Reserve space in your toolbox for low-tech work measurement.(Work Measurement: A Series of 3 Articles)(Cover Story)

Sophisticated work measurement tools available to today's IEs are a far cry from the simple watches and recording sheets that were the norm just a generation ago. The IE today can choose from an array of electronic tools--digital timers that emit signals for an observation at random intervals, bar code readers that record events in a service process, or electronic sensors that record the movement of a work piece in a manufacturing environment. But there's another option that may be exactly the right approach to a difficult problem. It's an approach tailored to IEs who work as independent consultants in a variety of settings. It also works well in a small department with a limited budget for electronic gadgetry. These were the circumstances when the IE services department at Kaiser Permanente completed a large-scale work measurement project in a distant city.

With more than 6.6 million members in eleven regions throughout the United States, Kaiser Permanente is the nation's largest health maintenance organization. While each region generally operates autonomously, there are interdependencies among the regions for some business services. For example, the Colorado Region office, located in Denver, provides most of the administrative functions and operations support services for medical office activities in Kansas City, Mo. This helps the company reduce costs without compromising the quality of medical care. IE services--called management engineering at Kaiser Permanente and in most healthcare settings--is one of the business services provided to Kansas City by the Colorado Region.

Management engineers perform study

Recently, my management engineering department was asked to measure work activities of the nursing staffs in all six medical offices in Kansas City. Its preliminary purpose was to determine how nursing staffs were being employed. Using this information, we could examine potential best practices within the system and establish a baseline for implementation of service enhancements and cost reductions.

Since Kaiser Permanente's Kansas City offices are small--staffing varies from three to nine full-time equivalents (FTEs), we attempted to sample 100 percent of the nursing staff--38 nurses in six locations. We decided to sample all of the nurses over the same three-week period. Because each nurse worked a forty-hour week, we would collect sample data for 570 staff days. As a result of travel and support costs, collecting a sample using traditional methods of random observation by an engineer would be expensive. Equipping even a portion of the nursing staff with electronic sampling devices would also be cost prohibitive.

Minimizing costs

To minimize study costs and still provide an accurate and responsive measurement, we developed a unique, but highly successful, study method. First, we conducted an on-site visit to all six medical offices with one engineer, who observed the general operations, interviewed the nursing staff, and developed a detailed list of the various tasks performed by nurses. The engineer then divided these tasks into ten principal categories of work. Weights assigned to the categories were based upon times recorded during the period of on-site observation of the various offices. Finally, each category was further subdivided into component tasks. Then medical office administrators approved this final organized task list. We asked the nursing staff to note on data sheets each time they changed from one category of work to another. This would allow us to capture a frequency distribution for the several categories. After weighing the categories, we would be able to record their different time requirements and accurately describe daily activities performed by the nurses. Figure 1 represents a data ...