A Research Project to Improve Human Resource Record Management System of Nurses in A Teaching Hospital, Sri Lanka

Poor quality records management in Sri Lankan Hospital offices is a major dissatisfaction and demotivation for healthcare staff. An intervention research project to improve the record management of selected Human Resource (HR) records of nurses in an Office of a Tertiary Care Hospital in Sri Lanka was carried out to identify the gaps, implement improvements and to test the outcome. Grade promotion and annual increment HR processes considered for the improvements. Qualitative and quantitative techniques used for gap identification, planning of interventions and assessment of the effectiveness. A package of quality improvements initiatives implemented following literature review and stakeholder participation. Absence of instructions/sample filled-forms and issues in the document flow were the inconsistencies noted. The record processing time was 30.83 days with an SD of ±4.84 for completion of annual increments and 24.33 days with an SD of ±4.21 for authorisation of grade promotions. The package of interventions included e-based/ paper-based guides and specimen request forms and a document movement register to track the records. Increased accessibility, accuracy, improved quality, timeliness and improved traceability of submitted forms and improvements in the average time spent for annual increments and grade promotions noted; 17.52 days (SD ±3.39) and 12.13 days (SD ±2.33) respectively, a statistically significant reduction (p<0.05). Implementation of quality improvement interventions using computer based initiatives with stakeholder participation can improve office management issues in the tertiary hospital setting. Creative Commons Attribution-ShareAlike 4.0 International License. 19 | Adikari, Dalpatadu Jurnal Manajemen (Edisi Elektronik)

Record Management, Human Resource, Hospital Office, Quality Improvement.

A B S T R A C T
Poor quality records management in Sri Lankan Hospital offices is a major dissatisfaction and demotivation for healthcare staff. An intervention research project to improve the record management of selected Human Resource (HR) records of nurses in an Office of a Tertiary Care Hospital in Sri Lanka was carried out to identify the gaps, implement improvements and to test the outcome. Grade promotion and annual increment HR processes considered for the improvements. Qualitative and quantitative techniques used for gap identification, planning of interventions and assessment of the effectiveness. A package of quality improvements initiatives implemented following literature review and stakeholder participation. Absence of instructions/sample filled-forms and issues in the document flow were the inconsistencies noted. The record processing time was 30.83 days with an SD of ±4.84 for completion of annual increments and 24.33 days with an SD of ±4.21 for authorisation of grade promotions. The package of interventions included e-based/ paper-based guides and specimen request forms and a document movement register to track the records. Increased accessibility, accuracy, improved quality, timeliness and improved traceability of submitted forms and improvements in the average time spent for annual increments and grade promotions noted; 17.52 days (SD ±3.39) and 12.13 days (SD ±2.33) respectively, a statistically significant reduction (p<0.05). Implementation of quality improvement interventions using computer based initiatives with stakeholder participation can improve office management issues in the tertiary hospital setting.

INTRODUCTION
The office is an integral element of a Hospital where planning and coordinating of tasks according to organisation objectives takes place (Balachandran & Chandrasekaran, 2009

LITERATURE REVIEW
Lost records, poor record organisation, record storage problems, wasted time, reduced productivity and clutter are significant gaps in record management in office environments that are paper-based (Kokemuller, 2018;Waters, 2017 (2017) has shown significant improvements in timeliness by implementing TQM techniques in a regional healthcare office context in Sri Lanka (Dias, 2017). An intervention project carried out in a rural hospital in Ethiopia showed, using simple ICT based interventions improved timeliness, completeness, user satisfaction and accessibility of records (Wong & Bradley, 2009).

An interventional project that used TQM
techniques has been carried out to improve all aspects of clinical record management in a UK hospital setting (Glen et al., 2015).

RESEARCH METHODS
This was an interventional research project to improve the HR record management system of nurses in a tertiary hospital within a six-month period from January to June 2018. Nurses were selected following discussions with experts in the field based on the number of documents submitted, their importance and urgency.    The average time duration for approval of grade promotion form has been reduced from 24 days to 12 days (Table 3).  (Murali, 1999). Paper-based records were maintained to ensure fair access to nurses with low ICT literacy.

Assessment of gaps.
Outcomes of this service improvement project were enhanced user satisfaction and a reduction in average process time for the selected two processes. Gains in process times were shown statistically significant. Dias (2017) has shown similar interventions successful in the office of regional healthcare setting in a suburban town of Sri Lanka. days with an SD of ±3.39 and 12.13 days with an SD of ±2.33 respectively, a statistically significant reduction (p<0.05). All stakeholders indicated high perceived satisfaction over the improvements in the processes.

Recommendations.
1. Service improvement projects to set right the record management process of the hospital offices should be implemented with the full participation of the stakeholders.
2. Electronic-based applications can be successfully implemented in HR records management in healthcare offices.
3. Implement electronic tools for HR record management in all major health staff categories.
4. Service improvement projects should also be aimed at upgrading financial and administrative record management processes using a similar approach.