Determining Dietitian Staffing Ratios Through a Consensus Building Process in a Large Canadian Health Authority

Dietitian managers are routinely asked to provide recommendations for dietitian staffing ratios (i.e., the number of patients a dietitian 1.0 full-time equivalent (FTE) position can adequately serve). These recommendations are used as a benchmark when advocating for improving dietitian service levels, future hospital planning, and ultimately guide the FTE for which the department is budgeted. To date, there is limited empirically based evidence supporting dietitian staffing ratios for multiple care areas. The purpose of this quality improvement project is to develop consensus on the dietitian staffing ratios for inpatient, ambulatory, and long-term care areas within a large Canadian health authority.

A modified RAND/UCLA method of consensus was used. A draft document of dietitian staffing ratios was informed by a literature review. Next, iterative rounds of anonymous surveys and virtual meetings were conducted until consensus on the dietitian staffing ratios for each care area was achieved. Consensus was defined as > 70% of respondents indicating they rated an item at least slightly agree on a 7-point Likert scale.

Eighty percent (12/15) dietitian leaders participated in the consensus process. The leaders had an average of 5.8 ± 6.3 years experience supervising a median of 8.0 FTE [1-42] of dietitian positions. Consensus was achieved after 3 rounds of surveys and meetings. The final document provides dietitian staffing ratios for 35 different practice areas.

This quality improvement project is the first to provide a comprehensive list of dietitian staffing ratios for inpatient, outpatient, and long-term care areas. It provides dietitian managers in other locations with insight into a process by which they could produce their own locally relevant dietitian staffing ratios.