Table 3 Key lessons learned

1

The WISN process is more important than the technical steps, because throughout the process, a lot is learned on how to better plan and manage the workforce and it promotes consensus at each stage and hence ownership

Careful design and implementation of the WISN process increases chances of using the results

Allocate ample time for the key WISN processes and ensure consensus at each stage

Involve key stakeholders early in the process

Obtain senior level management support for the WISN

A bottom up WISN implementation process is motivating to staff

2

The WISN is not a panacea for all HRH issues

WISN is not a solution to all HRH challenges

There is need to address other HRH issues, such as:

- Performance including absenteeism,

- Competencies,

- Attraction, motivation, and retention and,

- Supportive supervision, among others

3

Implementation of the technical steps of the WISN methodology requires specific competencies

Reading the WISN User’s Manual alone is not enough

Key competencies required include:

- Good understanding of the health sector

- Good mathematical skills

- Good computer skills

- Flexibility

- Good understanding of the local context if possible

- Previous experience practically implementing the WISN or collaborating with an experienced WISN user

4

Build on previous WISN experiences

Review what others have done and build on that—it saves time

Benchmark in determining workload components, setting activity standards, and determining AWT

Collaborate with an experienced WISN user

5

Good quality data in terms of completeness, accuracy, and availability are critical for successful implementation of WISN

Without good quality data, the WISN is impossible to implement accurately

6

WISN practical implementation is more complicated than described in the Manual

Implementation in secondary and tertiary hospitals is more complicated than described in the WISN User’s Manual hence the need for segmentation of the guidance to address the needs of the different levels of the health system

The Manual needs to provide more guidance on how to address task-shifting, prepare the data before entry into the software, make data entry less laborious, and how to set activity standards for bedside nursing

The Manual needs to provide more examples and tools to manage the different WISN technical steps

7

Start small

Start with small WISN studies before implementing larger studies: for example, starting at individual hospital level, then district level, then regional level, before national/health system-wide level to enhances skill, build confidence in the methodology, and ensure that the approach is feasible

The small wins during implementation of small studies are motivating

8

Setting activity standards is subjective

Using only expert group discussions to set activity standards is subjective

Complement the expert group discussions with other methods, such as direct observation, benchmarking, time motion studies and role-playing

Consider validating standards set by one expert group with another

9

WISN study recommendations may have significant financial implications

Resources may be need for:

- Recruiting additional health workers

- Training additional health workers

- Addressing other retention challenges, such as staff accommodation, training, resettlement packages, and transport if they must transfer staff across facilities, among others