Evaluation of the benefits of computer-aided scheduling for nurses work

Transcription

1 Evaluation of the benefits of computer-aided scheduling for nurses work Häber A 1, Eichstädter R 2, Haux R 1 Introduction The scheduling of the nurses work is an essential part of the patient care in a hospital. The care of clinical patients by nurses must be guaranteed 24 hours a day [1]. The university hospital of Heidelberg comprises 1700 beds in 103 wards. The planning of the scheduling is very time-consuming for the ward nurses. Legal considerations and individual arrangements have to be considered. Changes of the schedule due to e.g. an increased number of patients are difficult. Moreover, scheduling is an important economical factor. The senior nursing officer have to do statistics about patients and nurses and to guarantee the quality of patient care. All these tasks require high competence and very good knowledge of the ward, the nurses and relevant law. Moreover, filling out forms is time-consuming. All these documented data are used multiple times. Because of all these reasons the scheduling of the nurses work in the Heidelberg University Hospital should be done with the help of computers. Objectives Since 1997 the computer based application system 'DVD UKL-HD ' is used in some departments of the Heidelberg University Hospital. Now it is to be introduced in the whole university hospital. But before doing so the benefits of the software and the satisfaction of the users should be estimated [5]. Besides 'DVD UKL-HD ' it should be tested considering weak spots concerning the functionality and the adaptation in the organisational structure. Methods The project was carried out by students of the graduate program Medical Informatics [3] in their practical training information systems management in health care [2]. The study was planned and processed in summer 1998 as a prospective study with interviewing and observing two wards working with 'DVD UKL-HD ' and two wards with paper based scheduling. In the planning phase valuation criteria were fixed and forms of completion were developed. After that data was collected and analysed. Moreover the students themselves tested 'DVD UKL-HD ' to find weak spots [4]. 1 University of Heidelberg, Institut for Med. Biometry and Informatics, Department of Med. Informatics 2 Heidelberg University Hospital, Psychiatric Clinic

2 Results The process of scheduling is shown in figure 1 (it is shown relatively to the day the schedule table took effect). The schedule table is planed 1 month in advance. In the wards scheduling by computer the planning starts later, but the process itself is equivalent. First wishes of nurses are written down. These wishes will be considered in the 1st version if possible. After that the head nurse must have a look at the 1st version whether there are mistakes in the table. Figure1 about here By using the evaluation criteria it was found out that the quality of scheduling differs between computer aided and paper based scheduling in some ways (see table 1). Table1 about here In the print-out of the computer aided schedule table one can find manual corrections that will be manually registered in 'DVD UKL-HD ' in the evening. This will be done because the screen is too small to allow grasp the whole of the table. It is based on Microsoft Excel, and the data is too much and the font is to small for a typical 15 monitor. However the legibility of paper based schedule tables depends on the handwriting of the senior nursing officer. One great advantage of computer aided scheduling is the help of 'DVD UKL-HD ' in complying with legal demands. There are plausibility checks in the program code. In paper based scheduling the senior nursing officer has to watch legal demands by herself. Table2 about here Another aspect of our analysis was the time consumption of scheduling (see table 2). It differs between the wards using computer aided scheduling (table 2, line 3) because of the knowledge and interest in computers of the senior nursing officers. One of them is very enthusiastic and familiar with computers and 'DVD UKL-HD ', the other has had only a small introduction. She doesn't know anything about Microsoft Excel so the time of scheduling is nearly equivalent to the duration for paper based scheduling. The time to change the first version of the schedule table in the wards scheduling with 'DVD UKL-HD ' is quite short. The reason is that 'DVD UKL-HD ' helps the senior nursing officer in the phase of planning considering legal demands. So there are less mistakes in the table. In 'DVD UKL-HD ' there is the possibility to assume older schedule tables but this won't be used. The collection of data for statistics must be done once every month. Senior nursing officers scheduling manually must fill in forms, take and summarise data from the schedule table. 'DVD UKL-HD ' facilitates statistics by using data from the database. Statistics with 'DVD UKL-HD ' can be done whenever the nursing head of the clinic wants to.

3 An essential part of our study is the analysis of user satisfaction. A computer program can only be as good as the motivation of the users therefore nurses were interviewed about their knowledge of computers and their impressions of 'DVD UKL-HD '. It was asked if they understood the program, if the program was reliable and fast enough, if they had good support and a lot more criteria. The answers of the users were very different. They depended on the interest in working with a computer. Those nurses who had an interest in computers were satisfied with the program and saw only small and functional related weak spots. But nurses for whom computers are unknown and suspect things are not so delighted. It was determined that it is necessary to introduce and motivate the staff to work with a computer in general or with a special program like 'DVD UKL-HD '. Table3 about here Motivated by the nurses we have tested the functionality of 'DVD UKL-HD ', version 3.3. We have found a lot of small weak spots but most of them are eliminated in version 3.4. The inadequacies of version 3.4 are listed in table 3. Conclusion 'DVD UKL-HD ' facilitates the scheduling of the nurses work. In particular it supports the multiple use of data, e.g. for filling in and evaluation of the statistical forms. The users are satisfied with the program but there are a few conditions that have to be adressed, e.g. at least 17 -monitors to have a better overview of the planning table, exhaustive training of nurses because they often don't have any knowledge of computers, and software-support. Nowadays 'DVD UKL-HD ' is used in the whole university hospital of Heidelberg, in all wards and other departments working in shift. In 1998 all wards were equiped with 17 monitors and partially with new computers. DVD is available in version 3.5a. The software company (WMD, Hamburg) says that the weak spots are eliminated, but this must be checked. The students were taught to plan and run projects systematically. They decided to interview and observe nurses, senior ward officers and their nursing heads. But these methods are open to criticism. Data resulting from interviews is bound to be subjective. It was difficult to compare the results of our study because most of the nurses, the senior nursing officers and the nursing head of one of the wards using the software were familiar with the computer in contrast with the staff of the second ward. These nurses only had short training in using 'DVD UKL-HD '. As an important result of the study it was seen, that a computer program can only be as good as the motivation and the knowledge of the users. Literatur (1) POTTER PA, PERRY AG (1993): Fundamentals of Nursing, Concepts, Process & Practice. Mosby-Yearbook, Inc., St. Louis, International Edition, Third Edition,

4 (2) KNAUP P, HAUX R, HÄBER A, LAGEMANN A, LEINER F (1998): Teaching the fundamentals of information systems management in health care. Lecture and practical training for students of medical informatics. IJMI, 50, (3) LEVEN FJ, HAUX R (1998): Twenty five years of medical informatics education at Heidelberg/Heil-bronn: Discussion of a specialised curriculum for Medical Informatics. IJMI, 50, (4) WULFF KJ, WESTPHAL JR, SHRAY SL, HUNKELER, EF (1997): Using automated continual performance assessment to improve health care. MD Computing, 14, (5) OHMANN C, BOY O, YANG Q (1997): A systematic approach to the assessment of user satisfaction with health care systems: constructs, models and instruments. In: PAPPAS C, MAGLAVERAS N, SCHERRER JR (eds.) (1997): Medical Informatics Europe 97. Amsterdam, IOS Press.

5 wishes of nurses 1st version of plan changes agreement changes changes X days figure 1: Process of scheduling in wards, shown relatively to the day the schedule table take effect (day X). The nurses utter their wishes, after that the senior nursing officer drafts a first version, that must be agreed by the head nurse of the clinic.

6 Computer aided Paper based Presentation of all necessary Presentation of all necessary data data Manual corrections in the printout days Partial presentation of vacation Scheduling for 1 month in Scheduling for 1 month in advance advance Bad legability due to much data Good legability and small fonts Changes in the table can be seen Changes in the table can be seen promptly promptly Wishes of nurses are taken into Wishes of nurses are taken into account account Printed version is posted in the Last version is posted in the ward office, furthermore data ward office can be watched at the screen Legal demands are taken into Legal demands are taken into consideration, DVD helps consideration limitedly table1: Comparision of the quality of scheduling in computer based and paper based scheduling, using valuation criteria.

7 computer-aided paper-based start of planning of scheduling (before take effect) end of planning (before take effect) time consumption to plan the 1st version P1: 1 week P2: 4 weeks P1: 7 days P2: 10 days P1: 1 hour P2: 4 hours P1: 3 weeks P2: 4 weeks 10 days 5 hours time consumption to change the 1st version 10 minutes P1: 58 minutes P2: 170 minutes number of changes 4 1 Possibility to reuse old schedule plans? yes no use of the reuse? no - time consumption to make changes no answer some minutes time needed to understand the program DVD 6 month - table 2: Time consumption for computer based and paper based scheduling (P1 is one senior nursing officer of the study group, P2 the second one).

8 - To enlarge password window - To safe regional and self-defined public holiday for the next year - To permit the nurses to see the holiday plan - To warn if the qualification of a nurse on the schedule table is not sufficient table 3:Weak spots of the functionality of the program not eliminated with the update from version 3.3 to version 3.4.