Setting Benchmarks and Determining Psychiatric Workloads in Community Mental Health Programs

It is important to recognize that these benchmarks are working guidelines only, and that several assumptions have been made in the absence of clear data. Confounding variables, such as case mix and severity of illness, the program setting (for example, rural or urban), the availability of other nonphysician clinical resources and their expertise, and the needs of special client populations, must be taken into account when setting benchmarks. These factors are very difficult if not impossible to control—thus the need for built-in flexibility. However, some of these imbalances should even out over a period of time if the target population and workloads are similar for psychiatrists in similar settings.

We believe workloads rather than caseloads are a better indicator of clinical activities. We acknowledge the limitations of this method and emphasize the need for ongoing monitoring and evaluation until a dynamic balance is reached by a process of "successive approximations."

Resource allocation is closely linked to available funding and cutbacks, which in turn directly affect clinical services, the psychiatrist's workload, and the quality of care that the psychiatrist can provide. Unless we have guidelines for workload estimations based on acceptable standards of care and clinical outcomes, psychiatrists run the risk of spreading themselves too thin due to shrinking health care resources and increasing service demands. As Capen (4) warns, this situation can lead to a drop in service standards and quality of care, resulting in stress and liability risks for physicians.

Of particular importance is the fact that teaching, supervision of medical students and residents, and some degree of administration are essential roles for psychiatrists in a teaching hospital. Unfortunately, the importance of these activities is generally not recognized, and time and resources are not dedicated to them. A survey of part-time faculty in academic psychiatry by Charach and Leszcz (5) found that in the overall academic mandate, teaching and clinical services were undervalued compared with research and the ability to attract funding grants. In comparing themselves with tenured research faculty, part-time faculty were dissatisfied by the relative lack of recognition for educating students and providing training in clinical skills as well as by inadequate opportunities for promotion.

It is crucial that the concerns of part-time academic faculty be addressed by teaching hospitals, universities, and departments of health in collaboration. Attention to their concerns would definitely enhance job satisfaction and, more important, help with recruitment and retention of high-caliber psychiatrists in the public sector.

As community care gains momentum and we stride into the 21st century, the need for early intervention in psychiatric illness will continue to increase. The only way to ensure effective service delivery without compromising clinical standards is for psychiatrists, administrators, and health care planners to work together in setting and using benchmarks. With appropriate modifications, the guidelines presented here are broad enough to be applied to various clinical settings and programs. A similar approach can be used to set benchmarks for other clinical disciplines.

The author thanks Jill Petrella, M.H.A., for help with data analysis.

Dr. Bhaskara is lecturer and staff psychiatrist at Nova Scotia Hospital, P.O. Box 1004, Pleasant Street, Dartmouth, Nova Scotia, Canada B2Y 3Z9 (e-mail, [email protected]).