Tips for Getting Started

Whether you are a program manager, a service provider, a supervisor, or any other staff member, the following tips can help you start to improve organization of work:

1. Look at how work is now organized in your workplace. Ask yourself:

• Why is work organized in this way?
• Is work organized to meet clients’ needs?
• How are effectiveness and efficiency for the client balanced with effectiveness and efficiency for the staff?
• Are all the steps and activities absolutely necessary?
• Are there better ways to get the work done?

2. Put yourself in clients’ shoes and walk through the processes that various kinds of clients experience. Consider:

• Does the clinic feel comfortable and safe?
• Do instructions or signs help clients find their way?
• How long do clients wait for services?
• Do clients know when to return for follow-up or where to go for referral services?

3. Ask clients what they think of the way service is organized. How would they suggest improving it?

4. Ask colleagues what they think of how work is organized. How would they improve it?

5. Take the responsibility to improve the way work is organized. Enlist and empower others to take responsibility also. Praise those who propose and make constructive changes to their organization of work.

6. Based on your investigations, try some different ways of organizing work that might be more efficient, especially for the client.

7. Read and share technical information on how to improve work processes (see Table 1).

8. Over time, make more observations and ask for feedback to see which processes are working better.

9. Let other people in the organization know what worked well and what did not work well, and why.

JHU/CCP

Health providers in Mexico review program information. Improving organization of work is everyone’s responsibility.

Putting Organization of Work Principles into Practice

Palestine: Reorganizing Physicians’ Daily Hospital Round

The physicians and nurses at Al-Naser Hospital’s Pediatric Department Two in the Gaza Strip decided to improve the morning round. Each day, the four on-duty physicians performed the morning round as a team, visiting the children who were hospital in-patients, examining them, and deciding whether to discharge them, perform further evaluation, prescribe medication, or refer them to a specialist.

The team began rounds at different times each day, and the time required to carry out each day’s round varied. As the physicians made their rounds, they were interrupted by telephone calls, requests from managers, visits from patients’ families, and by other physicians seeking consultation on complicated cases. The rounds were disorganized and unsystematic: Instruments and patient files often were not readily available, leaving the physicians waiting at the bedside while a nurse obtained the missing item. As a result, the physicians spent only half of the round actually seeing patients. They had little time to complete patient history forms or to write follow-up remarks in patients’ charts.

To improve the morning round, a team of doctors, nurses, administrators, and other staff diagramed the steps of the morning round in a flow chart (Principle: Promote teamwork and avoid hierarchical thinking). After reviewing all the steps involved in the current process—that is, by looking at the “big picture”—the team agreed on a solution: divide the morning round into two parts—a primary round, beginning at 8:15 a.m., and a grand round, from 9:30 a.m. to 11:00 a.m., when hospital public visiting hours began. During the primary round each physician was assigned a number of patients to see and evaluate before 9:30 a.m., when the physicians would assemble as a group to begin the grand round (Principles: Modify approaches as needed and Schedule around both clients’ and providers’ needs).

As a result of these changes, the rounds began and ended on a standard schedule, physicians had enough time to write follow-up comments or to record patient histories, and the workload was distributed evenly. The team also established back-up plans in the event that fewer than four physicians could take part in the morning round (Principle: Plan for common fluctuations in health care delivery).

While the primary round enabled physicians to deal individually with routine cases, the grand round provided a forum for the physicians to discuss critical cases as a group and to exchange ideas for patient management and treatment (Principle: Enable positive human relationships). During the grand round the four physicians met with the department head to discuss the morning’s cases. Usual cases were reviewed quickly, leaving more time to discuss the critical cases in detail.

In addition, interruptions were minimized. Telephone calls were answered at the nurses’ reception desk, and the doctors received their messages only after rounds were done. Managerial requests that were not urgent were delayed until the end of rounds, and visitors were not allowed to visit until rounds were finished (Principle: Make gate-keeping appropriate to the need).

The new system provided patients with better care. Since the physicians had enough time to discuss critical cases during the grand round, they could develop more effective treatment plans. Time spent on patient-related work increased to nearly 100% from an average of 60%, and the average patient-physician contact time doubled, increasing from 7 minutes to nearly 15 (Principle: Balance client load with client flow). The patients’ parents and other family members reported greater satisfaction with services—for example, most rated the care their children received as “excellent” on a satisfaction survey as compared with “good” or “very good” before the changes (1).