Table 2 Challenges experienced and strategies/innovations used
No | Challenge | Strategy/innovation to mitigate challenge |
|---|---|---|
1 | Poor data quality and several data sources/systems | Used available data to extrapolate annual workload using different approaches or carried out primary data collection Benchmarked on other countries to address inaccurate or missing data on staff absences coupled with expert group discussions Triangulated the data from different sources |
2 | Laborious data entry | Locally developed software to export data into the WISN Software Enabled server-based data entry for simultaneous data entry by a large team of data entrants Prepared the data outside the WISN software before data entry and imported them later |
3 | Widespread task-shifting | Defined activities based on what each cadre should be doing and not what they are doing, where there was no task-shifting policy Apportioned the shared workload to the different cadres based on how much (percent) each cadre does and used this to determine the staffing requirement for each of the cadres |
4 | Actual working time shorter than AWT | Highlighted this as a management problem that needs to be addressed through strengthened supervision and management |
5 | Ensuring use of WISN results | Involved key stakeholders from the start of WISN implementation Held consultative workshops to collectively formulate recommendations based on study results Provided several scenarios for using the results Phased approach to implementation of recommendations Advocating for a policy change from fixed to workload-based staffing norms |
6 | Setting activity standards: described as time consuming and complicated example, e.g., bedside nursing activities did not have a clear workload statistic | Ensured that the expert group had the required level of expertise, experience, and credibility Allowed adequate time for discussion and debate within the expert group Benchmarked from other countries to save time Ensured tasks per cadre were in line with what the cadre should do and not what they are doing currently Set bedside nursing activity standards that varied by patient acuity with patient days as the workload statistic |