Impact of Workload of Anatomical Pathologists on Quality and Safety (2011)
Description
This study sought to identify ways in which workload impacts on professional pathology practice through three components designed to provide a workforce perspective, maximise the utilisation of Medicare data and provide a perspective of the individual pathologists. These were:
identification of the relative time values of pathologists’ work via the Medicare Schedule
a survey of the total workload of individual pathologists over a year using Medicare billing and relative time values
a diary that identified the time spent on individual items by participating pathologists over a given week including a survey (the Diary Survey) of the impact of existing workload on quality and safety of pathology work, including the impact on the health of pathologists.
There are also no current benchmarks for staffing and workload for pathology.
Grant Recipient
Royal College of Pathologists of Australasia (RCPA)
Aims and Objectives
to develop a better understanding of how the quality and safety of pathology service were being influenced from the perspective of Anatomical Pathologists
to address the impact of workforce shortages in the quality and safety of pathology services in Australia, and the impact on pathologists.
These aims and objectives were achieved by this project. Outcomes
Pathologists (65 out of the 96 surveyed) identified the following areas that could be changed to improve the quality and safety of pathology:
more pathologists
less workload/safe workload limits, better balanced workload
better information technology (IT) infrastructure/support
more time for professional development activities/reading
better reimbursement/improved remuneration per specimen/improved remuneration by Medicare
more scientific/technical staff
more secretarial support/clerical-admin staff
more trainees.
A workshop of senior experienced pathologists was convened to provide expert opinion into the Relative Time Units (RTUs) for items on the Medicare Benefits Schedule (MBS). The actual time reported in the diaries was less than the estimate of best practice identified in the expert workshop, however, these may be a due to reasons such as testing tasks such as cut, quality assurance and case conference being measured separately in the diary.
Following this workshop, a survey of pathologists’ annual work volume was undertaken which found a wide distribution of clinical workload ranging from less than 200 RTUs to over 3000 RTUs with an average of 1,439 RTUs.
Findings
Pathologists are unable to fully undertake quality assurance activities due to excessive workloads which represents a potentially serious public health concern.
The pathologists’ surveyed reported that an increase in workforce numbers is required to sustain existing workloads and address the issues of quality and safety.
While the RCPA has been successful in increasing the number of training places for pathologists in Australia, there appears to be a disconnect with recruitment at specialist level for graduating pathologists which means the increased numbers have not translated into an improvement of specialist workloads.
Full-time pathologists worked an average working week of 48 hours, while those who worked less than full-time reported a working week of 34.7 hours.
43% of pathologists who kept a diary for a week reported workings days of 10 hours or more.
The actual hours recorded in the Diary were substantially higher than the reported usual hours worked in a week which suggests that pathologists may underestimate the hours they work.
55% of pathologists reported they were working more now than they had been two years ago.
24% of pathologists considered they were working above their capacity, and a substantial proportion stated they were only able to sustain their workload for a limited period of time (23% for a year, 38% for no more than 2 years).
71% of those working above their full capacity indicated there had been times they were too busy to quality assure their work, 73% reported their workload compromised quality and 45% reported there had been times when patient care was compromised. A further 51% working at capacity reported their workload impacted on their ability to undertake quality assurance (QA) activities.
41% of the pathologists in regional centres reported situations where patient care had been compromised compared to 17% of the pathologists in capital cities.
Adverse quality and safety impacts increased sharply when pathologists worked more than 39 hours a week.
68% of pathologists indicated their workload had impacted on their health and wellbeing, while 91% of those working above their full capacity reported it was affecting their health and wellbeing. The four main areas mentioned were increased stress, feeling constantly tired, decreased physical fitness and impact on personal relationships outside work.
33% of pathologists in regional centres reported increased turnaround times, while 17% of pathologists in the metropolitan areas reported increased turnaround times.
8% of the actual working week of pathologists is allocated to QA activities.
The critical point at which quality and safety issues appear to be most at risk is after the 39 hours per week mark.
There is a strong relationship between capacity and the number of areas in which adverse quality and safety impacts associated with workload were identified.
The relationship between high workload and compromises in quality and safety is a systematic issue and not related to public or private laboratories, location or pathologists.
Recommendations
There is a strong imperative to establish safe working guidelines to address the current deficiency for anatomical pathologists in Australia.
The solution to addressing the quality and safety issues lies in addressing the workforce shortage.
Increasing the number of qualified pathologists will not significantly reduce the workloads of practicing pathologists unless the number of specialist positions is increased. These could be filled by the increase in trainees graduating, or by practicing pathologists moving from a part-time to a full-time arrangement. The RCPA will need to collaborate with Australian, State and Territory governments and the heads of private laboratories.
Ongoing monitoring of the workload is required. One method is for individual laboratories to use the tools developed in the course of this project to refine RTU estimates.
Ensuring good occupational health and safety practices within laboratories is a sound strategy for assisting in minimising the impact of workload.
Follow on Initiatives and Projects
To be taken up by the Workforce Advisory Committee and this issue was also specifically identified as an initiative in the Pathology Funding Agreement.
