• Summary
• Credits

1. Understanding the Concept
2. Evidence-Based Practices
3. Adaptability
4. Links with Other Services
5. Minimizing Paperwork
6. Physical Factors
7. Service Hours and Scheduling
8. Client Flow
9. Division of Labor and Job Design
10. Social Factors
11. Implementing the Concept
12. Bibliography

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This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.

Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Understanding Organization of Work

Many problems at the service delivery level can be best understood and solved by looking at the organization as a whole. The health care delivery system typically involves different geographic units, departments, and levels—including central, regional, and community. Thinking about the way work is organized helps managers and providers throughout the system to see their organization as a collection of interdependent resources (including infrastructure, supplies, and referral sites) and processes (such as client scheduling and information management) that change and evolve in response to both clients’ and staff needs. Rather than looking at individual tools or procedures, the concept of organization of work looks at whether the different elements of an organization work together, work efficiently, and focus on both clients’ and providers’ needs.

In the private sector concepts that help organizations focus on improving customer service long ago superseded earlier managerial approaches that focused on carrying out tasks. In health care, too, client-oriented and service-oriented concepts, rather than task-oriented approaches, increasingly guide service delivery. Now, the Maximizing Access and Quality (MAQ) Initiative has applied the concept of organization of work to facilitate more client-oriented services in family planning and other reproductive health care.

Organizing work better need not be complicated or time-consuming. Often, simple changes to processes and procedures can help address major work-related problems. For example, redistributing workloads among providers, removing unnecessary procedural steps, or performing certain tasks at the same time, rather than one after the other, can improve services and save time and money.

The organization of work concept can help address nine key elements that, when neglected, interfere with access to and quality of services. The elements apply to different levels of service delivery—the health system, the facility, and personnel (see figure below).

For each of these elements the MAQ Organization of Work Subcommittee has identified several basic principles to help staff make improvements. These principles reflect the experience and expert opinion of the Subcommittee. While they are drawn primarily from family planning and other reproductive health programs, they also can apply to a range of other health care delivery services.

The rest of this report consists of nine sections addressing in turn each of the nine key elements of organization of work. Each section presents and discusses the principles that guide effective performance. Also, each section contains one or more short boxes, “Principles in Action,” which present brief examples from country experiences. A final section offers tips and tools to help managers and providers put the elements and principles into practice.

1. Use of evidence-based practices Applying guidance based on demonstrated impacts and eliminating unnecessary procedural barriers (see Use of Evidence-Based Practices); 2. Adaptability Being flexible to meet the changing conditions common to health care service delivery (see Adaptability); 3. Links with other services and sites Improving internal and external referral systems (see Links with Other Services and Sites); 4. Minimizing paperwork, maximizing information use Collecting, recording, communicating, and applying the right information effectively (see Minimizing Paperwork, Maximizing Information Use); 5. Physical factors Encouraging staff to be resourceful when using facility space and ensuring supplies (see Physical Factors); 6. Service hours and scheduling Tailoring clinic hours, scheduling, and follow-up visits to meet both clients’ and providers’ needs (see Service Hours and Scheduling); 7. Client flow Shortening wait times and improving traffic patterns, balancing client load and client flow (see Client Flow); 8. Division of labor and job design Clearly defining staff responsibilities and functions, lines of authority, and management structures (see Division of Labor and Job Design); 9. Social factors Providing leadership and motivation, and encouraging skill development and positive human relations (see Social Factors).

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.