Assessing Staffing Needs in the Maintenance Department of a Tertiary Care Teaching Hospital Using Workload Analysis

 Introduction

With healthcare facilities facing increasing pressure to deliver high-quality patient care amidst limited resources, effective staffing in hospital maintenance departments has never been more critical. This study focused on the hospital maintenance department, exploring the complex relationship between workload, staffing levels, and employee fatigue. Using a combina- tion of workload analysis and case studies, this research provides actionable insights for healthcare managers and policymakers. By identifying optimal staffing levels and strategies to mitigate employee fatigue, this research  aimed to contribute to improved patient outcomes, reduced healthcare costs, and enhanced operational efficiency. Moreover, the study also examined the impact of staffing shortages on maintenance operations, patient safety, and employee well-being. Additionally, the research investigated the role of technology and automation in optimizing maintenance workflows and reducing employee workload. Effective staffing in hospital maintenance departments is crucial for ensuring smooth operation of healthcare facilities and main- taining high-quality patient care. However, determining optimal staffing levels can be challenging due to various factors such as workload fluctuations, skill mix, and budget constraints. Human resource management is a vital component of general management, encompassing a range of activities, including workforce planning, organization, implementation, and monitoring. Within this framework, employee planning plays a pivotal role in informing organizational strategy, closely following the establishment of position structures and job descriptions that define each role within the organiza- tional hierarchy.¹

Employee workload plays a crucial role in determining productivity and turnover. An imbalance in workload can have significant consequences. Underwork can lead to complacency, idleness, and engagement in unproductive activities, ultimately affecting performance. Conversely, excessive workload can overwhelm employees, leading to burnout, decreased job satis- faction, and an increased likelihood of turnover in search of less demanding roles.² Workload management is the adjustment of employee workloads to minimize the discrepancy between actual and potential workloads.³ Furthermore, effective staffing can also impact patient satisfaction, hospital reputation, and accreditation. Therefore, it is essential to develop evidence-based staffing models that consider the unique needs and challenges of hospital maintenance departments.

This study aimed to investigate the staffing needs in the maintenance department of a tertiary care teaching hospital. The research focused on analysing the current staffing pattern, workload, and employee fatigue in the maintenance department. The study employed a workload analysis approach to identify the optimal staffing levels required to meet the department's workload demands. The findings of this study provide valuable insights for healthcare managers and policymakers to make infor- med decisions about staffing and workload management in hospital maintenance departments.

Objectives

1. To assess the current staffing pattern and identify areas of improvement.

2. To calculate the standard working hours and actual working hours for determining the workload discrepancies.

3. To determine the actual staff requirements for the maintenance department based on the current workload and make recommendations for optimi- zation.

Materials and Methods

Study Design: This study employed a descriptive, cross sectional research design.

Tools and Techniques of Data Collection: Data was collected using direct interview methods, biometric attendance reports, and other relevant sources.

Data Collection Method: This study utilized a mixed methods approach, incorporating both quantitative and qualitative data collection and analysis methods.

Study Period: Data was collected over a seven-day period, from 03/06/2024 to 09/06/2024.

Inclusion Criteria: Staff members working in the hospital maintenance department were included in the study.

Results

This section deals with the analysis and interpretation of the data collected from the maintenance department. The results are presented in the following tables:

Table 1: Assessment of the current staffing patterns across different areas of the hospital

Table 2: Calculation of standard working hours and actual working hours

Table 3: Assessment of the actual staff requirements for the maintenance department based on the current workload

Table 1 shows the current distribution of staff across various operational areas of the maintenance department.

1. Area/Task: Specific tasks and responsibilities within the maintenance department.

2. Role/Responsibility: Description of the roles and responsibilities associated with each task.

3. Current Staff: Number of staff members currently assigned to each task.

 The maintenance department currently operates with 22 staff members distributed across various tasks. While the current staff allocation is efficient, the existing workforce is insufficient to meet the growing workload demands. The table highlights the current staffing pattern, with the largest number of staff members assigned to maintenance operations (4), and emergency response & night duty (4). The smallest number of staff members is assigned to preventive maintenance (1), and shift duties (2). The operational strain is particularly evident in areas like RO plant maintenance and night duty, which require increased workforce allocation for improved service delivery.

1. Mins/week: Minutes per week.

2. Desired Working Hours: Targeted work hours excluding breaks (7.5 hrs/day).

3. Actual Working Hours: Measured hours, including overtime (9.24 hrs/day).

4. Overtime (Daily): Extra hours worked daily beyond desired hours.  

5. Productive Time: Time spent on tasks, excluding break periods.

6. Break Time: Total weekly break time (tea and lunch).

Table 2 depicts the comparison between desired and actual working hours for maintenance employees. The desired working hours were 2,700 minutes per week per employee, equivalent to 56,700 minutes for 21 employees. This translates to 7.5 hours per day. However, the actual working hours for 21 employees were 69,875 minutes per week, equivalent to 3,327 minutes per employee or 9.24 hours per day. This indicates that the actual working hours are higher than the desired working hours. Additionally, the amount of overtime worked by full-time employees was approximately 1.7 to 2 hours per day. The total productive time, with breaks deducted, was 2,700 minutes per week. The total weekly break time was 540 minutes.

Table 3 outlines the current and required staffing levels for key operational areas in the maintenance department, as determined by workload analysis.

1. Area/Task: Specific tasks and responsibilities within the maintenance department.

2. Role/Responsibility: Description of roles and responsibilities associated with each task.

3. Current Staff: Number of staff members currently assigned to each task.

4. Required Staff: Number of staff members needed to fulfil workload requirements for each task.

5. Additional Staff: Number of additional staff members needed to meet the required staffing levels.

Table 3 shows that the current staffing of 22 employees is insufficient to manage the extensive workload in the maintenance department. The table outlines the current and required staffing levels for key opera- tional areas in the maintenance department. The required staffing levels are based on a workload analysis that takes into account the critical tasks and functions of each area. The results indicate that an additional 23 staff members are essential to ensure uninterrupted service, reduce employee burnout, and maintain operational efficiency. Prioritizing these roles, particularly for night shifts, emergency response, and RO plant maintenance, will help mitigate current challenges and improve overall performance.

Discussion

This study provides a comprehensive analysis of the staffing pattern and workload in the maintenance department of a hospital. The findings highlight a significant discrepancy between the desired and actual working hours, resulting in overtime work and potential employee burnout. Additionally, the staffing analysis reveals a shortage of staff to meet the workload demands, emphasizing the need for additional personnel.

The study findings indicate that the maintenance department's actual working hours (9.24 hours/day) exceed the desired working hours (7.5 hours/day), leading to overtime work (1.7-2 hours/day). This not only affects employee well-being but also impacts productivity and efficiency. Moreover, the staffing analysis revealed a significant shortage of staff, with 23 additional personnel needed to fulfil the workload demands.

This shortage can lead to delayed maintenance, equip- ment failures, and compromised patient care. Inadequate staffing can also result in decreased job satisfaction, increased stress, and burnout among existing employees. Furthermore, the excessive workload and overtime can lead to errors, accidents, and decreased productivity. The shortage of skilled maintenance personnel can also lead to increased training costs and reduced expertise.

Research indicates that an excessive workload can have far-reaching consequences for employees. When staff struggle to fulfil their assigned tasks, they often experience burnout, disengagement, and a decline in empathy towards patients. Furthermore, an unsustainable workload is a primary driver of job dissatisfaction among healthcare professionals and support staff, influencing their decisions to stay or leave their positions. Studies have also shown that individuals with heavier workloads tend to report more health issues compared to their counterparts with more manageable work- loads.⁴ According to Al-Momani, prolonged working hours and excessive workloads pose significant risks to the physical and mental wellbeing of healthcare professionals.⁵ The demanding nature of nursing and medical careers, which often involve irregular schedules, night shifts, and rotating shifts, has long been recognized as a major occupational health concern. Despite this, shift work remains an inherent aspect of these professions, underscoring the need for effective strategies to mitigate its adverse effects on healthcare workers. 

Barker LM observed that irregular schedules and shift work expose individuals to a multitude of health hazards, affecting their physical, mental, and social wellbeing. Research in occupational health has extensively documented the adverse consequences of shift work, revealing both immediate and long term effects that can lead to a range of work-related health issues.⁶ The overworking lifestyle causes a variety of mental problems, such as decreased work satisfaction, blue mind (a feeling of mental heaviness), stress, sadness, mood swings, anger, and anxiety. One additional issue related to extra employment is suicidal thoughts. Also, both male and female employees who worked 51 to 60 hours per week showed an increase in suicide thoughts. Workers' efficiency and production are diminished by prolonged and continuous work, a lack of breaks during the day, and working back-to-back days without a day off. Unusual work and sleep routines were the primary cause of major health problems.^7-9 Public hospital working conditions have sparked widespread concern among healthcare professionals globally. Despite their significance, a comprehensive literature review on this critical issue appears to be lacking from an international standpoint. This study aimed to provide an in-depth examination of the working conditions in public hospitals, a topic of growing concern worldwide. A comprehensive literature review was conducted, synthesizing research articles from prominent databases, including Google Scholar, PubMed, Science Direct, EBSCO, The Lancet, and MEDLINE. The review focused on peer-reviewed articles published in English between 2000 and 2014, utilizing search terms such as "working conditions," "occupational health," "public hospitals," and "healthcare personnel." The findings revealed that excessive workload, the HIV/AIDS epidemic, shift work, prolonged working hours, inadequate infrastructure, insufficient resources, and staffing shortages are the primary factors contributing to suboptimal working conditions in public hospitals.¹⁰ The literature emphasizes the importance of adequate staffing to ensure efficient operations and quality patient care.

This report's findings align with the literature, high- lighting the need for immediate attention to address the staffing shortage and prevent potential adverse outcomes. By adding the required staff, the maintenance department can ensure optimal functioning, reduce overtime work, and improve employee well-being, ultimately leading to enhanced patient care and satisfaction. Additionally, adequate staffing can lead to improved employee engagement, reduced turnover rates, and increased productivity. The findings of this study can assist healthcare administrators and policymakers in making informed decisions about staffing and workload management in hospital maintenance departments.

Recommendations

1. In areas with a greater shortage of staff, it is suggested that sufficient staff be appointed.

2. Outsourcing of maintenance services for hostels, outside locations and convention hall (only for related programs and minor maintenance work) should be considered in areas with a higher workload. Additional 11 staff members are required for the same.

3. The number of complaints increased upon reaching the hostels and outside locations. It is recommended to raise the right number of complaints online, ensuring that staff can plan their tasks efficiently and return to the department within a specified time.

4. To receive and attend emergency complaints during night and shift duty, two specific staff members are required.

5. For central supply (i.e., power house and oxygen) and RO plant, they need minimum of one employee each per day- one per shift as it requires 24 hours monitoring.

6. The nearest gates should be kept open for easy access to attend complaints.

7. Electrical materials should be supplied from the general stores within a day after indenting to ensure customer service is not affected. A specific staff member should be assigned from the general stores for maintenance related work to keep proper track of the materials.

8. Complaints from the ladies’ hostel should be attended only during the daytime, between 8.30 am and 5.30 pm, unless outsourced.

9. If any complaints are raised from the ward, the correct location details, including the room number should be provided in the system to prevent time wastage.

10. Farm workers can be utilized for assistance in tasks such as shifting the UPS, scaffolding work,  water pump installation, and digging for under- ground cables or pipes.

11. A transport facility should be provided for maintenance-related work at outside locations.

12. Wiring related complaints can be outsourced or complaints of telephone wiring can be handled by audio visual department.

13. Room keys for the hostel should be provided to the warden to prevent delays in attending complaints.

14. Cleaning of transformer room, generator room, manifold area, distribution panel can be given to farm workers or housekeeping staff.

15. During night time, all IT, biomedical, audio visual complaints are handled solely by maintenance department. One staff should be assigned from each area.

16. If the clerical staff of the maintenance department are on leave, a substitute staff member will replace them.

Conclusion

In conclusion, this report highlights the critical need for additional staff in the maintenance department to address the workload demands and prevent adverse outcomes. The findings and literature emphasize the importance of adequate staffing in ensuring efficient operations, quality patient care, and employee well being. Immediate action is necessary to address this shortage and ensure the maintenance department can function optimally. Poor employee morale can have a debilitating effect on productivity, as overwhelmed and stressed staff may struggle to deliver their best performance. To mitigate this, employers can consider implementing flexible work arrangements and granting employees greater autonomy over their workload and workflow, thereby fostering a more supportive and empowering work environment. Organizations need to adopt human resource strategies and policies to overcome the issues of work life balance of employees in the current business environment.

Conflict of Interest

The authors declare no conflict of interest.

Acknowledgement

None