productivity and activity slightly abstract, referring as they do to the often summated activity of several hospital workers over several days or weeks. We wonder whether activity measured on smaller temporal scales would feel more accessible and meaningful to staff. Such a measurement is difficult because of the lack of quantifiable outcomes. In an environment as sprawling and dynamic as a hospital, where the nature of each employee’s job can vary widely, it is difficult to find any common behaviour that could act as a global index of how busy the workforce is during any given moment of the day.
Ironically perhaps, a device often criticised for hindering productivity while generating needless activity (2,3), may help. The hospital pager can provide useful data regarding the general activity of a diverse workforce that is highly mobile around the hospital and otherwise lacking in common measurable behaviours. We recently analysed the 37,865 pages made during a two week period at a London teaching hospital (2,577 per day) finding a peak in activity at 14:30hrs and a variation in paging frequency that closely correlated that of reported “pager incidents”, hospital incident reports pertaining to pagers. A similar peak in incidents was found between 14:00hrs and 17:00 hrs, 26% of which were found to have caused some degree of harm to patients (4).
If the frequency of paging can be regarded as a crude index of general activity within the hospital workforce – albeit one that some might suspect is inversely proportional to productivity– it would appear that workers are busiest after lunchtime. It would also appear that this is the most likely time for pager communication to breakdown with ensuing repercussions to patient care.
Whether this finding is attributable to the timing of ward rounds, a backlog of work after a lunch-break, or indeed an effect of lunch consumption per se remains unclear. While such an analysis says little about productivity, at least it might resonate more with hospital workers by shedding some light on issues of quality of care, rather than the economics of inputs versus outputs.
[ Please see attached high resolution image, Figure 1]
References
1. Charlesworth A, Jones NM.The anatomy of health spending 2011-12. Mar 2013. www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305_anatomy....
2. Blum NJ, Lieu TA. Interrupted care. The effects of paging on pediatric resident activities. Am J Dis Child. 1992 Jul;146(7):806-8.
3. Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study BMJ 1998;316:67
4. National Patient Safety Agency. Patient safety incident reports in the NHS: National Reporting and Learning System Data Summary. Issue 8: 1 January 2007 to 31 March 2008.
Competing interests: No competing interests