Development of a productivity index to increase accountability of ambulatory nutrition services

The development of a system to assess the productivity of ambulatory nutrition services presented many challenges, including variations in provider settings and in the record-keeping techniques of ambulatory nutrition personnel. A model to measure the productivity of ambulatory nutrition specialists at a large urban teaching hospital was devised and was defined by the following equation: Patient/time productivity index = [(extended visits X 2) + (brief visits X 1) + (weigh-ins X 0.5) + (telephone consults X 0.25) + (group class census X 0.25)] divided by number of hours worked. Information obtained from this productivity measurement has been used to evaluate and improve patient scheduling and the organization of functions in various ambulatory nutrition settings. A productivity award based on the productivity index and distributed monthly has provided an incentive for all ambulatory nutrition specialists to streamline operations and maximize efficiency. The patient/time productivity index has been incorporated into performance reviews of ambulatory nutrition specialists as an objective measure of compliance with expectations. When used in conjunction with quality assurance techniques such as chart audits and patient satisfaction questionnaires, the patient/time productivity index can be a useful tool for management to maximize the quality and efficiency of ambulatory nutrition services.