Evaluating how staff use their time can be done different ways. One approach is to ask
staff members to record how they spend their time. Another way, called "patient flow
analysis," collects time data from clients, by having each staff member enter time of
arrival and departure on a form carried by the client as the client moves through the
clinic.
Yet another approach, more expensive and time consuming, is known as a
"time-motion" study, based on actually observing how personnel spend their time.
In general, the time-motion approach to cost analysis, in which staff are observed,
tends to be more accurate, says John Bratt of FHI, who has coordinated several large cost
studies. Unproductive staff time tends to be recorded more accurately using this approach.
A recent study compared the provider interview and patient flow analysis approaches to
actual time observed in clinics, a time-motion model. "The provider interview
approach was particularly weak, substantially overestimating contact time with clients and
underestimating non-productive time," says Bratt, who coordinated the study with the
Population Council. "The magnitude of error in these estimates calls into question
the validity of studies that use provider interviews for measuring staff time."
The researchers were hoping the study would provide a way to substitute less costly
methods of time measurements for time-motion studies. "But the outcome indicates that
these other methods perform far less well than does the time-motion method," Bratt
says. "We are now looking at ways to use time-motion in a small number of sites and
extrapolate from that to the full system. But we need to do more research to see if that
is as reliable."
-- William R. Finger
For more information, visit Family Health International's Website at www.fhi.org
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