Table 2 Comparison of current categories of TDABC approaches to staff time estimation
Approach | Brief description | Benefits and Challenges mapped to Domains of 5 R’s framework |
|---|---|---|
Self-report approaches | ||
- An average time is assessed for common tasks - Often used in concert with a process map to identify all tasks and the task frequency/actors - Can be self-tracked or an evaluation team member prompts individuals in each role to understand the time required for common tasks | • Relevance is high to implementers—these tasks are part of the existing process • Rapidity is low-to-moderate—some delays to initially estimate data, but data collection is fairly rapid • Rigor is moderate—recall bias is minimized for common tasks, but this may be a bigger problem for rare tasks. Systems use this approach more for common tasks • Replicability is moderate—other systems likely use different process maps, so this may not be fully replicable • Resources required are moderate for research assistants or quality improvement teams—both to ensure process map is accurate and to send surveys and compile survey results. This poses a challenge to continue tracking in a sustainment period | |
Retrospective time diary [16] | - Time diary may include a template or time card that tracks time spent in different aspects of a project - Recorded retrospectively (e.g., time spent in last week or last month), but can be real time - Either self-tracked or may need to be interviewed or prompted to complete | • Relevance is high—specific to the time spent on a relevant task for implementers • Rapidity is low-to-moderate—there are often delays to compile these self-report data, but templates are fairly quick to complete. Occasionally, these may be triggered automatically • Rigor is moderate, but recall bias is minimized for common tasks and by more frequent assessments with shorter recall periods (e.g., recall over 1 week is more rigorous than recall over a period of 1-3 months); as a negative, when using a time card type of approach, there is a more limited ability to capture variation of task type as compared to the uniform estimates of time for task approaches • Replicability is high—others may replicate this approach • Resources required are moderate—must be prompted to complete time diary (other than when it is triggered automatically) and compile survey results - thus at-risk to continue this in sustainment period |
Third party observer approaches | ||
Direct observation [22] | - Specific observation template for 3rd-party to document time spent in different aspects of project and by different staff members | • Relevance is high to implementers—these tasks are part of the existing process • Rapidity is low—this is a time-consuming process to observe and compile data, particularly for low-frequency events • Rigor is high due to direct observation—used as a “gold standard” comparison [27] • Replicability is high—others may replicate this approach • Resources required are high, and this is particularly challenging for low-frequency events due to large periods of “down time” for observers |
Semi-automated approaches | ||
Contemporaneous time diary embedded within electronic health record [26] | - Staff have a designated field to complete within the standard note used for delivering the EBP - Time template completed at the same time as delivery of each instance of the EBP | • Relevance is high to implementers • Rapidity is moderate-to-high—data are available immediately but staff or research assistants may still need to compile • Rigor is moderate-to-high—recall bias is mitigated by completing the template at time of EBP delivery but there may still be inconsistent recall of time spent, particularly if differentiating between time spent on > 1 implementation strategy (e.g., time spent preparing, time spent with patient) • Replicability is moderate-to high—many EHRs may replicate this approach • Resources required are low-to-moderate, low if report may be auto-generated and requires limited technical support/staff time to set up |
Automated electronic health record (EHR) approaches | ||
Time captured in real time by EHR or integrated software [23] | - Time spent completing certain EHR activities, such as a specific encounter type, is tracked using objective time stamps - What is tracked, how it is tracked, and data retrieval methods are specific to the EHR vendor and local system | • Relevance is moderate to implementers—may not capture a specific task as well as the other approaches listed • Rapidity is high if data are available immediately—rapidity is moderate if need to rely on vendor or local IT staff to run report at pre-specified intervals • Rigor can be high if multitasking is minimal/or if configured to stop recording if idle • Replicability is high within a system—may be difficult for other health systems to implement the same assessment program with a different EHR vendor • Resources required are low for data collection, may be moderate-to-high to set up |