BOOKS OF RtfiDIfGS - PAHO/WHO

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example, a physician may schedule two physicals at 8 a.m. These
patients will be worked up by fellows while the staff doctor may
be seeing former patients. In th,.s .ituation, the staff physician's
patients will be using three or more examination rooms at the
same time. As was seen in the study, few departments can afford
this many examination rooms for each staff physician.
Personnel-related problems
Obviously, the clinic's patient flow system is very complex. For
the entire existing system to work properly, it was necessary for
the many patient flow related processes to interact smoothly.
Thus, it was imperative that all personnel understand how their
work affected not only their particular process but also all the
others with which it interacts. At the time of the study, there
were no structured training prograr;is in which the new employees
were given an overall perspective of their job as it related
to other clinic operations. The only training which took place was
on-the-job because a. new employee was hired only when the
position was already vacant. Therefore, adequate training was
very difficult because of the urgency with which the employee
was needed. Poor job performance and lack of coordination resulted
since a new employee did not know how his or her work
interacted with the other employees' functions.
In some areas there were certain inequities in job classitications.
Some jobs, where specific skills were a definite requirement
(such as typing), were classified on the same level as jobs
requiring no specific skills, no ratient contact, and no machinery
to operate. This was due, in part, to incorrect original classifications
but more often it was the result of lack of reclassification as
job duties changed and became more complex. There was no
procedure apparent for regular updating of job descriptions and
classifications. The job classification inequity seriously delayed
recruitment of qualified personnel. To compensate for this problem
supervisors and department heads juggled personnel within
their departments to insure efficient operation. They, at times,
had to shift employees from one classification to another without
changing salary or job classification. This often resulted in per-