Patient-flow and waiting times in general medical and dental clinics in Jamaica's primary health care services

Jamaica has implemented primary health care services closely in accordance with the philosophy of the Declaration of Alma Ata. However, resources are scarce and need to be well managed. Ideal patient-flow in health centres (HCs) would achieve both high efficiency in use of staff time and minimum waiting times for patients. This study of 465 patients in 44 general medical clinics served by 34 doctors and 25 nurse practitioners, and 167 patients served by dentists in each of 15 clinics, showed that mean contact time of patients with doctors was 7 minutes, with nurse practitioners 11 minutes, and dentists 4 minutes. Medical patients waited an average of 3 hours 53 minutes, whilst dental patients waited an average of 2 hours 23 minutes. Doctors', nurse practitioners' and dentists' median times for starting to see patients were 10.00a.m., 9.35a.m. and 9.48 a.m. respectively. They were able to work without experiencing any delays in patient-flow since many patients were waiting at the HC by 8a.m., and preliminary processing was short. It is suggested that if they started seeing patients earlier, patients' waiting times would be shorter. The shortage of pharmacist to dispense drugs after medical consultations added to patients' waiting time. The results were a natural outcome of the low supply of personnel and high demand for services situation being experienced in the medical and dental sevices (AU)

A survey of patients with alcohol related problems in Carlton House, St. George's Grenada

Two years after the opening in Grenada of the Carlton House Alcoholism Treatment Centre, a review was conducted of the 45 persons admitted over a six-month period beginning February 1987, and a three month treatment outcome review was done. The review of admissions, using the CAGE questionnaire, shows findings similar to those in other hospital and field surveys in the Eastern Caribbean in terms of sex ratio (8 to 1), age of admission and age of first drink, social class distribution, choice of drink (rum) and a distribution of religious affiliation which reflects that of the population at large. Other characteristics of the Grenada study were that 25 of the 45 patients had first degree relatives who were alcoholic; half of the referrals were from a medical source, mainly the psychiatrist; although 1 in 12 general hospital admissions were diagnosed as suffering from alcoholism, only one fifth of these were referred to the Centre by physicians. One third of the patients had lost employment as a result of drinking. Treatment outcome was not improved by contact with Alcoholics Anonymous, but there was a better recovery rate among skilled than unskilled persons as judged by the number of relapses. Recommendations for improved staffing are made, as well as a plea for greater awareness of alcoholism on the part of physicians and surgeons (AU)

Proportion of time used productively by staff in Jamaica's primary health care service

The primary health care system in Jamaica offers extensive preventive and curative services to the public through a system of health centres, ranging from small centres with basic services to large centres with more sophiscated services. At a time of severe constraints in terms of financial and human resources, it is important to have a management system which will make the best use of these resources. The present survey was undertaken as part of management exercise initiated by the Minsitry of Health, Jamaica. The aim of the study was to describe what proportion of the working day was spent productively by various categories of personnel. A sample of 96 health centres was taken from 375 providing services in Jamaica. At each health centre selected, 1 of each type of staff category was randomly chosen and observed during 1 day, and 504 days' observations were so made. The work being done by the staff member was recorded and was classified as `productive', `other essential' or `unproductive'. It was found that productive time ranged from over 60 percent to under 40 percent, according to category of worker. It varied very little between large and small health centres. The results indicate that there is much scope for improvement of time and staff management in primary health care services. At present, based on findings reported here and on a model developed in a collaborative project, a new system of scheduling of clinics and of staff allocation to these clinics is being planned in two districts in Western Jamaica (AU)

Productivity analysis of health facility staffing patterns in Jamaica

Jamaica's public primary health care services are delivered by a system of health centers of varying levels of sophistication and through clinics of various kinds. The clinics are held according to a regular schedule, but the composition of the staff teams for conducting clinics varies considerably. To ensure best utilization of staff, a productivity study was sought by the Ministry of Health. The first part of the study described the current situation. Two indices of productivity were developed, using data collected by observation in a sample of health centers. The indices showed that there was much scope for improvement in productivity. In light of these findings and after discussion with senior health personnel, strategies for improvement in productivity were formulated. A model was constructed for clinic scheduling and deployment of staff, based on projection demand, clinic hours required, and necessary staff input. The strategy is to be tested and evaluated on a pilot scale. (AU)

Productivity improvement strategies using manpower planning models

This document describes the results of the study presented to senior personnel of Ministry of Health. The presentations were made jointly by UWI, Mona, who presented the findings in respect of personnel, time distribution, and by Price Waterhouse Associates, who presented findings in respect of productivity analysis. The weaknesses in the primary care sector that contributed to the low levels of productivity are also included

Proportion of time used productively by staff in Jamaica's primary health-care services - abstract

The primary health-care system in Jamaica offers extensive preventive and curative services to the public through a system of health centres, ranging from small centres with basic services to large centres with more sophiticated services. At a time of severe constraints in terms of financial and human resources, it is important to have a management system which will make the best use of these resources. The present survey was undertaken as part of a management exercise initiated by the Ministry of Health, Jamaica. The aim of the study was to describe what proportion of their working day was spent productively by various categories of personnel. A random sample of 96 was taken from approximately 400 health centres in Jamaica. At each health centre selected, 1 of each type of staff category was randomly chosen and observed during 1 day. About 500 days' observations were so made. The most being done by the staff member was recorded and classified as 'productive', 'other essential' or 'unproductive'. It was found that productive time ranged from over 60 percent to under 40 percent according to category of worker. It varied very little between large and small health centres. It has been proposed that 25 percent unproductive time would be suitable norm. The results therefore indicate that there is much scope for improvement of time and staff management in the primary in the primary health care services. At present, based on findings report here and on a model developed in a collaborative project, a new system of scheduling of clinics and of staff allocation to these clinics is being tried in two districts in Western Jamaica, the results of which will be available soon (AU)