title: Respiratory care work assignment based on work rate instead of work load.
abstract: BACKGROUND
  We previously reported a new management variable, work rate, defined as work load due per hour, based on cumulative standard treatment times. We found that work rates were unachievable (ie, exceeded 1 hour of scheduled work per hour of available labor) for 75% of scheduled  due times, despite presumed achievable average work load.
  
  
  OBJECTIVE
  To determine the optimal strategy for creating work assignments based on work rate.
  
  
  METHODS
  A focus group used root-cause analysis to identify ways to balance assignments based on work rate. We surveyed employees to assess  their willingness to start earlier. We determined the ratio of scheduled to unscheduled work during a 12-month period. The scheduled work comprised administering small-volume nebulizer, metered-dose inhaler, noninvasive ventilation, and mechanical ventilation. The unscheduled work consisted  of all other modalities. We also developed a spreadsheet model to assess the effect of shifting the start time on work-rate distribution in a representative 24-hour period.
  
  
  RESULTS
  The focus group determined that starting treatments 1 hour earlier would help. Fifteen of the 24 clinicians  surveyed responded, and 13 of the respondents were willing to start earlier. The scheduled work load averaged approximately 55% of the total work load, but there was high variability per assignment area (range 0-99%). The spreadsheet model showed that shifting treatment start times  improved the distribution of work rate throughout the day, but did not guarantee that labor demand never outstrips supply.
  
  
  CONCLUSIONS
  Our studies to date suggest that: basing assignments on average work load leads to periods of unachievable work rate, resulting in missed treatments and staff  dissatisfaction. We have only limited ability to reduce peaks in work rate, but staggering treatment times is effective. Fair assignment of work should differentiate scheduled from unscheduled work.
authors: Section of Respiratory Therapy, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. chatbur@ccf.org
authors: Robert L
authors: RL
authors: Chatburn
authors: Susan
authors: S
authors: Gole
authors: Philip
authors: P
authors: Schenk
authors: Edward R
authors: ER
authors: Hoisington
authors: James K
authors: JK
authors: Stoller