Development of a staffing norm framework for dietitians at South African central and tertiary public hospitals

Abstract

Background: The global human resources for health strategy indicates the necessity to prioritise human resources to improve health care and overall health outcomes. South Africa`s (SA) double burden of malnutrition, the core of the quadruple burden of diseases stresses the need for nutrition action. The absence of a national workforce planning tool to address nutrition workforce challenges impacts on the implementation of nutrition interventions and the aligned outcomes. The registered dietetic professional plays a significant role in the provision of appropriate and quality nutrition services. Hence, the need for an investment in an evidence-based workforce planning tool to determine the staffing needs of the cadre. Aims and Objectives: This study aimed to develop a staffing norm framework to determine the needs of dietitians at South African central and tertiary public hospitals using the Workload Indicators of Staffing Need (WISN). Design and Methods: A three phased developmental study based on the World Health Organisation Workload indicators for staffing (WISN) was conducted. In Phase 1 (preparatory phase) the distribution of permanently employed dietitians at South African public hospitals was mapped. The job descriptions of dietitians at central and tertiary public hospitals were analysed to inform a baseline of current dietetic practices for phase two of the study. In phase 2 (consensus phase) an online Delphi exercise was conducted to determine a standardised list of workload components and activity standards as per the WISN methodology. In phase 3 (finalisation phase) the eight step WISN methodology was applied to: 1) To conduct a case study at 21 central and tertiary public hospitals to determine the staffing needs of dietitians. 2) To develop a staffing norm framework and implementation tool for dietitians at the same level of care. Results: Findings from the preparatory phase indicated a total of 844 permanently employed dietitians and 189 available dietetic vacancies at SA`s public hospitals. This first phase also provided a baseline of the work activities of dietitians for the Delphi consensus phase. The online Delphi resulted in a 92% agreement rating on all proposed and newly added workload components. A total of 45 workload components together with aligned activity standards was finalised. The application of WISN in the finalisation phase indicated extreme understaffing with high work pressures at the 21 hospitals. The lack of support staff and managerial posts compounded staffing needs often resulting in unnecessary overtime. WHO recommends the use of WISN as part of periodic reviews to allow for long-term forecasting of staffing needs. Hence, this last phase developed a context and cadre specific staffing norm framework. In addition, a South African WISN based excel tool was also developed to support implementation of the framework, allowing for automation and user-friendliness. The validation of the tool against the WHO WISN supported its use in the South African central and tertiary hospital setting. Conclusion and Recommendations: WISN appears to be a beneficial tool in determining the needs of the cadre. The versatility of WISN has resulted in the development of a context specific tool to assist policy makers in prioritising the needs, future planning and forecasting of dietitians at South African central and tertiary public hospitals. It is recommended that similar tools be researched to prioritise the needs of dietitians at regional, district and specialised hospitals. Keywords: Delphi, Dietitian, Framework, Human resources, Hospital, South Africa, Staffing, Staffing Needs, Tools, WISN