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LETTER TO EDITOR  
Year : 2014  |  Volume : 39  |  Issue : 4  |  Page : 254-255
 

Time-motion study to know: Efficiency and effectiveness of clinical care is essential to hospital function?


Department of Community Medicine, Gajara Raja Medical College, Gwalior, Madhya Pradesh, India

Date of Web Publication15-Oct-2014

Correspondence Address:
Leena Bhargo
Department of Community Medicine, Gajara Raja Medical College, Gwalior, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.143035

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How to cite this article:
Bhargo L, Mishra A, Agarwal AK. Time-motion study to know: Efficiency and effectiveness of clinical care is essential to hospital function?. Indian J Community Med 2014;39:254-5

How to cite this URL:
Bhargo L, Mishra A, Agarwal AK. Time-motion study to know: Efficiency and effectiveness of clinical care is essential to hospital function?. Indian J Community Med [serial online] 2014 [cited 2020 Nov 27];39:254-5. Available from: https://www.ijcm.org.in/text.asp?2014/39/4/254/143035


Sir,

We have discussed the time-motion article [1] under articles review session and we would like to discuss our observations.

The present trend toward increased efficiency in all kinds of skilled work has brought about a widespread interest in motion and time study. The term "time study" and "motion study" have been given many interpretations since their origin. Time study, originated by Taylor was mainly used for rate setting; and motion study, developed by the Gilbreths, was largely employed for improving methods, one group saw time study only as a means of determining the size of the task that should constitute a day's work, using the stop watch as the timing device. Another group saw motion study only as an expensive and elaborate technique for determining a good method of doing work. Today the discussion of the comparative value of using either the one or the other of the two techniques has largely passed; industry has found that motion study and time study are inseparable, as their combined use in many sectors now demonstrates. [2] Taking cognizance of present trends and recognizing the fact that motion study always precedes the setting of a time standard, was presented in the same article. [1]

Time-motion study may be used for two purposes: (1) To assist in finding the most efficient method of doing work; and (2) to assist in training individuals to understand the meaning of time-motion importance, and when the training is carried out with sufficient thoroughness, to enable them to become proficient in applying time-motion principles. [3]

Today, the Indian hospital systems has in a state of transition and outpatient services in tertiary hospitals face daunting challenges, such as evolving technologies and reimbursement policies, demographic trends, competing fiscal demands, and a worsening skilled workforce shortage. This point in time also affords a unique opportunity as the India is in the midst of one of the largest health services and renovation booms in history. A reconsideration of skilled health work force and work processes holds the potential to affect the efficiency and effectiveness of healthcare delivery for the foreseeable future. Bold changes in the outpatient work environment are imperative to ensure the sustainability and affordability of the outpatient as part of the Indian healthcare delivery system. [4]

There is requirement to note the record of accountability staff and time spent debriefing and to make sure that an explanation of the debriefing is noted in the additional information of the data collection form.

A time and motion study is a scientific method for recording time spent on a variety of tasks. The methods used in the study [1] have been done in a narrow range of specialized work settings, such as the initial registration and nutritional assessment of the children. The results have to be very accurate since the mothers in the study record the amount of time spent on specific tasks. The sum for each specific case type, that is, old/new registration was averaged to yield the average time spent, but this value used in the calculations did not determine the need for an additional time.

Patient cares are the linchpin of a reconsideration of hospital design and work processes holds the potential to affect the efficiency and effectiveness of care delivery for the foreseeable future.

In healthcare centers, there is always the problem of finding most economical ways of doing tasks and then determine the amount of task completed in comparison to manufacturing unit due to lack of incentive plan of wage payment, but time-motion study provides a technique that is unequalled for finding method of greatest economy and for measuring labor accomplishment. [3]

There is much requirement to trained health personnel and hospital caregiver about the efficient use of their time and energy with accountability of interruptions and events, most often occur quickly and follow each other with only a minor pause, makes it difficult to list each individually. So, an option should be made of noting the beginning and ending time of the sequence of events or recording the time in 1/10 th make the best guess at the total numbers of cases that had entered. This sequence of events would be limited by time itself. After the last event, would take notice of the time and record on the next line of the collection form how long the break lasted. It would be appropriate to list, ever so briefly, at the beginning of the next event, and would move down to the next line. [5]

One study of hospital environment showed that how health personnel spend their time, in real time and in real work contexts. The findings demonstrate that health personnel spent more than three quarters of their time on clinical practice-related activities-but less than one-fifth of all health practice time on activities defined as patient care activities. Three other activities accounted for the majority of outpatient practice time: Documentation, care coordination, and medication administration. Only 7.2% (31 min) of clinical time was dedicated to patient assessment and recording of vital signs. Of all reported time, 6.6% (36.3 min) was categorized as waste. Activities within this category-many of which were "hunting and gathering" behaviors-are clearly targets for improving efficiency. The much larger proportions of time devoted to care coordination, medication administration, and in particular, documentation may also represent opportunities for process improvement. Documentation accounted for the largest proportion of nonclinical time; in fact, this category by itself accounts for 27.5% of all reported time, more than unit-related functions, nonclinical activities, and waste combined. [6]

These findings illustrate the complex and demanding hospital work environment and suggest opportunities to improve the efficiency of clinical work. Changes to the process and technology of documentation, communication, and medication handling, as well as the physical design of units, could benefit physician efficiency and the safe delivery of care. Truly transforming the hospital-patient care environment to improve the delivery of safe, high quality, patient-centered care would be a paradigm shift. The task now is to test solutions to create a more effective work environment that seamlessly supports clinicians in the direct care of the patients.

 
   References Top

1.
Chattopadhyay A, Ghosh R, Maji S, Ray TG, Lahiri SK. A time motion study in the immunization clinic of a tertiary care hospital of kolkata, west bengal. Indian J Community Med 2012;37:30-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Baurngart A, Neuhauser D. Frank and Lillian Gilberth: Scientific Management in the operating room. Qual Saf Health Care 2009;18:413-5.  Back to cited text no. 2
    
3.
Barnes RM. Motion and Time study. 2 nd ed. New York: John Wiley & Sons Inc; 1940.  Back to cited text no. 3
    
4.
Anand TR, Gupta YP. Rationalization of working of OPD in a hospital: A case study. Health population. Perspect Issues 1983;6:77-94.  Back to cited text no. 4
    
5.
Tucker AL, Spear SJ. Operational failures and interruptions in hospital nursing. Health Serv Res 2006;41(3 Pt 1):643-62.  Back to cited text no. 5
    
6.
Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? Perm J 2008;12:25-34.  Back to cited text no. 6
    




 

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