STAFF MIX AND PATIENT OUTCOME IN STATE AND FEDERAL TEACHING HOSPITALS

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

[Namgada 2008] Health systems in both rich and developing countries are under pressure to improve service delivery to an ever-growing population with limited or restricted resources. This is due to an increase in the prevalence of diseases, a desire to receive the highest quality care, advancements in health-care technology, increasing awareness of health-care rights, and enhanced access to a wide range of health-care services. For the provision of health services to patients/clients, health care systems require the following: efficient health policies, adequate educated health workers, proper equipment, and financial resources [Olade, 2005]. The basic goal of all health-care systems is to provide high-quality care; nevertheless, certain variables appear to be impeding efforts to achieve this goal to its full potential.

According to a World Health Organization research from 2009, the staff-to-population ratio in some affluent countries ranges from 1000 to 100,000. It ranges from 100 to 100,000 in poor countries. According to a survey on Nigeria’s health workforce country profile, as of December 2010, there were 52,408 doctors on the medical registry and 128,918 registered nurses [Labran, Mafe, Onajole, & Lambo, 2011]. Nigeria has a population of roughly 160 million people, according to the World Health Organization (2009); based on the data above, the ratio of health professionals to the population is predicted to be: doctors 1:3052 and nurses 1:1241.

According to Ozcan and Horby [2004], the quantity of skilled health staff in Africa, as well as other parts of the world, has been insufficient, necessitating the need for more.  Aside from a lack of health-care providers, a lack of suitable staff mix in health-care delivery is another major issue in many developing countries’ health-care systems (McGillis, 2005). The term “staff mix” refers to the mix of different types of health personnel/workers who are engaged to provide treatment to patients in healthcare facilities [within the same or across different professional disciplines]. The staff mix in healthcare facilities affects the overall outcome of care [McGillis, 2005]. The standard practice in human resource management is to provide the right number of staff [health personnel], with the right knowledge, skills, and attitude, performing the right tasks in the right place, at the right time, in order to meet predetermined health goals [Mark and Staton, 2003: International Council of Medical Societies].  The ratio of staff mix to patient is a factor that affects the care process in a certain unit or facility. This staff mix ratio could be expressed in terms of the proportion of available staff to the patient population, years of experience, professional qualifications, number of years personnel worked in a unit, and cadre of staff [junior/senior]. The normal staff mix to patient ratio, depending on unit size, is 1:4-6 patients, according to Needleman (2005). It is 1:2-3 patients in more intensive care units. The Nursing and Midwifery Council of Nigeria (N&MCN, 2005) specifies that in clinical practice, the staff/patient ratio for different cadres of staff, depending on the unit and kind of patient managed, is 1:4-5 (for general wards) and 1:1-3 (for intensive care units).

The adequate staffing of a unit ensures that patients are properly cared for and discharged at the appropriate time (Cheryl and Clark, 2007) According to Aiken [2007], a larger staff mix to patient ratio ensures that patients receive proper direct care. Staff can also provide ongoing in-depth assessments and tracking of clinical developments. Staff has more time to monitor changes in the patient’s condition and provide prompt response for any concerns that arise. All of these are expected to have an impact on the care result.

Patient outcome, according to Quan [2006], is an observable change that occurs as a result of the patient’s exposure to interventions or the care environment.

There is a link between personnel mix and care outcomes, according to studies. Positive outcomes are linked to highly-trained personnel, staff experience and training, more intensity of care, greater therapy, general staffing levels, as well as teamwork, team order, and organization, according to Strasser (2005). On the other hand, poor recruitment and retention, delayed care or absent employees, a lack of facilities and supplies, poor administrative management, the severity of sickness [chronic or acute] and co morbidity variables are all linked to a negative outcome (Anderson, Weiner & Khatusky, 2006).

There is a considerable association between worker ratio and care outcome, according to Bolton (2001) and Needleman (2005). They emphasized that allocating the proper amount of workers to patients reduces the risk of adverse events such as pneumonia, pressure ulcers, failure to rescue, deep venous thrombosis, death, urinary tract infection, and shock. Reduced hospital stay, medical errors, hospital costs, and surgical wound breakdown/infection are among the others. Suzanne and Smeltzer [2010] also stated that the outcome of care could be attributed to other factors such as the risks associated with specific surgeries, the patient’s overall health status, concomitant conditions such as diabetes mellitus, which can affect wound healing, chronic smoking, unnecessary invasive procedures, post-operative pain management, nutritional status, and the patient’s immune status, among others.

The majority of these investigations took place in wealthy countries. In Nigeria, and Africa in general, there is a scarcity of data on staff composition and patient outcomes. The personnel mix and patient outcomes in state and federal teaching hospitals in Enugu State were investigated in this study.

The problem is stated.

 

Enugu State University Teaching Hospital, Parklane Enugu (ESUTH) and University of Nigeria teaching hospital Ituku/ Ozalla are the two teaching hospitals in the state (UNTH). They offer education, research, and health care. These health facilities are used by patients and clients from both within and beyond the state.

According to the 2008 medical records report, the number of patients attending UNTH for special and general care has increased since the hospital’s transfer in 2007 to its permanent site, which is roughly 21 kilometers from Enugu city. Prior to 2007, UNTH’s yearly patient coverage was 90,000. In the years following the transfer to Ituku/Ozalla, from 2008 to 2010, the health center saw a cumulative increase of 200,000 cases. The growth in patient traffic over time has necessarily increased the hospital’s overall workload.

The progressive conversion of Park-lane general hospital in Enugu to a speciality hospital in 2006, and then to a teaching hospital, has resulted in an inflow of patients at ESUT.

Prior to 2006, ESUT medical records showed that the health institution served 50,000 patients per year. According to the medical record report from 2009, special clinics and units saw an average of 75,000 patients per year.

From 2007 to 2009, UNTH employed 200 nurses and 150 doctors, according to the administrative personnel record [2011]. From 2007 to 2010, 104 nurses and 109 doctors were employed by ESUTH, according to the administrative personnel record [2011] report. However, these personnel numbers are insufficient to meet the needs.