MANPOWER

Work overload for Specimen efficiency Staff communication of

nurses results

Reduced availability of Nurse Patient Ratios Different point persons Limited provision of information
about test and results
nurse aides

Solution: Improve communication of results

to patients as well as over-all communication
Solution: Improving the staff in their of the health care team
overall management, knowledge and
Relationship of nursing workload and patient care skills in hospital protocol and guidelines

Solution # 1: Four Step

Reduced communication and
insufficient time to do nursing
procedures
Solution: Proper management of stress, addressing work
Solution # 1: SEIPS
model of work system
and patient safety
The work system
redesign interventions
should follow the two
basic principles of the
Balance Theory of
Leads to errors
overload and adapting a system for work overload
Solution # 2: Stress
Audit
Conduct a stress audit
to identify main sources
of stress; structured
interviews with
employees can be
used to collect the
necessary information
Difficulty in following Solution # 1: Improving People Solution # 2: Solution # 3: Individual
Procedure
Effort
guidelines, increased violations Test ordered Documentation One approach to reducing
and workarounds in the rules Maximizing staff experience- optimizing their Step 1: Track until results
knowhow, removing them from tedious tasks, received
This means failure rates would be to rely
on the efforts of individual
and reducing repetition. During a recent Step 2: Notify patient of including in the physicians and to exhort them
microbiology lab assessment, analysis results
revealed that 69 people were involved in Step 3: Document patient's chart to try harder to notify patients.
Alternatively, failures to inform
specimen processing. Not only is this a waste notification whether or not the could be approached as a
of precious human resources, but it introduces Step 4: Track until follow-up
too much variability into what should be a done patient was systems problema problem
of organization and incentives
Done
uniform system, as well as increasing the notified of results. rather than as a failing of
likelihood of human error. individual physicians. We
1. Make sure all tests ordered
observed practices that use
are tracked until the report is In the continuum EMRs in which the only way to
received or until the
physician is notified that the of care, experts see test results is by searching
the record of each patient for
test was not done. As many
Solution # 3: Stress Solution # 4: Team as one-third of the physicians
say, merely telling whom a physician has ordered
a test; in these practices we
Management of Work Work, EQ responding said they had no someone he or she found individual physicians
Improving the quality reliable way to determine if
Encouraging team results of all tests ordered has an abnormal devising their own methods,
of work life at the had been received. finding is not
such as Excel spreadsheets, to
studied hospital, setting work between 2. Notify patients of the
help them remember to check
for results. At the opposite
enough. Follow-up
SMART objectives, coworkers and results. "For abnormal
results," the investigators
extreme, some practices used
with proactive planning, is a hallmark of EMRs in which all results are
finally introduce commented dryly,
"notification is essential for responsible care routed to the electronic
open communication mailbox of the responsible
channels with peers and
training courses good patient care."
3. After notification, and, as such, needs physician. Abnormal results are

Carayon and Smith: (1) or a questionnaire. with management, in emotional document the notification in to be tracked and
highlighted and the system
records the fact that the
the medical record.
eliminating the source Observation of increase levels of intelligence and 4. Make sure that patients documented. physician has clicked on the
results. (Frequency of Failure
of the excessive certain indicators like empowerment and requiring repeat testing or
workload, or (2) sick leave,
stress control and follow-up are tracked until
to Inform Patients of Clinically
autonomy, rewarding Significant Outpatient Test
compensating or absenteeism could be creativity and management. such testing is done or until
the physician is notified that
Results)

balancing out the useful too (Rue and innovation. follow-up testing was not
done.
workload. Byars, 2007)