WISN is a scientific tool to determine the number of people you need to carry out a work. In other words it is a cadre determination tool used mostly in health sector.

1. Workload Indicator Staffing Need (WISN)
D.Venoden
Specialist in Medical Leadership & Management

2. What is WISN?
 Human resource management tool
 Determines how many health workers of a
particular type are required to cope with the
workload of a given health facility
 Assesses the workload pressure of the health
workers in that facility
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3. Why is WISN?
Traditional ways to determine staffing requirements
1. Population to staff ratio
2. Facility based staffing standards
Disadvantages
1. Fail to take into account both the wide local variations
in the demand for services
2. Fail to work that health workers actually do
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4. WISN method is based on a health worker’s
workload, with activity (time) standards applied
for each workload component
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5. Steps of WISN
1. Determining priority cadre(s) and health facility type(s)
2. Estimating available working time
3. Defining workload components
4. Setting activity standards
5. Establishing standard workloads
6. Calculating allowance factors
7. Determining staff requirements based on WISN
8 .Analysing and interpreting WISN results
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6. Calculation of MOs cadre for OPD/ETU @
BH A
 BH A is the A secondary care hospital serves to a
population of 150000
 Average daily Out Patient Department (OPD)
attendance of patients is 395 and admission is 56 in
2019; average daily admissions of the emergency unit
(EU) is 11
 Medical officers (MO) of the OPD and EU function in a
common roster
 The Senior Medical Officer (SMO), OPD and EU are the
direct supervisor
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7. Steps and calculations
1. Determining priority cadre(s) and health facility
type(s)
It is generally better to start with the staff and facilities at
the primary care level/single unit of a hospital
2. Estimating available working time (AWT)
AWT is defined as “the time a health worker has available
in one year to do his or her work, taking into account of
authorized absences.
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8. Steps and calculations
2. Estimating available working time (AWT)
BH A
Staff category Weeks in one
year
Working days in
one week
Possible
working
days in one year
Doctors 52 6 52*6=312
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9. Steps and calculations
2. Estimating available working time (AWT)
BH A
Reason for the absence of MOs Days of absence
1. Casual leave 21
2. Vacation leave 28
3. Public holidays 25
4. Training 20
Total annual days of absence 94
Total annual working days 312-94=218
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10. 3. Defining workload components
 Health service activities (HSA) is defined in the WISN
tool as “activities performed by all members of the
staff category; regular statistics are collected on them”
 Supportive activities (SA) is defined in the WISN tool as
“activities performed by all members of the cadre, but
regular statistics are not collected on them”
 Additional activities is defined in the WISN tool as
“activities performed only by certain (not all) members
of the cadre. Regular statistics are not collected on
them
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11. 3. Defining workload components
BH A
Work load group Work load component
Health Service Activities (HSA) Treating OPD patients
Admitting patients to EU and wards
Managing EU patients till the relevant unit MOs
come and take over the management part of the
patients
Accompanying critical patients in the ambulance
when they transferred to TH B
Support Activities (SA) Notification of the communicable diseases
Attending Work Improvement Team meetings
Recording and reporting works
Additional Activities (AA) Preparing duty roster for the MOs
Supervision of the OPD units
Making decision on the treatment of anti rabies
serum and vaccine for the patients who were
bitten by the animals.
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12. 4. Setting activity standards
An activity standard is defined in the WISN tool as “the
time necessary for a well-trained, skilled and motivated
worker to perform an activity to professional standards in
the local circumstances”
1. Service standard
Service standards are developed for HSA
2. Allowance standard
Allowance standards are developed for SA and AA
Category Allowance Standards (CAS) is developed for SA and
Individual Allowance Standard (IAS) is developed for AA
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13. 4. Setting activity standards
BH A
HSA Unit time
Treating OPD patients 3 min per patient
Admitting patients to EU and
wards
8 min per patient
Managing EU patients 30 min per patient
Accompanying critical patients in
the ambulance when they
transferred to THJ
180 minute per patient transfer
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14. 4. Setting activity standards
BH A - OPD and EU
Available working hours in a day – 6
Available working days in a week – 6
Available working hours in a week – 6*6=36
Available working days in a year – 218
Available working hours in a year – 218*6=1308
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15. 4. Setting activity standards
Work load
group
Work load
component
CAS Percentage of CAS
(Percentage of total working
hours dedicated for CAS)
SA activities
of all
members
Notification of the
communicable
diseases
20 min/day 20/60/6*100=5.6%
Attending Work
Improvement Team
meetings
2 hours per
month
2*12/1308*100=1.8%
Recording and
reporting works
3 hours per
month
3*12/1308*100=2.7%
Total CAS 10.1%
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16. 4. Setting activity standards
BH A
Work load group Work load component Number of
persons
performing the
job
IAS (Actual
working time
per person)
Annual IAS
(for all staff
performing
the activity)
AA of SMO Preparing duty roster
for the MOs
1 (SMO) 2 hours per
month
24 hours per
year
Supervision of the OPD
units
1 (SMO) 30min per
week
26 hours per
year
Making decision on the
treatment of anti rabies
serum and vaccine for
the patients who were
bitten by the animals.
1 (SMO) 30 min per
day
182 hours
per year
Total IAS in a year 232 hours10/2/2020
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17. 5. Establishing standard workloads
A standard workload is defined in WISN tool as
“the amount of work within a health service
workload component that one health worker
can do in a year”
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18. 5. Establishing standard workloads
BH A
AWT in year 1308
HSA Unit time Standard workload
Treating OPD patients 3min/patient 1308*20=26160
Admitting patients to EU
and wards
8min/patient 1308*7.5=9810
Managing EU patients 30min/patient 1308*2=2616
Accompanying critical
patients in the ambulance
when they transferred to
TH B
3 hours 1308/3=436
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19. 6. Calculating allowance factor
Calculating Category Allowance Factor (CAF)
CAF = 1 / [1 – (Total CAS / 100)]
1/[1- (10.1/100)] = 1.1
Calculating Individual Allowance Factor (IAF)
IAF is defined in the WISN tool as “the staff
requirement to cover additional activities of certain
cadre members”
IAF=Total IAS/AWT
232/1308=0.18
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20. 7. Determining staff requirements based on
WISN
BH A
AWT – 1308 hours
HSA Work load component Annual workload Standard
workload
Requires
number of staff
Treating OPD patients 395*365=14417
5
26160 144175/26160=
5.5
Admitting patients to EU and
wards
56*365=20440 9810 20440/9810=
2.1
Managing EU patients 11*365=4015 2616 4015/2616=
1.5
Accompanying critical patients in
the ambulance when they
transferred to THJ
1*365=365 436 0.8
Total staff required for HSA 9.9
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21. 7. Determining staff requirements based on
WISN
Total number of the staff required = (Staff required to
perform HAS*CAF) + Total IAF
(9.9*1.1)+0.18=10.89+0.18=11.07
Total No of MOs required for OPD and EU =11
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