Workload Indicators of Staffing Need method in determining Anesthesia and Surgical Technologist Staff in Operating Room

4 Background: Human resources in health are limited, and a variety of healthcare services are 5 increasing, especially in developing countries. This study aimed to determine the anesthesia and 6 surgical technologist staff for operating room based on the Workload Indicators of Staffing Need 7 (WISN). 8 Methods: This cross-sectional descriptive study was conducted at Shahid Madani Medical and 9 Training Hospital in 2019. The data collected through interview and hospital documents 10 observation. The WISN method was used to analyze and determine staffing need. 11 Results: The WISN ratio for anesthesia and surgical technologist staff were 1.60 and 4.94, 12 respectively. In other words, in both categories, this ratio is >1.00. 13 Conclusions: WISN results can used to assess staffing capacity and capability over the previous 14 year and the policy and financial implications due to staff shortages or surplus. As the workload 15 of staff is an important issue and the staff have a right to have a standard workload in their 16 position, then determining this workload is an essential issue in healthcare organization. Also, 17 WISN method work as a human resource management tools, it improvers health managers to 18 make right decision about staffing needs and then better manage of organization’s resources. 19

the department (14). The purpose of study of Noprianty et al (2020) was to determine the analysis 77 of the needs of nurses based on the WISN method. The results showed that the need for nurses is 78 28 people, while which are available is 24 nurses, with the WISN Ratio result, it is found that 0.8 79 is less than 1. The results of this study can be taken into consideration in reducing the number of physicians and nurses is more than actual need (16). 88 For a variety of reasons, including a lack of funding for employment, a lack of employment 89 licenses in some occupations, and a lack of proper use of hospital bed capacity, these hospitals 90 often do not comply with the Ministry of Health's human resource standards(3).The application 91 of appropriate, scientific and logical methods in estimating the required human resources not 92 only leads to productivity and employee satisfaction, but also maintains the quality of services 93 provided(5). The WISN approach allowed us by measuring the demand and supply improve 94 many types of decisions regarding health workforce planning and management(10). WISN 95 method can aid the policy-makers in optimizing utilization of existing human resources. Given 96 the importance of human resource planning, the purpose of this paper was to use the WISN 97 method to calculate the number of anesthesia and surgical technologist staff.

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We conducted a cross-sectional descriptive study in the operating room of the Shahid Madani 101 Medical and Training Hospital. This study was conducted using the WISN methodology that was 102 recommended in 1998 by the WHO. This method calculates actual and (required) number of 103 personnel with the workload of a given health facility and shows the level of staff shortage or 104 surplus. Population in this study was the entire anesthesia cadre. Data were collected through 105 structured interviews and by reviewing annual service statistics from each hospital's records.

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The structured interviews included available staff time, workload components (i.e. Health 107 Service Activities, Support and Additional Activities) and staff time spent on each activity (i.e.

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Activity Standards).Based on the WISN user's manual the method steps are described as follows:  Step 2: Determining working components: 123 Workload components include health services, support and additional activities, i.e. work 124 activities that take up most of a health worker's daily working time.

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Step 3: Activity Standards 127 An activity standard (AS) is the time necessary for a well-trained, skilled and motivated worker 128 to perform an activity to professional standards in a given circumstance. There are two types of 129 activity standard: service standard and allowance standard. Service standard is main activities of 130 personnel during their service provision that performed by all members of the staff category.

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Allowance standards are the activity standards for support and additional activities. Step 5: Allowance factors 141 142 Allowance standards are in 2 types: Individual allowance standards (IAS): Support or additional activities performed by certain 146 members of the staff cadre activities.

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Allowance factors are two types of factors as category and individual allowance factors.

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The category allowance factor (CAF) is a multiplier that is used to calculate the total number of 149 health workers, required for support and health service activities. Step 6 Step 7: Analysis and interpretation of results 160 The seventh step is the analysis and interpretation of the above results. The results analyzed using two ways, the difference and the ratio. auxiliary staff to support operating rooms is sufficient for each operating room.

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The calculated number for surgical technologist staff (3.64) is for the total of 6 operating rooms.

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There are 3 surgical technologists in each operating room that indicates approximately 4 staff 229 members are required to cover 6 operating rooms. Therefore, in ideal conditions, one surgical 230 technologist for each operating room (n=6) to support operating rooms is sufficient.

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According to our results, if the WISN ratio for both categories of staff is >1.00, the staff is more 232 than sufficient to cope with the workload (Tables 7 and 8). The results of this study cannot be generalized because the varying quality and quantity of 242 service delivery. Some service statistics data, which were essential for establishing standard 243 workloads, were not readily available due to research in the operating room that requires special 244 conditions. Thus, the accuracy of this study's results is directly depends on the accuracy of the 245 service statistics of each hospital. The present study showed that due to the volume of work in the operating room of the hospital workload pressure. In fact, sanctioned number of physicians and nurses is more than actual need.

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It is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This 283 reveals high demand for these health workforces in the respective sub-districts (16).
The WISN tool was used in assessing the staffing requirements of the frontline health workforce  Human resource management and planning is a big challenge, especially in developing countries.

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On the other hand, resources for the health sector are scarce and demand is increasing instead.

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The WISN method is a simple, easy to calculate the requirements of hospital ward staff. This 317 method is also useful to identify staffing inequities between facilities by comparing the 318 calculation results. Such an analysis can also help to assess distribution of staffing between 319 similar types of health facilities in order to estimate the size of the staffing deficit or surplus.