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2018 moncler De op behoeften gebaseerde benadering beoordeelt de hoeveelheid en de omvang van de diensten die bij elk type faciliteit geleverd moeten worden door middel van een normatieve benadering op basis van de mening van experts. Hoewel moncler outlet zeer informatief is, heeft deze benadering, wanneer alleen gebruikt, verschillende beperkingen. stelt behoeften gelijk aan de vraag Er is veel gepubliceerd werk over de impact van infrastructuur, onderwijs, economische status, gewoonten en overtuigingen op patronen van hulpzoeken.4,5 Behoeften worden niet altijd vertaald in de vraag naar gezondheidsdiensten en de op behoeften gebaseerde aanpak kan overschatten het niveau van de te leveren gezondheidsdiensten. Ten tweede is de op behoeften gebaseerde aanpak afhankelijk van het pakket aangeboden diensten en weerspiegelt deze niet gemakkelijk de veranderingen in aangeboden diensten. Ten derde is er een onderliggende veronderstelling dat zorg voor de gezondheid van mannen middelen zullen worden ingezet in overeenstemming met de relatieve behoeftenniveaus. Human resources worden vaak gebruikt om te voldoen aan eisen die niet samenvallen met behoeften, terwijl de eds van veel kwetsbare en gemarginaliseerde bevolkingsgroepen blijven onvervuld. Ten slotte past de behoeftenbenadering niet gemakkelijk aan veranderingen in patroon van ziekten of prevalentie.6 2018 moncler

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moncler nederland In dit document beschrijven we de aanpassing van de werklastindicator van de WGO (WISN) 8 om de uitdagingen en beleidsopties in plattelandsgebieden in Zuid-Afrika te weerspiegelen. moncler nederland

Inadequate aantallen en slechte verdeling van gezondheidswerkers zijn geïdentificeerd als cruciale uitdagingen voor het Zuid-Afrikaanse gezondheidssysteem, met name in landelijke gebieden. Het Primary Health Care Core Package voor South Moncler Outlet Store Africa9 definieert klinieken, satellieten en mobiele klinieken als verpleegkundigen, met af en toe sessies door artsen en gemeenschapsgezondheidscentra als verwijzingscentra, waarbij artsen ter plekke nodig zijn. Verpleegkundigen vallen in drie categorieën: professionele verpleegkundigen met vier jaar opleiding, ingeschreven verpleegkundigen met twee jaar en verpleegkundige assistenten met een jaar.

De volgende aannames en bijdragen zijn geformuleerd na initiële deskwerk om eerdere studies te identificeren, gevolgd door overleg met het National Department of Health, districten en faciliteiten:

moncler dames Toewijzing van soorten raadplegingen aan categorieën van gezondheidswerkers werd gedaan in samenwerking met de Zuid-Afrikaanse verplegingsraad, om ervoor te zorgen dat bestaande scopes van de praktijk werden gerespecteerd. moncler dames

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moncler uitverkoop Klinische ondersteuningsvereiste: het onderzoek naar ‘behoeftennormen’ werd gebruikt. Dit onderzoek combineerde een tijd- en bewegingsstudie met doelstellingen op het gebied van doelkwaliteit en efficiëntie en suggereerde een gemiddelde van 0,57 klinische ondersteuning van fulltime werknemers per clinicus. Deze schatting werd vervolgens in gelijke delen verdeeld tussen ingeschreven verpleegkundigen en geregistreerde verpleegkundige assistenten. moncler uitverkoop

moncler jassen heren sale Managementtijd: bij gebrek aan adequaat onderzoek, werd een informele evaluatie van deze taken in de West-Kaap gebruikt, die schat dat één fulltime managementfunctie vereist is voor elke 200 patiënten per dag. moncler jassen heren sale

Vereisten administratief en schoonmaakpersoneel: een bestaand tijd- en bewegingsonderzoek werd gebruikt 12, waarbij werd geschat dat één fulltime administratief medewerker nodig is voor elke 100 patiënten per dag en één fulltime algemeen assistent voor elke 150.

Minimale personeelsvereisten per type faciliteit: er was minimum personeel geplaatst bij een professionele verpleegkundige, een geregistreerde verpleegsterassistent en een halve tijd general assistant voor een kliniek. Voor een gemeenschapsgezondheidscentrum werden een arts en een klerk toegevoegd als personeel dat op elk moment tijdens de openingsuren nodig was.

Moncler Outlet moncler jas outlet Dienstverlof: 12 weken werden opgenomen voor jaarlijks verlof, ziekteverlof, feestdagen en opleiding. Bovendien werd verondersteld dat verpleegkundigen en artsen tijdens hun werk respectievelijk 62% (5 uur) en 80% van hun tijd doorbrengen in direct contact met patiënten. moncler jas outlet

moncler heren Afgezien van deze overkoepelende veronderstellingen, waren er twee gebieden die specifiek aandacht behoefden: de impact van HIV / AIDS en de impact van uitgebreide opening in landelijke voorzieningen. De volgende veronderstellingen werden gemaakt: Het aantal counselingbezoeken werd geëxtrapoleerd uit het aantal pretest-counselingbezoeken, dat minder dan 1,5% van de presentaties vertegenwoordigde. Begeleiding omvat echter ook posttesten, rouwverwerking en doorlopende counseling. Er werd dus aangenomen dat 8% van de aanwezigen begeleiding nodig zou hebben, waaruit het aantal benodigde counselors werd beoordeeld. moncler heren

moncler jassen Op de werklast gebaseerde berekening van de personeelsvereisten moet rekening houden met het feit dat in voorzieningen met verlengde uren de werklast niet gelijk over alle uren wordt gespreid. Een studie in Kaapstad toonde aan dat moncler outlet-verkoop in faciliteiten 168 uur per week open is, moncler jassen kopen, een gemiddelde van 70% van de opkomst vond plaats gedurende de kern 40 uur, terwijl de resterende 30% gebeurde in de andere 128 uur. 11 De tool verdeelde de werklast over de openingstijden in deze verhoudingen. moncler jassen

Nadat de gewijzigde aannames waren ingebouwd in het model en de feitelijke gebruiksgegevens van de districten waren ingevoerd, werden de resulterende personeelsbehoeften besproken in een andere ronde van overleg met de plattelandsdistricten om de geldigheid van de aannames tegen de redelijkheid van de resultaten verder te testen.

moncler jas heren Zes van de armste districten in vier van de negen provincies in het land werden geïdentificeerd door het National Department of Health voor opname in het onderzoek. Alle 340 voorzieningen in deze zes districten waren inbegrepen. moncler jas heren

Als output levert de tool de verwachte personeelsbezetting (voltijdse werknemers) per personeelscategorie per faciliteit en vergelijkt deze met de werkelijke personeelsbezetting om een ​​tabel met ‘hiaten en excessen’ per personeelscategorie per faciliteit te bieden. Een ratio van 0% geeft aan dat er geen personeel in deze positie is en de waarde ‘N / A’ geeft aan dat deze categorie personeel niet vereist is in dat type faciliteit.

moncler jas dames De tool is ontwikkeld in Microsoft Excel, software beschikbaar in alle districten. Om het gebruiksgemak te vergroten, is het formule-gedreven, maar buiten de black box-benadering om, worden alle aannames en berekeningen duidelijk omschreven om het begrip en de transparantie te vergroten. moncler jas dames

moncler jas heren sale Alle zes districten hadden een drastisch tekort aan artsen, ofwel gezien als afwezigheid van artsen die klinieken bezochten of te weinig of geen artsen om de openingstijden van gezondheidscentra voor gemeenschappen te dekken. Sommige districten hadden geen artsen voor eerstelijnsgezondheidszorg. Over het algemeen was het aantal artsen slechts 7% van het vereiste aantal. moncler jas heren sale

Terwijl het totale aantal professionele verpleegkundigen 94% van het doelwit was, hadden twee districten algehele excessen en vier hadden een algemeen tekort. Het aantal ingeschreven verpleegkundigen en geregistreerde verpleegassistenten was respectievelijk 60% en 83% van wat ze zouden moeten zijn. Counselors waren zeer ongelijk verdeeld, met het algemene overschot dat hun afwezigheid in veel faciliteiten verhulde. Administratief personeel was 30% van het doelwit en afwezig in veel faciliteiten. Algemene werknemers leken in het algemeen groter in aantal dan vereist in veel faciliteiten.

moncleroutlet.nl Naast de zeer gebrekkige inzet tussen voorzieningen, in klinieken met een overmaat aan professionele verpleegkundigen, is er een tekort aan andere gezondheidswerkers, zoals verpleegkundigen en adviseurs met moncler dommekrachten, die de voordelen van het eigen risico in veel faciliteiten opheffen. De tabel laat zien hoe belangrijk het is om personeelsbehoeften te beoordelen, niet alleen in termen van professionele verpleegkundigen, maar in termen van het hele team. Het gebruik van de verhouding van patiënten tot professionele verpleegkundigen als indicator van de werkbelasting kan zeer misleidend zijn, omdat moncler outlet online niet de aanwezigheid of afwezigheid weerspiegelt van ondersteunend personeel dat de werklast van professionele verpleegkundigen beïnvloedt.

moncler jassen outlet Wat de personeelsimplicaties betreft van de verlenging van de openingstijden op het platteland, bleek uit het model dat het minimumaantal professionele verpleegsters (met behulp van professionele verpleegkundigen als indicator) 1,3 voltijdse werknemers is voor de kern 40 uur per week en 4,2 fulltime werknemers voor de extra 128 uur, meer dan drie keer dat van de kernuren. Deze aanzienlijke toename van personeelsvereisten wordt niet gecompenseerd door een parallelle toename van de werklast. In deze landelijke districten, in faciliteiten die 168 uur geopend waren, was de werkbelasting tijdens de niet-kernuren laag: er waren doorgaans acht keer meer patiënten per uur tijdens de kernuren dan tijdens de niet-kernuren. Dientengevolge zou het aantal personeelsleden dat wordt vereist door de werkbelasting aanzienlijk lager zijn geweest dan het aantal dat is voorgeschreven door de minimale personeelsbezetting. moncler jassen outlet

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