A comparison of four approaches for measuring clinician time use
Bratt,John H.; Foreit,James R.; Chen,Pai-lien; West,Caroline; Janowitz,Barbara; de Vargas,Teresa
Health Policy and Planning 14(4): 374-381
Publication date: 1999
Concern about rapid growth in demand for reproductive healthservices in developing countries has created interest in productivityand costs of existing programmes. Staff costs usually constitutethe largest share of total service costs, meriting special effortto ensure that they are measured accurately. Several techniqueshave been used in the literature to analyze staff activity,but these techniques have not been validated. This paper reportson a study conducted in three Ecuadoran clinics. The study usesan observational time-motion (TM) technique as a benchmark,and compares results from three other techniques to those obtainedusing TM. None of the alternative techniques produces estimatesthat agreed with TM estimates; deviations from TM are particularlylarge for non-contact time, defined as clinician activitiescarried out when clients are not present. Implications of thesefindings for productivity and cost studies are discussed, andpossible avenues for future research are proposed.