Project Materials

STAFF MIX AND PATIENT OUTCOME IN STATE AND FEDERAL TEACHING HOSPITALS

CHAPTER ONE

INTRODUCTION

Background of the Study 

With a growing population and fewer or no resources, health systems in both developed and developing nations are under pressure to provide better services [Namgada 2008].

This is brought on by a greater number of illnesses, a demand for the highest calibre of care, enhanced access to a variety of health services, understanding of one’s rights, and advanced medical technology.

The following are necessary for health care systems to provide health services to patients/clients: adequate qualified health workers, proper equipment, financial resources, and effective health policies [Olade, 2005].

Providing high-quality care is the main objective of all health systems; nonetheless, some variables appear to impede efforts to reach this objective as much as possible.

The quality and results of care have been found to be impacted by the worldwide scarcity of health professionals and the standard of healthcare providers, for instance (Olade, 2005).

A 2009 report by the World Health Organisation reveals that in many developed nations, there are between 1000 and 100,000 employees per 100,000 people. It is between 100 and 100,000 in poor nations.

As of December 2010, Nigeria has 128,918 registered nurses and 52,408 doctors on the medical register, according to a survey on the country’s health workforce [Labran, Mafe, Onajole & Lambo, 2011].

Nigeria has a population of approximately 160 million, according to the World Health Organisation (2009). Based on the facts above, the projected ratio of health professionals to the population is doctors: 1:3052 and nurses: 1:1241.

According to Ozcan and Horby (2004), there hasn’t been enough qualified health workers in Africa, as well as in many other parts of the world, thus it’s important to make good use of the few resources.

There is a severe lack of medical staff in the majority of Nigerian hospitals today, according to Okoronkwo (2005); the staff that is there is unable to effectively attend to the patients’ requirements due to an overwhelming workload.

This suggests that even while the need for healthcare is growing, hospitals are unable to supply enough staff to deal with the demand. Thus, the quality of care declines and the workload for current employees rises.

Aside from the lack of medical professionals, most health systems in developing nations also struggle with the proper staffing mix in the provision of healthcare services (McGillis, 2005).

In healthcare facilities, the term “staff mix” describes the combination of several types of health workers [from the same or distinct professional disciplines] who are employed to provide patient care.

The overall quality of care in healthcare facilities is influenced by the mix of staff members [McGillis, 2005]. In terms of human resource management, the standard procedure is to assign the appropriate number of health personnel, who possess the necessary knowledge, abilities, and disposition, to carry out the appropriate tasks in the appropriate location at the appropriate time in order to meet the established health goals [Mark and Staton, 2003: International Council of Nurses (ICN), 2006].

The staff-to-patient ratio is the determinant of the care process in a particular unit or facility. This staff mix ratio may be expressed as the ratio of available personnel to patient population, years of professional experience, professional qualifications, number of years of service in a unit, or cadre of staff (junior/senior).

The typical staff-to-patient ratio, contingent on unit size, is 1:4-6 patients (Needleman, 2005). The ratio is 1:2–3 in more critical care units.

For various staff cadres and depending on the unit and kind of patient managed, the Nursing and Midwifery Council of Nigeria (N&MCN, 2005) states that the staff/patient ratio in clinical practice should be 1:4-5 for general wards and 1:1-3 for intensive care units.

Patients are given the best care and are released at the appropriate time when a unit has the appropriate amount of staff members (Cheryl and Clark, 2007). Higher staff-to-patient ratios, according to Aiken [2007], guarantee that patients receive the proper direct care.

In-depth evaluation and continuous monitoring of clinical changes are also capabilities of the staff. Employees have more time to track alterations in patients’ conditions and provide prompt assistance for issues that are found. All of these are anticipated to have an effect on the care result.

Quan [2006] asserts that a patient’s outcome is an observable change brought about by their exposure to therapies or the care environment. It is the outcome of an illness, a medication, a therapy, or an incident.

In medical and surgical instances, the results include a change in the patient’s functional status, either positively or negatively, throughout the hospital stay, as well as the occurrence of unpleasant events such as infection, pressure ulcers, urinary tract infections, and medical errors.

Research has indicated that the mix of staff and the quality of care are related. According to Strasser (2005), positive outcomes are linked to well-trained staff, staff training and experience, higher levels of therapy, more intense care, overall staffing levels, teamwork, and team order and organisation.

Conversely, adverse outcomes are linked to inadequate hiring and retention, absenteeism or delayed care, inadequate facilities and supplies, inadequate administrative management, the severity of the illness (acute or chronic), and co-morbidity variables (Anderson, Weiner & Khatusky, 2006).

Both Bolton (2001) and Needleman (2005) noted that the staff-to-patient ratio and care outcome are significantly correlated. They emphasised that when the right number of staff members are assigned to patients, the likelihood of adverse events such as the development of pneumonia, pressure ulcers, failure to rescue, deep vein thrombosis, death, urinary tract infections, and shock is decreased.

Others include shorter hospital stays, medical mistakes, healthcare expenses, and infection or disintegration of surgical wounds. According to Suzanne and Smeltzer [2010], patients’ overall health, the risks associated with a particular surgery, concurrent conditions like diabetes mellitus that may impact wound healing, chronic smoking, unnecessary invasive procedures, post-operative pain management, nutritional status, immune status, and other factors may also have an impact on the patient’s outcome of care.

These investigations were mostly carried out in industrialised nations. Data on staff mix and patient outcomes is scarce, both in Nigeria and throughout Africa. This study looked at patient outcomes and staff composition in Enugu State’s state and federal teaching hospitals.

Statement Of The Problem

The two teaching hospitals in Enugu State are the University of Nigeria Teaching Hospital Ituku/Ozalla (UNTH) and Enugu State University Teaching Hospital, Parklane Enugu (ESUTH).

They offer health services, training, and research. Patients and consumers from both inside and outside the state use these medical facilities.

According to the 2008 medical records report, the number of patients arriving at the hospitals for general and special care has increased since UNTH moved to its permanent location in 2007, which is roughly 21 kilometres from Enugu city. Prior to 2007, UNTH had 90,000 patients annually.

Following the move to Ituku/Ozalla in 2008–2010, the number of cases at the medical institution increased by 200,000. The entire burden at the hospital inevitably increased as patient patronage increased over time.

Patients have also flocked to ESUT as a result of Park-lane General Hospital Enugu’s gradual transformation into a specialist hospital in 2006 and then into a teaching hospital.

Prior to 2006, the ESUT medical records indicated that 50,000 patients visited the clinic each year. According to the 2009 medical record report, there were 75,000 patients on average each year in special clinics and units.

Between 2007 and 2009, 200 nurses and 150 doctors were employed at UNTH, according to the Administrative Personnel Record [2011] report.

Between 2007 and 2010, 104 nurses and 109 doctors were employed, according to the ESUTH administrative personnel record [2011] report. Nevertheless, these staffing levels are insufficient to satisfy.