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Background Healthcare interventions are shaped by the resources needed to implement them, including staff time. This study, part of a process evaluation, aims to compare time spent on antenatal care (ANC) and related recordkeeping in two rural primary-level health facilities in Nepal, before and after implementation of an electronic decision support system intervention to improve ANC quality that required additional electronic documentation. Methods The study is a before-and-after, observational time-motion assessment. Researchers used the WOMBAT (Work Observation Method By Activity Timing) software to observe and record activities performed by auxiliary nurse midwives providing ANC in two rounds of data collection. We summed the observation time (in minutes) spent on activity categories for each day of observation, in each round of data collection. For each auxiliary nurse midwife, we estimated the proportion of total observation time spent on activities and compared these proportions before and after intervention implementation. We also compared the mean minutes per day spent on ANC and recordkeeping in the two rounds. Results Six auxiliary nurse midwives were observed over two data collection rounds (41 total observation days). Prior to intervention, providers spent 7% of their workday on ANC and 6% on related recordkeeping, and time spent on these activities did not change after intervention implementation. Only one of the six auxiliary nurse midwives demonstrated a statistically significant increase in time spent on ANC and recordkeeping after implementation. There was considerable day-to-day variation in ANC time, and substantial periods of “non-work” time (on break or not engaged in work-related activity). Non-work time reduced from 42% in the first round to 26% in the second round of data collection. Conclusions Time spent on ANC and related recordkeeping was low and did not change after implementation of the electronic decision support system. ANC and recordkeeping time was sensitive to day-to-day fluctuations in numbers of women attending for ANC at these rural facilities, which may have masked the intervention’s effects. However, the large amount of non-work time observed suggests time constraints during the workday were not a major factor inhibiting use of the electronic decision support system.

Simplified vaccine preparation steps would save time and reduce potential immunisation errors. The aim of the study was to assess vaccine preparation time with fully-liquid hexavalent vaccine (DTaP-IPV-HB-PRP-T, Sanofi Pasteur MSD) versus non-fully liquid hexavalent vaccine that needs reconstitution (DTPa-HBV-IPV/Hib, GlaxoSmithKline Biologicals). Ninety-six Health Care Professionals (HCPs) participated in a randomised, cross-over, open-label, time and motion study in Belgium (2014). HCPs prepared each vaccine in a cross-over manner with a wash-out period of 3–5min. An independent nurse assessed preparation time and immunisation errors by systematic review of the videos. HCPs satisfaction and preference were evaluated by a self-administered questionnaire. Average preparation time was 36s for the fully-liquid vaccine and 70.5s for the non-fully liquid vaccine. The time saved using the fully-liquid vaccine was 34.5s (p≤0.001). On 192 preparations, 57 immunisation errors occurred: 47 in the non-fully liquid vaccine group (including one missing reconstitution of Hib component), 10 in the fully-liquid vaccine group. 71.9% of HCPs were very or somewhat satisfied with the ease of handling of both vaccines; 66.7% and 67.7% were very or somewhat satisfied with speed of preparation in the fully-liquid vaccine and the non-fully liquid vaccine groups, respectively. Almost all HCPs (97.6%) stated they would prefer the use of the fully-liquid vaccine in their daily practice. Preparation of a fully-liquid hexavalent vaccine can be completed in half the time necessary to prepare a non-fully liquid vaccine. The simplicity of the fully-liquid hexavalent vaccine preparation helps optimise reduction of immunisation errors.

Background Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve. Methods A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation. Results Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily. Conclusion The CHW’s are “dedicated” mental health workers as opposed to being “generalists” and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.

Rituximab is a standard treatment for non-Hodgkin lymphoma. The SABRINA trial (NCT01200758) showed that a subcutaneous (SC) rituximab formulation did not compromise efficacy or safety compared with intravenous (IV) infusion. We aimed to quantify active healthcare professional (HCP) time and patient chair time for rituximab SC and IV, including potential time savings. This non-interventional time and motion study was run in eight countries and 30 day oncology units. Rituximab SC data were collected alongside the MabCute trial (NCT01461928); IV data were collected per routine real-world practice. Trained observers recorded active HCP time for pre-specified tasks (stopwatch) and chair time (time of day). A random intercept model was used to analyze active HCP time (by task and for all tasks combined) in the treatment room and drug preparation area, drug administration duration, chair time and patient treatment room time by country and/or across countries. Active HCP and chair time were extrapolated to a patient's first year of treatment (11 rituximab sessions). Mean active HCP time was 35.0 and 23.7 minutes for IV and SC process, respectively (-32%, p <0.0001). By country, relative reduction in time was 27-58%. Absolute reduction in extrapolated active HCP time (first year of treatment) was 1.1-5.2 hours. Mean chair time was 262.1 minutes for IV, including 180.9 minutes infusion duration, vs. 67.3 minutes for SC, including 8.3 minutes SC injection administration (-74%, p <0.0001). By country, relative reduction was 53-91%. Absolute reduction in extrapolated chair time for the first year of treatment was 3.1-5.5 eight-hour days. Compared with rituximab IV, rituximab SC was associated with reduced chair time and active HCP time. The latter could be invested in other activities, whereas the former may lead to more available appointments, reducing waiting lists and increasing the efficiency of day oncology units. ClinicalTrials.gov NCT01200758.

This manuscript presents a method for motion capture–based manufacturing time and motion studies. The proposed human motion analytics system uses motion capture technology to collect, transform, store, and analyze data from repetitive physical motions performed by manufacturing workers. The system supports the isolation of basic simple motions for analysis using statistical process control and data analytics techniques. The proposed method has resulted in the ability to identify patterns of repetitive motions and statistically significant deviations from those patterns.

ObjectivesTo determine whether postponing daily medical rounds to provide additional preparation time for residents reduces round duration and alters time allocation during rounds, with the hypothesis that increased preparation leads to more efficient rounds without reducing patient contact.DesignTime and motion study with a before-and-after comparison.SettingInternal medicine division of Lausanne University Hospital, a Swiss tertiary teaching hospital.Participants75 residents; 60% women; mean age of 29.6 years and 3.0 years of training.InterventionIn 2017, the daily work schedule was reorganised by postponing rounds from 09:00 to 10:00 and moving educational sessions to the afternoon, thereby freeing 90 min to prepare patient cases before rounds.Primary and secondary outcome measuresThe primary outcome was the duration of rounds and the proportion thereof spent with patients, using computer systems or in discussion with colleagues. Secondary outcomes included the detailed distribution of resident activities during the officially scheduled round period, particularly time dedicated to supervision, teaching and administrative tasks.ResultsRound duration decreased from 142 min per shift (95% CI 128 to 156) in 2015 to 112 min (95% CI 101 to 124) in 2018 (p=0.001). The proportion of round time spent directly with patients remained stable at 47%. Computer use during rounds decreased from 43% to 32% (p<0.001). During the official round period, time allocated to supervision and teaching increased from 12% to 32% (p=0.002), while time spent on administrative tasks decreased from 54% to 41% (p<0.001).ConclusionsPostponing rounds to allow more preparation time was associated with shorter, possibly more efficient rounds, reduced computer use in patient presence and increased supervision and teaching.Trial registration numberISRCTN69703381, https://doi.org/10.1186/ISRCTN69703381 (registration date: 24 April 2018).

Medicines used at Danish public hospitals are purchased through tendering. Together with drug shortage, tendering result in drug changes, known to compromise patient safety, increase medicine errors and to be resource demanding for healthcare personnel. Details on actual resources required in the clinic setting to manage drug changes are unknown. The aim of the study is to explore time spend by hospital personnel in a drug change situation when dispensing medicine to in- and outpatients in a hospital setting in the Capital Region of Denmark. A time and motion study, using direct observation combined with time-registration tools, such as eye-tracking, video recording and manual time tracking. Data were obtained from observing nurses and social and health care assistants with dispensing authority while dispensing or extraditing medicine before and after the implementation of drug changes in two clinical setting; a cardiology ward and a rheumatology outpatient clinic. Hospital personnel at the cardiology inpatient ward spent 20.5 seconds on dispensing a drug, which was increased up to 28.4 seconds by drug changes. At the rheumatology outpatient clinic, time to extradite medicine increased from 8 minutes and 6 seconds to 15 minutes and 36 seconds by drug changes due to tender. Similarly, drug changes due to drug shortage prolonged the extradition time to 16 minutes and 54 seconds. Statistical analysis reveal that drug changes impose a significant increase in time to dispense a drug for both in- and outpatients. Clinical hospital personnel spent significantly longer time on drug change situations in the dispensing of medicine to in- and outpatients in a hospitals. This study emphasizes that implementing drug changes do require extra time, thus, the hospital management should encounter this and ensure that additional time is available for the hospital personnel to ensure a safe drug dispensing process.

Background Mobile Health Clinics (MHCs) are an alternate form of healthcare delivery that may ameliorate current rural–urban health disparities in chronic diseases and have downstream impacts on the health system by reducing costs. Evaluations of providers’ time allocation on MHCs are scarce, hindering knowledge transfer related to MHC implementation strategies. Methods Retrospective economic cost was assessed using business ledgers and expert assessments in 2023 US Dollar (USD) from 2022 to 2023. Time motion observational study assessed nurse practitioner (NP) and community health worker (CHW) time allocation and compared them between patients residing in isolated rural areas (hereafter isolated rural patients) and patients experiencing houselessness (PEH) sub-populations. Procedure codes were assessed retrospectively for each patient encounter ( n  = 1,981) over one year (April 2022 to April 2023). We used statistical significance tests (chi-square and Fisher’s Exact) to evaluate difference across sub-populations. Results Intervention start-up and operational costs totaled 275,000USD and 308,000USD, respectively, with the largest allocations to the modified recreational vehicle (RV) unit and labor. NP attributed 32% of time on direct care (mean = 153.00 min (SD = 37.80 min)), 38% on indirect care (186.0 (53.40)), and 21% on MHC tasks (104.00 (23.94)). CHW spent 47% of time on MHC tasks (182.00 (29.46)), 22% on medical care tasks (85.01 (SD 81.97)), and 22% on social needs tasks (87.70 (86.71 min)). NP time allocation did not differ significantly between isolated rural patients and PEH ( p  > 0.01), but CHW time did ( p  < 0.01). Of all procedures, 31.3% were vaccinations ( N  = 438), 27.0% were Covid-19 related ( N  = 377), 12.8% were outside referrals ( N  = 179), and 11.8% were point of care testing. Healthcare utilization varied between patient sub-populations, with Isolated Rural patient use dominated by Covid-19 and Influenza vaccines whereas PEH use was dominated by point of care testing ( p  < 0.01). Conclusion Patient sub-populations require varying provider time in different tasks and variable economic resources for interventions. As local policy makers balance resources and community health needs, a complete understanding of the resources required to operate an MHC and use of provider time is essential for informed decision making and successful implementation in underserved communities.

Ethiopia implemented an innovative community-based health program, called the health extension program, to enhance access to basic health promotion, disease prevention and selected curative services by establishing health posts in every village, also called kebeles, with average of 5000 people, staffed with two health extension workers (HEWs). This time and motion study was done to estimate the amount of time that HEWs spend on various work duties and to explore differences in urban compared with rural settings and among regions. A total of 44 HEWs were observed for 21 consecutive days, and time and motion data were collected using tablet computers. On average, HEWs were on duty for 15.5 days out of the 21 days of observation period, and on average, they stayed on duty for about 6 hours per day. Out of the total observed work time, the percentages of total time spent on various activities were as follows: providing health education or services (12.8 %); participating in meetings and giving trainings (9.3 %); conducting community mapping and mobilization (0.8 %); recordkeeping, reporting, managing family folders (13.2 %); managing commodities and supplies (1.3 %); receiving supervision (3.2 %); receiving training (1.6 %); travel between work activities (15.5 %); waiting for clients in the health post (or health centre in urban settings) (24.9 %); building relationships in the community (13.3 %); and other activities that could not be meaningfully categorized (4 %). The proportion of time spent on different activities and the total time worked varied significantly between rural and urban areas and among the regions (at P < 0.05). Findings of this study indicate that only a minority of HEW time is spent on providing health education and services, and substantial time is spent waiting for clients. The efficiency of the HEW model may be improved by creating more demand for services or by redesigning service delivery modalities. L’Ehiopie a mis en œuvre un programme de santé communautaire novateur, appelé le programme de vulgarisation sanitaire, dans le but de promouvoir l’accès aux soins de base, la prévention médicale et certains services curatifs sélectionnés, grâce à l’implantation dans chaque village de pôles de santé, aussi nommés kebeles, avec une moyenne de 5000 personnes réparties en deux équiupes d’agents de vulgarisation sanitaire (HEW). L’objectif de cette étude de temps et de mouvement était d’estimer le temps passé par les HEW pour différentes t âches professionnelles, et d’explorer les différences entre les milieux urbains et ruraux, et au travers des régions. En tout 44 HEW ont été observés pendant 21 jours consécutifs, et les données de temps et de mouvement ont été collectées grâce à des tablettes. En moyenne, les HEW étaient en service pendant 15,5 jours sur les 21 jours de la période d’observation, et restaient en service en moyenne pendant 6 heures par jour environ.sur la totalité du temps de travail observé, le pourcentage du temps total consacré à différentes activités étaint le suivant: offre d’éducation ou de prestations sanitaires (12,8 %), participation à des réunions et dispense de formations (9,3%), réalisation de cartographie et de mobilisation communautaire (0,8%), enregistrement de données, rapports, tenue de dossiers familiaux (13,2%), gestion des biens et des produits (1,3%), réception de surveillance (3,2%), réception de formation (1,6%), déplacement entre les périodes de travail (13,5%), attente des clients dans les pôles de santé (ou centres de santé dans les environnements urbains) (24,9%), élaboration de relations au sein de la communauté (13,3%); les autres activités qui n’entraient pas dans une catégorie définie (4%). La proportion du temps consacré à ces différentes activités, et le temps total de travail variaient de façon significative entre les zones rurales et urbaines, et suivant les régions (at P<0.05). Les résultats de cette étude indiquent que seule une mineure partie du temps de travail des HEW est consacrée à l’éducation et aux services de santé, et un temps considérable est consacré à attendre les clients. L’efficacité du modèle des HEW peut être améliorée par la création d’une plus forte demande pour les prestations, ou par la rédifinition des modalités de délivrance des prestations de service. 埃塞俄比亚实施了一项创新性的以社区为基础的卫生项目, 称 为卫生推广项目。在平均居住5000人的村 （Kebele） 设立卫 生站点, 配备两名卫生推广人员 （HEWs）, 以此来提高基本 健康促进、疾病预防和部分治疗服务的可及性。我们进行了 此次时间与动作研究, 估算HEWs完成各种工作任务所用的时 间, 探讨城乡和地区间的差异。连续21天观察44名HEWs, 使 用平板电脑收集时间和动作数据。在21天的观察期内, HEWs 平均在岗15.5天, 平均每天6小时。在观察的总工作时间中, 各 种活动所用的总时间占比分别为：进行健康教育或服务 （12.8%） ； 参加会议和提供培训 （9.3%） ； 社区测绘和动员 （0.8%） ； 保存记录、汇报、管理家庭档案 （13.2%） ； 管理 物资 （1.3%） ； 接受监督 （3.2%） ； 接受培训 （1.6%） ； 不 同工作间的移动 （15.5%）； 在卫生站 （或城镇的卫生中心） 等待患者 （24.9%） ； 建立社区关系 （13.3%） ； 其他无法明 确分类的活动 （4%） 。 城乡之间, 以及各地区之间, 不同工作 活动时间所占比例和总工作时间均有显著差异 （P<0.05） 。 本研究结果显示, 仅有一小部分HEW工作时间是用于提供健 康教育和健康服务, 大部分时间用于等待患者。创造更多的服 务需求, 或重新设计服务提供模式, 或许可以提高HEW模式的 效率。 Etiopía puso en práctica un innovador programa comunitario de salud, denominado programa de extensión de la salud, para mejorar el acceso a la promoción básica de la salud, la prevención de enfermedades y servicios curativos seleccionados mediante la creación de puestos de salud en cada pueblo, también llamado kebeles, con un promedio de 5.000 personas, equipados con dos trabajadores de extensión de la salud (TESs). Este estudio de tiempo y movimiento se realizó para estimar la cantidad de tiempo que los TESs emplean en varias tareas laborales y para explorar las diferencias en los ambientes urbanos comparados con los rurales y entre las regiones. Se observó un total de 44 TESs durante 21 días consecutivos, y se recogieron datos de tiempo y movimiento utilizando computadores de tableta. En promedio, los TESs estuvieron en servicio durante 15.5 días de los 21 días de período de observación, y en promedio, permanecieron en servicio durante aproximadamente 6 horas por día. Del total del tiempo de trabajo observado, los porcentajes del tiempo total dedicado a diversas actividades fueron los siguientes: suministrando educación o servicios de salud (12.8%); participando en reuniones y dando entrenamiento (9.3%); llevando a cabo el mapeo y la movilización de la comunidad (0.8%); manteniendo los registros, presentando informes, manejando las carpetas familiares (13.2%); manejando productos y suministros (1.3%); recibiendo supervisión (3.2%); recibiendo entrenamiento (1.6%); viajes entre actividades laborales (15.5%); esperando a los clientes en el puesto de salud (o en el centro de salud en los entornos urbanos) (24.9%); construyendo relaciones en la comunidad (13.3%); y otras actividades que no pudieron ser categorizadas de manera significativa (4%). La proporción de tiempo dedicado a diferentes actividades y el tiempo total de trabajo varió significativamente entre las zonas rurales y urbanas y entre las regiones (en P<0.05). Las conclusiones de este estudio indican que sólo una minoría del tiempo del TES se dedica a la prestación de educación y servicios de salud, y un tiempo considerable se gasta esperando a los clientes. La eficiencia del modelo de TES puede ser mejorada creando una mayor demanda por los servicios o rediseñando las modalidades de prestación de servicios.

Background Surgical capacity assessment in low- and middle-income countries (LMICs) is challenging. The Surgeon OverSeas’ Personnel Infrastructure Procedure Equipment and Supplies (PIPES) survey tool has been proposed to address this challenge. There is a need to examine the gaps in veracity and context appropriateness of the information obtained using the PIPES tool. Methods We performed a methodological triangulation by comparing and contrasting information obtained using the PIPES tool with information obtained simultaneously via three other methods: time and motion study (T&M); provider focus group discussions (FGDs); and a retrospective review of hospital records. Results In its native state, the PIPES survey does not capture the role of non-physician clinicians who contribute immensely to surgical care delivery in LMICs. The surgical workforce was more accurately captured by the FGDs and T&M. It may also not reflect the improvisations (e.g., patients sharing beds, partitioning the operating theater, and using preoperative rooms for surgery, etc.) that occur to expand surgical capacity to overcome the limited infrastructure and equipment. Conclusions The PIPES tool captures vital surgical capacity information but has gaps that can be filled by modifying the tool and/or using ancillary methodologies. The interests of the researcher and the local stakeholders’ perspectives should inform such modifications.