Tool to measure workload of health professionals in Primary Health Care: development and validation

Bonfim, Daiana; Pereira, Maria José Bistafa; Pierantoni, Célia Regina; Haddad, Ana Estela; Gaidzinski, Raquel Rapone

doi:10.1590/S0080-623420150000800004

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ORIGINAL ARTICLE • REEUSPRev. esc. enferm. USP 49 (spe 2) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000800004 copy

Tool to measure workload of health professionals in Primary Health Care: development and validation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To develop and validate an instrument that addresses the interventions/activities carried out by the family health team as reference for staff planning.

Method

Methodological research developed in stages: instrument development, content validation, and pilot test in three units located in the southeastern region of Brazil.

Results

39 interventions were validated in a single instrument to measure workload for clinician, dental surgeon, oral health technician/assistant, nurse, nurse assistant, and community health agent. In the pilot test, the instrument contained 100% of the interventions observed and the observers reached 93.7% agreement.

Conclusion

The proposed instrument is an innovating tool because of its configuration for health team and supports staff planning in primary health care.

Primary Health Care; Human Resources in Health; Workload; Validation Studies, Planning

Instrument to Measure Workload of Primary Care Health Professionals

Intervention/Definition	**Type of care	***Professional Category
[Intervention 01] Educational activities of health workers Development of and participation in permanent education actions.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 02] Medication AdministrationPreparation, supply, and evaluation of the effectiveness of prescription and non prescription medicines.	D	2, 5, 6, 7
[Intervention 03] Support to student Assistance and support to the student in learning experience.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 04] Support to clinicianCollaboration with doctors in assistance to client.	D	5, 6, 7
[Intervention 05] Assistance in examinations/procedures Assistance to client and other health care provider during a procedure or examination.	D	2, 3, 4, 5, 6, 7
[Intervention 06] Assistance to breastfeedingPreparing a mother to breastfeed her baby.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 07] Attending the spontaneous demand Attending a client without scheduling, which includes production and health promotion practices with co-responsibility of staff/client.	D	1, 2, 3, 4, 5, 6
[Intervention 08] Performance assessmentSystematic assessment of professional performance.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 09] Scientific research data collection Data collection for scientific research.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 10] Appointment Application of knowledge to provide a set of activities to an individual, aimed at the restoration or maintenance of health.	D	1, 2, 5
[Intervention 11] Community Disease ManagementActions directed to a community to reduce and control the incidence and prevalence of communicable diseases.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 12] Electrolytes ManagementPromoting electrolyte balance and preventing complications resulting from abnormal or undesired levels of serum electrolytes.	D	5, 6
[Intervention 13] Immunization/vaccination management Monitoring of immunization status, facilitating access to immunizations and provision of immunizing agents to prevent communicable diseases.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 14] Infection control Minimizing the risk of contamination and transmission of infectious agents.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 15] Control of supplies Request, acquisition, and maintenance of adequate items to offer care to client.	I	1, 2, 3, 4, 5, 6
[Intervention 16] Organization of work processOrganization and distribution of work activities in health services.	I	1, 2,3,4, 5, 6, 7
[Intervention 17] Urgent/emergency careProvision of measures to save a life at risk.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 18] Community health developmentSupport to the community in identifying health problems, mobilization of resources, and implementation of solutions.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 19] Development of administrative routines and processes Construction and use of a programmed sequence of administrative routines and processes to improve the desired results for the client, at an efficient cost.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 20] Development of healthcare protocols Construction and use of a carefully programmed sequence of activities to improve the desired results for the client, at an efficient cost.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 21] Documentation Taking note of data and information related to the client, the family, population and territory (record on consultation and clinical procedures; record on home visits; record on monitoring).	I	1, 2, 3, 4, 5, 6, 7
[Intervention 22] RiskIdentification Analysis of potential risk factors (biological, social, environmental, and related to labor) to health and prioritizing risk reduction strategies for an individual or a group.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 23] Laboratory data interpretation Client laboratory data analysis to assist in decision making.	I	1, 2, 5, 6
[Intervention 24] Mapping and determining territory Recognition of structural, social, economic, political, cultural, environmental, and social interaction of the health unit’s area of reach and its delimitation.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 25] Monitoring of vital signs and/or anthropometric measures Verification and analysis of cardiovascular, breathing, and body temperature data and/or anthropometric measures to determine and prevent complications.	D	5, 6
[Intervention 26] Health System GuidanceFacilitating client/population proper access to and use of health services.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 27] Outpatient proceduresApplication of specialized knowledge and specific ability to conduct clinical and/or surgical procedures.	D	1, 2, 3, 4, 5, 6
[Intervention 28] Collective proceduresEducational and preventive actions carried out in the sphere of health units (health team work with the groups of elderly, hypertensive, diabetic, pregnant women, adolescents, mental health, family planning, and waiting room), of households, street groups, schools, kindergartens, associations, club of mothers or other social spaces, and offered on an ongoing basis.	D	2, 3, 4
[Intervention 29] Promotion of educational activities Development of health education activities for individuals, families, groups or communities, as well as specific guidance to a client, family, partner, or caregivers seeking their understanding of a prescribed procedure or treatment.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 30] Puncture of vessel: sample of venous blood Collection of venous blood sample from a noncannulated vein.	D	1, 5, 6
[Intervention 31] Reference and counter-reference Referral and monitoring of clients for secondary care, tertiary care, and other services.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 32] Administration meetingAdministration meeting to plan, discuss and evaluate technical and administrative issues related to service organization.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 33] Meeting for evaluation of multidisciplinary care Planning and evaluation by the multidisciplinary team of the offer of comprehensive care to the client/population.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 34] Unit workers supervisionFacilitating the provision of high-quality care to clients by other individuals.	I	1, 2, 4, 5, 6
[Intervention 35] Environmental management: safety Deliberate and continuous collection and analysis of information about the service environment for use in the promotion and maintenance of client safety.	I	1, 2, 3, 4, 5, 6
[Intervention 36] Interinstitutional transportTransport of clients to another health unit.	D	1, 5, 6
[Intervention 37] Exchange of information on health care and/or health service Providing information on the care of client/population and/or health service to other health professionals.	I	1, 2, 3, 4, 5, 6, 7
[Intervention 38] Health surveillance Impacting actions on avoidable causes in the epidemiological, sanitary, and environmental context.	D	1, 2, 3, 4, 5, 6, 7
[Intervention 39] Home Visit Providing care to clients/population to integrate and optimize the use of resources, ensure the quality of healthcare, and achieve the desired results in order to favor interaction with the dynamics of family relationships and the establishment of bonds.	D	1, 2, 3, 4, 5, 6, 7
[Other Activities] Associated activity: activities of other professional categories, which are assumed by the health professional, such as clerical work and cleaning. Personal activity: necessary breaks in the working day to meet the workers’ physiological and personal communication needs. Standby time : when the worker is at the work post available for service, waiting for the client and/or professional, because of absence and/or delay of client, lack of demand, or other professional being engaged in another activity. Absence: when the professional, during the workday, is absent to conduct activities unrelated to the health unit, such as delays and early departures.		1, 2, 3, 4, 5, 6, 7

Unit/City	Professional Category*							Overall total

	1	2	3	4	5	6	7
FHU São Paulo	810	378	162	324	1350	1836	1458	6318	33%
FHU Ribeirão Preto	810	540	432	0	540	1890	1458	5670	30%
FHU Rio de Janeiro	810	756	432	378	1242	1188	2268	7074	37%
Overall total	2431	1676	1029	706	3137	4920	5191	19062	100%

Professional category

Test		1		2		3		4		5		6		7		Total

		n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
SP	D	9	12.3	9	52.9	0	0	3	17.6	17	15.5	8	5.7	1	5.6	47	12.0
	A	64	87.7	8	47.1	16	100	14	82.4	93	84.5	133	94.3	17	94.4	345	88.0
RP	D	1	5.6	0	0	0	0	0	0	0	0	2	6.1	2	4.4	5	4.0
	A	17	94.4	12	100	0	0	6	100	12	100	31	93.9	43	95.6	121	96.0
RJ	D	8	3.6	5	4.5	2	2.2	1	1.9	10	3.4	14	6.0	7	10.8	47	4.4
	A	217	96.4	107	95.5	87	97.8	52	98.1	281	96.6	218	94.0	58	89.2	1020	95.6

Subtotal	D	18	5.7	14	10	2	1.9	4	5.3	27	6.5	24	5.9	10	7.8	100	6.3
Subtotal	A	298	94.3	127	90	103	98.1	72	94.7	386	93.5	382	94.1	118	92.2	1486	93.7

Overall total		316	100	141	100	105	100	76	100	413	100	406	100	128	100	1585	100

Unit/City	Professional category

	Clinician		Dental Surgeon		Oral Health Assistant		Oral Health Tech./Assistant		Nurse		Nurse Assistant		Community Health Agent

	N	%	N	%	N	%	N	%	N	%	N	%	N	%
São Paulo	14	41	11	30	9	29	10	31	19	50	22	59	9	32
Ribeirão Preto	17	50	14	39	8	26	12	38	23	60	27	73	13	46
Rio de Janeiro	15	44	21	58	14	45	10	31	25	66	23	62	10	36

Total interventions provided in the instrument	34	100	36	100	31	100	32	100	38	100	37	100	28	100

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence Addressed to: Raquel Rapone Gaidzinski. Av. Dr. Enéas de Carvalho Aguiar, 419. CEP 05403-000 - São Paulo, SP, Brazil. raqui@usp.br