Til tross for økt satsning via Opptrappingsplanen, er produksjonen per fagårsverk marginalt endret innen norsk psykiatri

Sammendrag

Abstract

Despite an increase in resources through the national psychiatric Escalation plan, Norwegian psychiatry has only seen a marginally change in productivity per clinician.

Background: When an evaluation of the national Norwegian psychiatric Escalation plan was carried out, the conclusion was that the Norwegian Parliaments demand of a 50% increase in productivity had been achieved. The number of treated patients went from 476 000 to 1,1 million a year over a 10 year period. What wasn’t highlighted was the fact that the actual number of clinicians also almost doubled. The purpose of this study was to investigate how the accessible resources within Norwegian psychiatry was utilized, and from a society’s point of view, is it possible to achieve a true increase in productivity through better management of available resources.

Method: For the analysis of resources used, the cost analytical tool TDABC was chosen. Data used was obtained from The Norwegian Directorate of Health, Statistics Norway and a hospital trust. Clinicians at several sites were interviewed in person, and 235 clinicians completed a web-based survey in order to gain insight in an ordinary clinical working day.

Results: The findings consistently indicate low productivity on a national level within hospitals. This study investigated 95 062 outpatient consultations in the mentioned Trust, and on average 75% of the working hours were not used on face-to-face patient consultations. Further, available resources were not optimally utilized, patient related outcomes were not used as a tool to adapt/tailor service offered and low productivity has on a national level gained acceptance. The national hospital productivity was on average 38% compared to the productivity by out of hospital practitioners financed by the state. These state financed practitioners have a cost rate of approximately 14%-21% compared to practitioners in hospitals.

Implications: If the issues highlighted in this study are addressed, the productivity within Norwegian psychiatry should be able to meet and excel the demands set forth by the Norwegian Parliament. Such an outcome would require appropriate management on all levels within the service.