STAFF MIX AND PATIENT OUTCOME IN STATE AND FEDERAL TEACHING HOSPITALS

STAFF MIX AND PATIENT OUTCOME IN STATE AND FEDERAL TEACHING HOSPITALS

CHAPTER ONE

INTRODUCTION

Background of the Study 

With populations growing at an alarming rate and healthcare budgets shrinking, health systems worldwide are feeling the heat to do more with less [Namgada 2008].

This is because there is a rise in the prevalence of diseases, a rise in the demand for high-quality medical treatment, a rise in the understanding of patients’ rights to health care, and an expansion of the range of health services available.

To provide health services to patients and clients, health care systems require effective health policies, enough qualified health workers, suitable equipment, and funding [Olade, 2005].

Although providing high-quality care is the fundamental objective of any health system, there are a number of obstacles that seem to limit how far we can move in this direction.

The quality and outcome of care may be impacted by factors such as the worldwide lack of health professionals and the calibre of health providers (Olade, 2005).

A study by the World Health Organisation in 2009 found that in many wealthy nations, the staff-to-population ratio ranges from 1,000 to 100,000. Centuries to one hundred thousand in underdeveloped nations. As of December 2010, there were 52,408 doctors and 128,918 registered nurses on the medical register in Nigeria, according to a survey on the country’s health workforce [Labran, Mafe, Onajole & Lambo, 2011].

The World Health Organisation estimates that there are 160 million people living in Nigeria in 2009. With this number in mind, we should predict a doctor-to-population ratio of 1:3052 and a nurse-to-population ratio of 1:1441.

According to Ozcan and Horby [2004], there is a pressing need to make the most efficient use of limited resources due to the shortage of qualified health care workers in Africa and other regions worldwide.

Okoronkwo (2005) states that there is a severe lack of medical professionals in Nigerian hospitals at the present time, and that the staff that is there is overworked and unable to adequately attend to patients’ requirements.

This suggests that hospitals are struggling to meet the growing demand for healthcare services due to a lack of available personnel. As a result, the quality of care declines and the workload for current staff members rises.

Most health systems in many developing nations have two major problems: a lack of medical professionals and an inadequate combination of medical and support personnel to offer quality health care (McGillis, 2005).

In healthcare facilities, staff mix refers to the combination of different categories of health personnel/workers engaged to provide patients with healthcare, whether they are from the same professional discipline or from distinct ones. Staff composition has an effect on patient outcomes in healthcare facilities [McGillis, 2005].

Typically, in human resource management, the goal is to ensure that there is an adequate number of qualified health personnel who possess the necessary knowledge, skills, and attitude to carry out their duties in an efficient and timely manner in order to meet the established health objectives [Mark and Staton, 2003: International Council of Nurses (ICN), 2006].

The care procedure in every particular unit or facility is dependent on the staff-to-patient ratio. There are a variety of ways to define staff mix ratios, including the ratio of available staff to patient population, staff years of experience, staff professional qualifications, staff number of years employed in a unit, and cadre of staff [junior/senior].

Depending on the unit size, the normal staff-to-patient ratio ranges from one to four to six patients, according to Needleman (2005). The ratio is 1:2-3 in higher-level ICUs.

The Nursing and Midwifery Council of Nigeria (N&MCN, 2005) states that, in clinical practice, the staff-to-patient ratio should be 1:4-5 for general wards and 1:1-3 for critical care units, with the exact ratio varying by cadre of staff and unit.

Ensuring that a unit has an adequate number of staff members allows for timely and appropriate patient discharge (Cheryl and Clark, 2007). According to Aiken [2007], providing patients with the right kind of direct care depends on having a larger staff-to-patient ratio.

Ongoing monitoring of clinical changes and comprehensive evaluation are also within the staff’s capabilities. With more time on their hands, staff can better track patients’ vitals and respond quickly to any changes. Care outcomes are likely to be affected by all of these.

An observable change that occurs as a result of a patient’s exposure to therapies or their care environment is referred to as a patient’s outcome (Quan, 2006). A illness, an event, a medication, or a treatment all contribute to its development.

Changes in the patient’s functional state during hospitalisation, the occurrence of adverse events such as infection, pressure ulcer, UTI, etc., and positive or negative changes in the patient’s functional status are all examples of medical and surgical case outcomes.

A correlation between personnel mix and care outcome has been demonstrated by research. Staff experience and training, higher levels of care intensity, more therapy, adequate general staffing, and teamwork, order, and organisation are all factors that contribute to excellent outcomes, according to Strasser (2005).

In contrast, factors that contribute to unfavourable results include ineffective hiring and staff turnover, long wait times for treatment or workers’ absences, inadequate infrastructure, incompetent administrative leadership, and factors related to the severity of the patient’s condition (chronic or acute) and any co-morbidities (Anderson, Weiner & Khatusky, 2006).

A correlation between staff-to-patient ratio and clinical outcomes has been noted by Bolton (2001) and Needleman (2005). They emphasised that when staffing levels are appropriately distributed among patients, adverse outcomes such as pressure ulcers, pneumonia, death, shock, deep vein thrombosis, failure to rescue, and infections of the urinary tract and urethra are minimised.

Surgical wound breakdown or infection, medical mistakes, hospital expenses, and shorter hospital stays are a few more. In addition to the factors already mentioned, Suzanne and Smeltzer [2010] added that the patient’s overall health, any co-existing conditions (such as diabetes mellitus), the patient’s nutrition, the patient’s immune system

the patient’s postoperative pain management, any unnecessary invasive procedures, and the patient’s smoking habits could all influence the care outcome.

The majority of these investigations took place in industrialised nations. In Nigeria and across Africa, there is a dearth of information regarding the relationship between staff mix and patient outcome. Enugu State’s public and private teaching hospitals were the subjects of this analysis of staff composition and patient outcomes.

Statement Of The Problem

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

Their offerings include health care, research, and training. These medical centres serve patients and clients both inside and outside of the state.

An rise in the number of patients seeking both general and specialised care has been documented in medical records from UNTH after its 2007 move to its permanent site, some 21 km from Enugu metropolis.

As of 2007, UNTH’s yearly patient coverage was 90,000. From 2008 to 2010, following the move to Ituku/Ozalla, the number of cases at the health institution increased by 200,000. The entire workload in the hospital was bound to expand due to the increase in patient patronage over the years.

Patients have been flooding into ESUT’s Park-lane General Hospital in Enugu since its progressive upgrade to a specialist hospital in 2006 and, later, a teaching hospital.

The yearly patient volume at ESUT was 50,000 according to medical records from before 2006. An average of 75,000 patients visited speciality clinics and units per year in 2009, according to the medical record data.

Between 2007 and 2009, 200 nurses and 150 doctors were employed by UNTH, according to the administrative personnel record report from 2011.

A total of 109 physicians and 104 nurses were employed by ESUTH between 2007 and 2010, according to the administrative personnel record report from 2011. Unfortunately, the staffing levels do not fulfil the requirements.