estimation of staffing requirements in primary care in Oman using the Workload Indicators of Staffing Needs method

Background: Oman is a high-income country having a relatively small population scattered over large sparsely populated areas. This presents challenges to the provision of health services. It is important to ensure that all health facilities at all levels of care have the right number and skills mix of health workers to deliver quality health care.

Aims: The main aim was to develop national staffing norms to ensure adequate numbers, appropriate skills mix and equitable distribution of health professionals in primary health care [PHC] using the workload indicators of staffing needs [WISN] method.

Methods: All types of PHC services were itemized [promotive, preventive, curative, and rehabilitative and support services]. We used 2014 data from the health information system and the human resources management information system to develop staffing norms using the WISN method. First we set the norms based on the national average for the activity standards, then simulated the norms in Muscat governorate, which has 32% of the population.

Results: We calculated the required numbers of GPs and specialists for PHC centres providing core as well as core and supplementary services and the expected annual outpatient attendance. The simulation showed that doctors were less workload stressed [WISN ratio 1.02] than nurses [WISN ratio 0.66] on average, although some variations between health centres were noted.

Conclusions: Additional parameters [e.g. planned new services; local disease profile; change in health policies] may be added in future to re-adjust the calculation method once the health services mapping and human resources for health profiles for each governorate is completed.

Prevalence of and reasons for patients leaving against medical advice from paediatric wards in Oman

The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice [LAMA] in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA [prevalence: 1.6%]. Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital's electronic system [27.9%] and telephone conversations with patients' parents [55.0%]. No reasons for LAMA were documented in the hospital's electronic system for 109 patients [59.6%]. The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA

Staff perception of relative importance of quality dimensions for patients at tertiary public services in Oman

This research attempted to explore the public healthcare providers understanding the quality dimensions and patient priorities in Oman. It also addresses the issue of risks confronting health professionals in management without "a customer focused" approach. A descriptive study was carried out using a self-administered questionnaire distributed around two tertiary public hospitals. A total of 838 respondents from several specialties and levels of hierarchy participated in the study. The data was analyzed to compare the perception of two groups; the group of junior and frontline staff, as well as of managers and senior staff involved in management. The results showed that 61% of the junior and frontline staff, and 68.3% of the senior staff and managers think that cure or improvement in overall health is the single most important quality dimension in healthcare. Both groups perceive that technical dimensions have greater importance [to patients] over interpersonal aspects such as communication with the exception of dignity and respect. There was no significant difference between the perception of the managers and senior staff vis-a-vis the perception of junior and frontline staff on the importance of technical dimensions and the interpersonal aspects of service quality. Despite the proven contribution of empathy to patient satisfaction, it was ranked by both groups as the least important among the dimensions examined. The findings of this research are therefore informative of the need to implement strategies that deal effectively with such attitudes and create the platform and programs that reinforce the culture of good quality service amongst healthcare providers, managers in particular, and to improve patient satisfaction

Hospitalised patients with influenza A [H1N1] in the Royal hospital, Oman. Experience of a tertiary care hospital, July-December 2009

The aim of this study was to describe the clinical characteristics, risk factors, laboratory investigations and outcome of hospitalised patients with positive influenza A [H1N1] at the Royal Hospital in Oman. We extracted data from the retrospective medical charts, radiological and laboratory findings of 131 patients who were confirmed as positive foriInfluenza A [H1N1] by real-time reverse-transcriptasepolymerase-chain-reaction from 21 July to 23 December 2009. The median age was 24 years with 34.4% in the paediatric age group. Most [63%] of hospitalised patients were female. Symptoms at presentation included mainly fever [93.9%] and respiratory symptoms [89.3%]. 83% of the patients had at least one risk factor and pregnancy was the most common associated condition [22.9%]. Most of the patients had reduced lymphocytic count [57.3%] and high levels of serum C-reactive protein, aspartate transaminase and lactate dehydrogenase [75.7%, 75% and 70.8% respectively]. The majority of the patients [64.5%] had evidence of pneumonia and radiological findings constituted mainly bi-lateral infiltrates [60.6%]. Antiviral therapy was administered to 95.4% of the patients who mostly received it 48 hours after disease onset. Death occurred in 6.9% of patients. Out of these, 88.9% required Intensive Care Unit [ICU] care and mechanical ventilation. Influenza A [H1N1] infection mainly affected those of younger age and females. Associated medical conditions were common, with pregnancy being interestingly the commonest risk factor. The infection caused severe illness that required ICU admission and led to death in 6.9% of patients