Investment in Training Staff to Improve Workforce Productivity and Customer Service in Healthcare - Research Proposal Example

Matching Investment in Training Staff to Improved Workforce Productivity and Customer Service in the Australian Healthcare System in the Long Term Student’s Name: Tutor’s Name: Course Code: Date of Submission: Table of Contents Table of Contents 2 Executive summary 3 1.0 Introduction 3 1.1 Report aims and scope 3 1.2 Context and industry information 4 2.0 Research Approach 5 2.1 Nature of the problem 5 2.2 Research Approach 6 3.0 Review of the evidence 7 3.1 Observation 7 3.2 Interview 8 3.3 Data and literature review 8 3.3.1 Peer-reviewed articles 8 3.3.2 Other information sources 11 4.0 Findings and Implications 11 4.1 Management 11 4.2 Employees 12 4.3 Patients and non-patients (relatives and friends) 12 5.0 Conclusions and recommendations 12 5.1 Conclusions 12 5.2 Recommendations 13 5.3 Expected outcomes 13 6.0 References 14 Executive summary There has been increasing investment in training staff in the Australia’s Healthcare system which is intended to solve the workforce productivity and customer service problems as well as developing the departmental (hospital institutions) capabilities in the long-term in the Australian Healthcare system in the long term. This business report addresses the problems as expressed by the head human resource of the Department of Health and Ageing, which engages in national health policy-making, funds health care and is concerned with population health, and with research and monitoring of population health and health system activities. The mixed research approach was used to assess the problem. The findings showed that the public had moderate confidence levels in the public health system. There lacks proper planning and performance management in public health facilities thus moderate productivity and customer service. 1.0 Introduction In regard to the problem the Australia’s healthcare system is facing, Bolt Consultants were engaged to undertake an evidence based response to the Head of Human Resources (Department of Health and Ageing). This business report is the consultant’s response on how the Australia’s healthcare system can match the high investments in staff training to improve workforce productivity, customer care service and development of departmental capabilities in sustaining efficient health care in the long-term. 1.1 Report aims and scope The report is intended to tackle the stated problem by demonstrating how investment by the Australia’s Department of Healthcare and Ageing in the country’s healthcare system is generating generating returns in terms of improved workforce productivity, customer service and the development of departmental capabilities that will sustain us in the long term. The report focuses on the Australian public health system; 25 general and 25 acute care hospitals. This report is presented in five parts; introduction, research approach, review of evidence, findings and implications, and conclusions and recommendations. 1.2 Context and industry information The Australia health system is mainly publicly funded. Its financed through general taxation and a small compulsory tax-based health insurance levy. The Australia government funds Medicare (the tax-funded national health insurance scheme), offers patients subsidized access to their doctor of choice for out-of-hospital care, free public hospital care and subsidized pharmaceuticals (essential drugs). The Australian Health Care Agreements contributes funds to the States to run public hospitals while the Department of Health and Ageing engages in national health policy-making but also funds health care and is concerned with population health. The department is also concerned with research and monitoring of population health and health system activities. Approximately 68% of total health expenditure is provided from public sources, with the Australian Government financing 46% and the States 22%; the rest (32%) comes from private sources. Australia spends 9.7% of GDP on health, and expenditure per capita in terms of purchasing power parity (PPP) was US$ 3652, which puts Australia to some extent above the Organization for Economic Co-operation and Development (OECD) average. Healthcare spending is anticipated to increase further with growing demand by the public, who have high expectations of health care goods and services, with increasing costs of high-technology medicine, and with the increasing need for health care for a quickly ageing population. The primarily tax-funded health system achieves convincingly cost-effective health care and good health outcomes. In fact it enjoys general public support. Despite these substantial achievements, some endemic problems so far have not been solved: whether rising health expenditures are sustainable, tensions between levels of government, long waiting lists for elective surgery, disparities in urban and rural service access, and the continuing very poor health status of Indigenous Australians. However, of importance is improving healthcare workforce productivity and customer care services. The generation of this report was funded by the Head of Human Resources, Department of Health and Ageing. The department has been in operation since 1921 (aged 92 years) though with different names and scope until 2001 when it was given the current name. Over this time it has been in existence, the department of health has undergone numerous changes including being amalgamated with community services in 1987, housing services in 1991 and local government services in 1993. In 1994, the department was named as Department of Human services and Health, Department of Health and Family services in 1996 and Department of Health and Aged Care in 1998. 2.0 Research Approach 2.1 Nature of the problem In research, the research approach is usually determined by the nature of the problem. In view of this, there was need to define the prevailing problem in the Australian health system. The Head of HR, Department of Health and Ageing provided a basis during his briefing to the consultant (Bolt Consultants) who explained that the health system financiers (Australian Government, States, and private providers) had asked the department to demonstrate how its investment in training staff was generating returns in terms of improved workforce productivity, customer service and the development of departmental capabilities that would sustain the country in the long term. The consultant has put the problem forward through analysis of the current situation and compared it to the last five years when investments in staff training have increased. The problem needed to be addressed so as to establish the contribution of the foresaid investments towards enhanced workforce productivity and custom services. In addition, if not tackled the problem has the potential of declining confidence in health system financing by the financiers. Further, the problem poses a high risk to health care seekers in the Australian health system as a result of likely inefficiency and poor services. 2.2 Research Approach In order to have a fair view of the problem, the mixed approach was adopted; observation, face to face interview and analysis of the available data combined with literature review for comparison purposes. The approach was adopted due to its richness and ability in giving a fairly balanced method to the problem thus ensuring accuracy (Kennedy, 2009). The methods used are as discussed below: 2.2.1 Observation The method was employed mainly on the front office operations as customers (patients and non-patients) sought for inquiry from the customer service personnel, the amount of time taken to be directed to a physician for services. The observations made were recorded on structured questionnaires by people engaged by the consultant in various health facilities both general services and acute care public hospitals. In order to avoid change of behaviour, the staffs of these health facilities were not informed about the consultant observation. The people engaged by the consultant sat on the waiting bays of hospitals just as other clients while observing the customer service staff behaviour. This approach was used in order to retain the normal work conditions and behaviour. In addition to staff behaviour limitation, the observation method was also limited to the front desk services provision. Physicians’ consultations and/or health services provisions were not observed (Kennedy, 2009). 2.2.2 Face to face interview This method was employed to get the views of out-patients visiting the various hospitals, upon introduction and request for the interview. The inpatients and their families/friends were also interviewed. This was intended to seek the customer services they receive as well the efficiency of the staff in their view. In addition, some of the staff who had undergone training were also interviewed to get their view on whether the training was useful and if it had made any changes in their work. Further, the hospital management and various departmental heads were also interviewed to seek their views on their departmental capabilities arising from staff training as a tool for health provision services provision sustenance in the long term. In contrast to the observation method the hospital managements were informed about the interviews. However, observations were made much prior to interviews-at least one week gap. A structured questionnaire was used in the face to face interviews rather than staff self completion. This was meant to avoid collusions in completing the questionnaire. The main limitation of this method is the ability to recall past events in furnishing the consultant to arrive at a fair conclusion of their productivity (Kennedy, 2009). 2.2.3 Data analysis and Review of literature This method involved review of the available electronic data as keyed in by staff as per the patients they attended to (general and normal cases), how many acute cases had been successfully attended to and number of deaths (general and acute patients) in the last 5 years. In addition, available literature materials whether published or unpublished were reviewed. The purpose of this method was to provide another opinion from other sources independent of the consultant thus being able to strike a balance between the consultant’s primary work and work already done in the health system. This meant that the method was quite useful for comparative purposes. The process involved illustrating the scope of the literature review to avail a replicable and clear process in order to minimize biases and errors, as well as analysis of the results from a thematic approach to arrive at informative conclusions (Kennedy, 2009). 3.0 Review of the evidence 3.1 Observation The observation method was useful. The consultant gathered evidence of customer service without any influence that is as they occur. This was quite informative on the level of professionalism in customer care services amongst health workers. The major strength for this method is its unbiased nature. However, replication of this method is difficult as the behavior of health workers offering customer care services may change depending on the customer being served and situation. In order to address this weakness the observation method was complemented by interview of the health workers. 3.2 Interview On one hand the interview method was used as a complementary tool of the deficiencies of the observation method. The face to face interview method used to come up with this business report is quite effective than the self questionnaire completion in that the answers to the questions asked by the consultant were provided in real time mostly through recall or reviewing of health workers’ notebooks. The collusion between health workers that may occur if the later method was used was eliminated thus ability to achieve truthful results. The interview method was able to establish the working conditions such as the staff who had undergone training views on the tools provided for their work in relation to their productivity. In order to break any likely bias of the general staff on their productivity the departmental heads and health facilities top management were also interviewed. 3.3 Data and literature review The historical data of staff and health facilities provided scientific and tangible evidence on the productivity of workers for a period of 5 years. Due to the internal controls nature of electronic data in health facilities it highly unbiased, provided the reality. The available literature from the health facilities, other published and unpublished materials further boosted the reliability of observation and interview data. The consultant decisively and thematically scrutinized evidence from the most recent and related peer-reviewed articles as well as other sources of information as expounded below. 3.3.1 Peer-reviewed articles A total of 13 peer-reviewed articles were reviewed by the consultant from 1982 to 2011. The disparities in years of publication was important to avoid a skewed view in the health sector thus ability to compare the past and the present. This is particularly important in the trend of healthcare development issues which are experienced all globally. The analysis of the sources of the peer-reviewed journal articles used in this study was from language, management, policy, environment and health categories (Sahney, 1982; Sommer and Merritt, 1994; Orr et al., 2001; Smith, 2001; Goetzel et al., 2001; Wanless, 2002; Ling et al., 2002; Rhian, 2005; Dieleman et al., 2006; O'Toole and Kirkpatrick, 2007; Miller and West, 2007; Wuliji, 2009; Dieleman et al., 2009; Freyens, 2011). The investments in health workers training and eventual productivity, customer care and departmental development progress information from various public health facilities in Australia is important in drawing the trends in healthcare services. The usefulness of staff training is questioned in relation to these improvements is the basis to demonstrate whether the investments the Department of Health and Ageing is making in the health systems particularly in the public facilities. The themes highlighted in the above articles offer direction for possible pertinent issues which need to be improved in order for the investment staff training to match productivity and customer care of the health system workforce. One of the article focuses on instituting major performance measures, benchmarking, and best practices in the health systems (Goetzel et al., 2007) while another focuses into the importance of electronic data in health services for establishing productivity (Miller and West, 2007) and technology impact on healthcare in Australia (Orr et al., 2001). Another crucial article focuses on securing the national health systems on a long term basis (Wanless, 2002). Further analysis established that none of the articles individually addressed the cited problem in entirety. Thus all the amalgamation of ideas in the articles was important to bring about the problem focus. 3.3.1.1 Conceptual Approach Conceptually, the review of the cited articles highlighted four major themes. First, all the studies presented in the articles had focused on health issues only (Smith, 2001; Wanless, 2002; Rhian, 2005; Wuliji, 2009; Dieleman et al., 2009; Freyens, 2011) or health issues combined/in relation to other areas such as environment, language, technology, policy and management (Sahney, 1982; Sommer and Merritt, 1994; Orr et al., 2001; Goetzel et al., 2001; Ling et al., 2002; Dieleman et al., 2006; O'Toole and Kirkpatrick, 2007; Miller and West, 2007).This implies that the findings of these study articles may be relevant to a considerable degree to the situation of the Australia’s Public Health System due to the similarity in their area of focus. The interweaving of health issues and other areas like environment, motivation, policy and management brings about a good approach in synthesis of the problem since it may not entirely exist in exclusion but rather intertwined with other related health issues. In light of areas that the articles identified, the consultant acknowledged a noteworthy gap in the conceptual approach that research scholars in the health related issues have been employing in the Australian health sector, they failed to interrelate investments in health workers training, their productivity and customer care services contributions and the long term departmental developmental aspects. 3.3.1.2 Methodological approach In terms of methodological approach, the consultant found significant similarities by the peer-reviewed studies cited in this report. In all the studies the interview-questionnaire method featured dominantly (Sahney, 1982; Sommer and Merritt, 1994; Orr et al., 2001; Smith, 2001; Goetzel et al., 2001; Wanless, 2002; Ling et al., 2002; Rhian, 2005; Dieleman et al., 2006; O'Toole and Kirkpatrick, 2007; Miller and West, 2007; Wuliji, 2009; Dieleman et al., 2009; Freyens, 2011). However, observation method was also employed in some studies (Sahney, 1982; Sommer and Merritt, 1994; Orr et al., 2001; Goetzel et al., 2001; Rhian, 2005; Dieleman et al., 2006; Dieleman et al., 2009; Freyens, 2011). All the peer-reviewed articles used in this report used an aspect of literature review while some used case studies (Orr et al., 2001; Ling et al., 2002; Miller and West, 2007; Wuliji, 2009; Freyens, 2011) in setting a basis in the healthcare system of various countries. Although some of these studies used at least two similar research approaches, there were dissimilarities in their results because of the non-standardized nature of the methods. 3.3.2 Other information sources As a way to supplement the gathered information from the peer-reviewed sources non-scholarly articles were used (Health Reference Center Academic, 2010; NSW Government 2012). These articles conceptual and methodological approaches were similar to the ones cited above under the peer-reviewed articles 4.0 Findings and Implications On overall, the key findings from the study using observation, face to face interview and data analysis and literature review indicated that the employees were aware of the link between training and productivity but not to the extent of their importance in health care customer service and developmental sustainability in the long term. Moreover customers (patients and non-patients) expressed upper moderate confidence levels (62%) in the pace of attendance by the health workers while general customer service scored 60%. The departmental heads and top level health facilities management were of the view that staff training was contributing to improved productivity especially in information Technology (IT). In general, the consultant established that there was rare performance management assessment by the health facilities financiers or the management of the health facilities. 4.1 Management The health facilities were managed by board of directors at the decision making level, general manager at the supervisory and accountability level and departmental heads at the departmental levels. The general manager and his/her deputy was member of the board. Departmental heads had specialties of their respective departments and would be called occasionally to the board in case of a decision to be made concerning their department. Due to a lack of proper framework for performance assessment in public health facilities the departmental heads and top management were unable to adequately establish whether the staff who had undergone training had translated that to productivity. The management depended on the work schedule as a formula to ensure the health workers were at their stations during the required time. The workers productivity in regard to data they keyed in electronically on their daily work was never reviewed unless there was a complaint from patients or their families or due to reconciliation issues relating to drugs issued and the balance. However, from observation the management appreciated the fact that IT training had contributed to swift customer services. 4.2 Employees The employees of the public health facilities had the required educational qualifications and were from diverse backgrounds. The staff training offered through the Department of Health and Ageing was viewed by workers as an opportunity to further their skills with an aim of promotional orientation rather than services provision. This perspective was worsened by unclear instructions on the importance of the staff training by the concerned department. Therefore, staff were highly unaware that the extra training they were being offered was being aimed at improving their productivity, customer service and long term departmental sustenance in health facilities. In other instances, upon training the health staff continued to work in the same environment that is using the same tools thus being unable to translate their skills to faster service. 4.3 Patients and non-patients (relatives and friends) Patients as the main customers of the health facilities expressed their frustration in the waiting time at the front desk between their arrival time to the time they see a physician. Patients explained that they could wait for up to 2.5 hours. This indicated an issue of low productivity of the staff. The relatives also expressed moderate levels of confidence on the attention their colleagues got in public health facilities in terms of the services offered. They explained that health workers take a span of between 5 to 25 minutes upon request on an emergency situation of a patient. This showed a lapse between proper planning of the management and the staff in general rather than workers shortage. 5.0 Conclusions and recommendations 5.1 Conclusions The performance of the health staff was above average in the health facilities under the study. The investments by the Department of Health and Ageing were in no doubt increasing productivity especially in the IT related areas. However, productivity of staff was curtailed by poor performance management and poor planning. There were major gaps in the workforce working conditions. These included lacks of proper plans in attending to emergency cases, failure to inform the staff the need of the training they underwent through and what the staff were expected to achieve. 5.2 Recommendations In regard to the findings by the consultant, it is recommended that a proper structured training on the goals, scope and expected outcomes should be structured. The management of public health systems in Australia should introduce performance management which clearly indicates the minimum output of a worker quarterly, tracks the performance of the health workers and recognition of the outstanding performers. In regard to this, departmental committees should be set up and be responsible for monthly scheduling in the public health facilities. Further, upon training of the staff they should be provided with the necessary tools especially in the areas of their training. 5.3 Expected outcomes The consultant predicts that if all the recommendations made will be adopted and implemented, the public health systems will attain a confidence level of at least 85% from patients, relatives and friends. This is especially crucial in creating hope and service delivery in the Australia’s health system in the long term. 6.0 References Dieleman, M,. Gerretsen, B. and Wilt, G. (2009). Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review, Health Research Policy and Systems, 7(7), 45-67. Dieleman, M., Toonen, J., Touré, H. and Martineau, T. (2006). The match between motivation and performance management of health sector workers in Mali, Human Resources for Health, 4(2), 23-90. Freyens, B. (2011). Managing skill shortages in the Australian public sector: Issues and perspectives, Asia Pacific Journals of Human Resources, 48(3), 262–286. Goetzel, RZ., Guindon, AM., Jeffrey, T. and Ozminkowski, R. 2001, Health and Productivity Management: Establishing Key Performance Measures, Benchmarks, and Best Practices, Journal of Occupational and Environmental Medicine, 43(1), 10-17. Kennedy, P. (2009). How to combine multiple research methods: Practical Triangulation, Viewed on 15th May 2013 http://johnnyholland.org/2009/08/practical-triangulation/ Ling, X., Benton, W. and Leong, G. (2002). The impact of strategic operations management decisions on community hospital performance, Journal of Operations Management, 20(4), 398-408. Miller, RH. and West, C. (2007). The Value Of Electronic Health Records In Community Health Centers: Policy Implications, Health Aff, 26(1), 206-214. NSW Government. (2012). Workforce Planning Toolkit: Research Background for Health Workforce Planning, Workforce Assessment and Planning Unit. Orr, S., Sohal, AS., Gray, K., Harbrow, J., Harrison, D and Mennen, A. (2001). "The impact of information technology on a section of the Australian health care industry", Benchmarking: An International Journal, 8(2), 108-120 O'Toole, C and Kirkpatrick, V. (2007). Building collaboration between professionals in health and education through interdisciplinary training, Child Language Teaching and Therapy Sage journals, vol. 23, no. 3, p.325-352. Rhian, S. (2005). Applying gap analysis in the health service to inform the service improvement agenda, International Journal of Quality & Reliability Management, 22(3), 215-233. Sahney, V. (1982). Managing variability in demand: a strategy for productivity improvement in health care services. Health care management review Aspen Publishers, 7(2), 5-97. Smith, J. (2001). Redesigning health care, BMJ, 322(7297), 1257–1258. Sommer, S. and Merritt, D. (1994). The Impact of a TQM Intervention on Workplace Attitudes in a Health-care Organization. Journal of Organizational Change Management, 7(2), 53 – 62 Wanless, D. (2002). Securing our Future Health: Taking a Long-Term View, Health Trends Review HM Treasury. Wuliji, T. (2009). Current status of human resources and training in hospital pharmacy. American Journal of Health-System Pharmacy, 66(5), 356-360. Read More