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. 2025 Jan 23;25(1):130.
doi: 10.1186/s12913-025-12286-8.

A Workload Indicators of Staffing Need (WISN) based framework and implementation tool for dietitians at South African central and tertiary public hospitals

Vertharani Nolene Naicker  1   2 , Jane W Muchiri  3 , Keshan Naidoo  4 , Modiehi Heather Legodi  5
Affiliations

A Workload Indicators of Staffing Need (WISN) based framework and implementation tool for dietitians at South African central and tertiary public hospitals

Vertharani Nolene Naicker et al. BMC Health Serv Res. .

Abstract

Background: Quality nutrition services are dependent upon the accessibility and availability of nutrition professionals. In this study, we used the World Health Organization's Workload Indicators of Staffing Need (WISN) methodology to develop a dietetic staffing norm framework and implementation tool for South African central and tertiary public hospitals.

Methods: We followed the eight step WISN methodology as a basis for this developmental study. National data on permanently employed dietitians in public hospitals were used to determine the facility type. Available working time (AWT) was determined using WISN calculations and SA labour regulations. Consensus on workload components (WC) and activity standards (AS) was achieved through a Delphi exercise. Steps 5 to 8 ended in determination of dietitian requirements based on WISN software. Similar steps were used to develop the framework and tool. The tool's calculated outputs were compared against the WISN software.

Results: Central and tertiary public hospitals were identified as the target facilities. Dietitians AWT at these facilities was calculated as 1528 h per year. A final list of 45 WC and aligned AS was obtained and provided the necessary contextualization. A WISN based framework, and a Microsoft Excel tool (calculator) resulted. Calculated average dietitians' requirements were 24.59 and 24.23 for WISN software and the excel tool respectively.

Conclusion: The WISN methodology is a versatile tool that allows for the development of context and cadre specific staffing norm implementation frameworks and tools. The developed tool is valid and contextualized to determine the specific need for dietitians at SA central and tertiary public hospitals. These results will help policy makers to plan and forecast dietetic staffing needs at a macro level.

Keywords: Dietitian; Framework; South Africa; Staffing norm; Tool; Workload Indicators of Staffing Need.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval was obtained through the Research Ethics Committee, Faculty of Health Sciences at the University of Pretoria (Ethics Number: 97/2021). All procedures were performed in accordance with the Helsinki Declaration. The study was registered and approved for data collection via the National Health Research Database. Study participants were provided with a formal letter detailing the study and invited to participate in the study. All participants signed an informed consent form prior to the commencement of study. Consent to participate was completely voluntary. Only consenting individuals were included in the study. Consent for publication: Consent for publication was obtained through the South African National Health Research Database, corresponding provincial research committees and hospital research committees where applicable. Patients were not included in this study and thus patient consent was not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The World Health Organization Workload Indicators of Staffing Need (WISN) eight step methodology [16]
Fig. 2
Fig. 2
The facility identification sheet
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Fig. 3
Available working time
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Fig. 4
Heath service activities
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Support service activities
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Individual/additional service activities
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Health Service statistics
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Fig. 8
Standard workloads
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Fig. 9
Category allowance factors
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Individual allowance factors
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Fig. 11
Summary dashboard with WISN calculated results
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Fig. 12
A WISN based staffing norm framework for dietitians at South African central and tertiary public hospitals
Fig. 13
Fig. 13
The user-Interface Sheet of the South African WISN based staffing tool for dietitians at central and tertiary public hospitals
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