Functional Job Analysis and Health Care Management Mark Mackay - PDF document

1/24/2014 Functional Job Analysis and Health Care Management Mark Mackay Department of Health Care Management June 2013 Functional Job Analysis (FJA) • An approach of measuring work • Developed by US Employment and Training Administration • The notion was to produce standardised occupational information relating to the – The worker, and – The job (role). 2 1

1/24/2014 FJA (cont.) • It’s a Quantitative approach • Relies upon a taxonomy or inventory of the various functions that compose the work • Assumption was that any job had 3 broad components: – Data – People – Things. • Components expanded to include: – Worker Instructions – Reasoning – Maths, and – Language. 3 FJA – in Health • Frank Moore applied FJA to tasks in health (family planning) e.g., Moore, F. I. (1972). Dictionary of family planning job tasks. New Orleans: Tulane School of Public Health. • Steve Fine applied it to human services workers e.g., Fine, S. A. (1988). Human service workers (Chapter 10.2, pp. 1163-1180). In S. Gael (ed.), The job analysis handbook for business, industry, and government, Vol. 2. New York: Wiley. • Cronshaw and Best applied FJA to job redesign in Veteran Affairs (hospital and primary health) (US) e.g., Cronshaw, S. F., Best, R., Zugec, L., Warner, M. A., Hysong, S. J., & Pugh, J. A. (2007). A five component validation model for functional job analysis as used in job redesign. Ergometrika, 4, 12-31. 4 2

1/24/2014 FJA in Australian Health • We wanted to know what medical practitioners did in hospitals (Castle & Mackay) • We knew that this work was usually characterised by worker mobility and task fragmentation (see Mejia, Morán, and Favela, 2007). • Were given access to the work undertaken by Cronshaw et al in Veterans Health • Adapted their taxonomy of job description from a US primary health care setting to suit an Australian acute care setting • Applied it 5 FJA + Temporal Analysis • An important difference between the past FJA work and the work undertaken in Australia was in the introduction of temporal analysis 6 3

1/24/2014 The Observation Process • Training Job Analysts/Observers • Information dissemination to potential participants • Pre-observation questionnaire – role expectations, barriers to safe patient care, levels of satisfaction with ways of work organisation • Observing doctors using electronic purpose-built tracking tool – Observations by the minute according to task taxonomy (based on purpose of activities) – Work impact options – interruptions, activity blocks, OACIS • Post observation questionnaire – experience of tracking, validity, unfinished work • Work context – purpose of unit, structure, staffing, research, achievements, vacancies • Analysis – individual reports and presentation of unit results (focus group– impediments and solutions) • Final report for the Unit Head 7 24/01/2014 The Tracking Tool The tracking tool was comprised of two components: • Rigid task taxonomy – 6 Functions – 30+ Sub-functions – 130+ outputs (or activities) • Flexible Work Impact Options – tailored to suit departments and purposes Around people (e.g., contacts, communications, interruptions) Around data (e.g., access to OACIS) Around things (e.g., sourcing, waiting) Electronic collection – Collect more data – Collect more frequently (1 minute observations) – Clean collection * 8 24/01/2014 4

1/24/2014 Task Taxonomy FUNCTIONS SUBFUNCTIONS CLINICAL SERVICE Pre-patient Intervention Patient Assessment and Monitoring Patient Treatment Patient Coordination Preventative Healthcare Patient Education Medication Management Co-ordination of Patient Care Assist with activities of daily living ADMINISTRATIVE DUTIES Patient Records and document control Exchanging Information/Meetings Administrative Support Unit management Corporate Marketing Legal matters 300 LOGISTIC SUPPORT Clinical Set-up /Maintenance Supply Maintenance Maintaining Equipment Downtime due to travel or waiting Hospitality services 400 WORKFORCE DEVELOPMENT Training/Supervising Mandatory training Continuing Medical Education Performance Management & counselling Recruitment OHS&W 500 RESEARCH Planning Research activities Reporting and publishing 600 BREAKS Breaks 9 24/01/2014 Work impact options • Where is the activity occurring? • What interruptions occurred in this one minute interval? Options • What type of interruption? selected, adapted to fit • When was the pager/person responded to? the PURPOSE • Was OACIS accessed to perform the task? of study • Did the patient change? • Was the phone call necessary? • Did the handover process follow the recognised format? • How was the transfer of information about the patient between doctors and nurses performed? 10 24/01/2014 5

1/24/2014 Results • Number of observations – 5-10k observations per trial – Total observations 20k+ • Clean data – almost no missing records • At least 95% of planned tracking completed for each role • Observations / Tracking –reflected work generally representative of role (including roles that work around the clock) 11 24/01/2014 Did we do enough tracking? Stacked Mixture Graph: Unit Functions 120% stability 100% 80% % of observations 60% 40% 20% 0% block 1 block 3 block 5 block 7 block 9 block 11 block 13 block 15 block 17 block 19 block 21 block 23 block 25 block 27 block 29 block 31 block 33 block 35 block 37 block 39 block 41 block 43 block 45 block 47 block 49 block 51 block 53 block 55 block 57 block 59 block 61 block 63 block 65 block 67 block 69 block 71 block 73 block 75 block 77 block 79 block 81 block 83 Time Block (2 hours) 100 Service Delivery 200 Administrative Duties 300 Logistic Support 400 Workforce Management 500 Research 600 Rostered & other breaks Stability of the function mix achieved at 125 hours for the unit 12 24/01/2014 6

1/24/2014 Proportion of time by function Proportion of Time Spent by Function 600 Rostered & other breaks 5% 500 Research 0% 400 Workforce Management 16% 300 Logistic Support 8% 100 Service Delivery 62% 200 Administrative Duties 9% Variation of function profile noted across the surgical and medical units. Minimum of 50% of time spent on service delivery. 13 24/01/2014 Sub-functions Sub-functions as a percentage of total observations 25% 20% % of observations 15% 10% 5% 0% 120 Patient 110 Patient Assessment Coordination Training/Supervising 340 Downtime due 610 Breaks 440 Performance 100 Pre-patient Information/Meetings 150 Patient Other (12 sub- 130 Patient to travel or waiting Treatment Education Management Intervention 220 Exchanging functions) 410 Sub-functions 14 24/01/2014 7

1/24/2014 Activities / outputs as a percentage of observations Sum total of all activities performed infrequently 15 24/01/2014 Where activity was observed theatre theatre theatre theatre theatre On the ward Outpatients clinic Emergency Department 16 24/01/2014 8

1/24/2014 Work-flow patterns Work Flow Pattern: Where, Functions and Interruptions 19 18 respond to interruption 17 interruption 16 Breaks 15 Where/Function/Interruption 14 Research 13 Workforce Logistics 12 11 Admin 10 Clinical 9 8 7 6 Theatre 5 Seminar 4 Other 3 On the ward 2 Office 1 ED 7:50 8:08 9:02 9:56 10:14 10:32 10:50 11:08 11:26 11:44 12:02 12:20 12:38 12:56 13:14 13:32 13:50 14:08 14:26 15:20 15:38 15:56 16:14 16:32 8:26 8:44 9:20 9:38 14:44 15:02 Time Shows where work occurred, what function was occurring and what interruptions occurred 17 24/01/2014 Cumulative work-flow patterns - intensity Work Intensity Work Intensity Cumulative effect of task changing and/or patient changing and/or interruption occurring and/or responding to an interruption – concurrent over 100 Responses minutes of one person ’ s work Interruptions Location change Patient changes Activity changes 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 Record No. (minute intervals) 18 24/01/2014 9

1/24/2014 Changing task focus Comparative Work Intensity - duration before change: Sun, Wed and Sat 100% 90% 90% or more 80% changes occur in 6 minutes or less 70% 60% Cum % 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 more than 10 Duration before change (min.) Wed Sat Sun On average 50% of change occurs within one minute 19 24/01/2014 Some Management Implications • Confirmed staff are mobile and tasks are fragmented • Data helped quantify extent of anecdotal concerns (e.g., interruptions and research) • Showed managers didn’t always understand what staff were doing (in significant ways) • Enabled realignment of duties (e.g., RMO got extra theatre time in order to progress to registrar training program) 20 10