Work Measurement & Measures of Work in the Publicly Funded Health Services of New Zealand
North, Nicola H., Management Services
Work measurement has, since the advent of scientific management, historically supported the management activities of planning and control. Techniques include time studies, motion studies, combinations of these such as predetermined motion-time studies, various kinds of estimates, work and activity sampling, and production studies (Dudley, 1968). These have the common objective of predicting the actual amount of time required to carry out a specified task, thus enabling managers to tighten control of human resources and thereby improve efficiency.
Work measurement has been a traditional management tool in manufacturing organisations. A survey carried out in 1990 indicated that work measurement techniques were being used by the majority of manufacturers in New Zealand (Slappendel, Vitalis and Walker, 1990). Further, such practices appeared to be increasing, with respondents anticipating that this trend would continue. Slappendel et al interpreted these findings in the context of deregulation and the rapid social and economic change that was taking place in New Zealand during the 1980's, a phenomenon which has given rise to an emphasis on improving efficiency and productivity while containing costs.
Publicly funded health services in New Zealand have been subject to similar pressures to the manufacturing sector, including restructuring, a demand for increased responsibility and accountability, cost-containment and improved productivity. Thus it was to be expected that health service managers would search for proven techniques to improve efficiency of their organisations. Work measurement provides one such tool. However traditionally these techniques have not been favoured or widely used in healthcare. Providers of health services commonly hold to the belief that the health industry is unique, and management techniques used in other industries are often inappropriate. Up until the recent past, the system of funding health services based on past expenditure gave little incentive to increase organisational productivity and efficiency. Likewise, wage awards rewarded high performers and low achievers alike, providing little incentive to staff to improve productivity and quality of work.
By mid-1991 when this study was conducted, a number of major reforms had turned around that situation. In the place of a multitude of hospital boards and public health offices, 14 area health boards (AHBs) had been established, responsible for providing comprehensive healthcare to geographically-described populations. Specific responsibilities and budgets were established through contracts with the Minister of Health. These incorporated national health goals (priorities), and annual renewal was contingent on achieving specified health care outcomes, and included efficiency measures. Generic management had replaced the traditional triumvirate of management, with managers at all levels being accountable for the work of their area of responsibility. Most recently, employment legislation had replaced collective awards with individual employment contracts, which for the first time in the public sector, included provision for rewarding performance. In this context, it may be expected that there would be an increased interest in what work measurement offers managers of health services to support their responsibilities in improving performance and efficiency.
The survey was carried out in the context of these recent reforms, to determine the extent to which work measurement techniques were employed in health services, and to investigate whether the trend of increasing use, as found in the manufacturing sector, was also evident in health services. Noting that in 1991, 82 percent of all spending on healthcare came from taxes, this study was limited to the public sector.
No recent New Zealand studies on work measurement in health services were located. Further, recognising that work measurement techniques had historically not been widely used in health services, this survey was intended to be exploratory. …