Table 3 Computation of estimating staffing requirements using WISN
Establish activity and its standard |
The activity chosen for the clinicians who run the consultation clinic was a consultation which is estimated to last 15 min (0.25 h). |
Ascertain the workload (sum activity standards) |
Each patient was estimated to have up to 10 scheduled clinic appointments in a year (Table 1). For 10,000 patients, this translates to 100,000 clinic appointments. With each appointment lasting 0.25 h, the annual workload would require 25,000 h to complete. With each working day lasting 8 h, this translated to 3125 days. |
Establish annual available working time |
This was the number of days spent in consultations each week. Clinicians spend 4.5 days a week in consultations and 0.5 days a week in a multidisciplinary team meeting. There are 52 weeks in a year so this translates to 234 days in a year spent on consultations. There are 10 public holidays in Kenya when the clinic remains closed and this reduces the annual available working time to 224 days. Each staff member is entitled to 30 days of annual leave which reduced the annual available working time to 194 days. Each staff member is also allowed 15 days of sick leave on full pay which effectively reduces the annual available working time per clinician to 179 days. |
The baseline staff requirement (divide workload by sum activity standards) |
The baseline staff requirement was given by the annual workload (3125 days) divided by the annual available working time (179 days) = 17.46 staff |
Calculate category allowance and multiplier quotient |
The category allowance, the time a clinician spent on non-clinical activities (training sessions) each year was ascertained to be 10 days. The proportion of annual available working time spent on non-clinical duties (10/179 = 0.056). |
The multiplier quotient is the reciprocal of 1 − category allowance. The multiplier quotient = 1/(1 − category allowance) =1/(1 − 0.056) =1.06 |
The intermediate staff requirement |
The intermediate staff requirement = the baseline staff requirement (17.46) × the multiplier quotient (1.06) = 18.51 |
Calculate individual allowance |
The lead clinician spends 4.375 days monthly on non-clinical duties (the individual allowance as shown in Table 4). The individual allowance is therefore 4.375 × 12/179 = 0.29 |
Optimal number of clinical staff Optimal number of clinical staff = intermediate staff requirements + individual allowance = 18.51 + 0.29 = 18.8~19 clinicians |
Staffing requirements Number of clinicians available = 12 Staff shortage = optimal number of clinical staff-number of clinical staff available = 7 clinicians Current staff proportion = number of clinical staff available/optimal number of clinical staff =12/19 =0.63 of the optimal staff requirements |