Workload Pressures Research Articles

Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study

BackgroundRural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation. The Workforce Indicators of Staffing Needs (WISN) approach can identify shortages and inform appropriate sanctioning norms. India currently lacks nationally relevant WISN estimates. We used existing data and modelling techniques to synthesize such estimates.MethodsWe conducted a retrospective analysis of existing survey data for 93 facilities from 5 states over 8 years to create WISN calculations for HRH cadres at primary and community health centres (PHCs and CHCs) in rural areas. We modelled nationally representative average WISN-based requirements for specialist doctors at CHCs, general doctors and nurses at PHCs and CHCs. For 2019, we calculated national and state-level overall and per-centre WISN differences and ratios to depict shortage and workload pressure. We checked correlations between WISN ratios for cadres at a given centre-type to assess joint workload pressure. We evaluated the gaps between WISN-based requirements and sanctioned posts to investigate suboptimal sanctioning through concordance analysis and difference comparisons.ResultsIn 2019, at the national-level, WISN differences depicted workforce shortages for all considered HRH cadres. WISN ratios showed that nurses at PHCs and CHCs, and all specialist doctors at CHCs had very high workload pressure. States with more workload on PHC-doctors also had more workload on PHC-nurses depicting an augmenting or compounding effect on workload pressure across cadres. A similar result was seen for CHC-specialist pairs—physicians and surgeons, physicians and paediatricians, and paediatricians and obstetricians–gynaecologists. We found poor concordance between current sanctioning norms and WISN-based requirements with all cadres facing under-sanctioning. We also present across-state variations in workforce problems, workload pressure and sanctioning problems.ConclusionWe demonstrate the use of WISN calculations based on available data and modelling techniques for national-level estimation. Our findings suggest prioritising nurses and specialists in the rural public health system and updating the existing sanctioning norms based on workload assessments. Workload-based rural HRH deployment can ensure adequate availability and optimal distribution.

Assessment of Staffing Needs for Frontline Health Workers in Selected Maternal and Child Health Services in 3 Countries of Sub-Saharan West Africa: Cote d'Ivoire, Burkina Faso, and Niger.

Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current-required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries.

Use of the WISN method to assess the health workforce requirements for the high-volume clinical biochemical laboratories

BackgroundThe clinical laboratory services, as an essential part of health care, require appropriate staff capacity to assure satisfaction and improve outcomes for both patients and clinical staff. This study aimed to apply the Workload Indicators of Staffing Need (WISN) method for estimating required laboratory staff requirements for the high-volume clinical biochemical laboratories.MethodsIn 2019, we applied the WISN method in all 13 laboratories within the Center for Medical Biochemistry of the University Clinical Centre of Serbia (CMB UCCS). A review of annual routinely collected statistics, laboratory processes observations, and structured interviews with lab staff helped identify their health service and additional activities and duration of these activities. The study outcomes were WISN-based staff requirements, WISN ratio and difference, and a recommendation on the new staffing standards for two priority laboratory workers (medical biochemists and medical laboratory technicians).ResultsMedical biochemists’ and laboratory technicians’ annual available working time in 2019 was 1508 and 1347 working hours, respectively, for the workload of 1,848,889 samples. In general, the staff has four health service, eight support, and 15 additional individual activities. Health service activities per sample can take from 1.2 to 12.6 min. Medical biochemists and medical laboratory technicians spend almost 70% and more than 80% of their available working time, undertaking health service activities. The WISN method revealed laboratory workforce shortages in the CMB (i.e. current 40 medical biochemists and 180 medical laboratory technicians as opposed to required 48 medical biochemists and 206 medical laboratory technicians). Workforce maldistribution regarding the laboratory workload contributes to a moderate–high workload pressure of medical biochemists in five and medical laboratory technicians in nine organizational units.ConclusionsThe WISN method showed mainly a laboratory workforce shortages and workload pressure in the CMB UCCS. WISN is a simple, easy-to-use method that can help decision-makers and policymakers prioritize the recruitment and equitable allocation of laboratory workers, optimize their utilization, and develop normative guidelines in the field of clinical laboratory diagnostics. WISN estimates require periodic reviews.

Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines

BackgroundHealth services cannot be delivered without an adequate, competent health workforce. Evidence suggests a direct relationship between density of health workforce and health outcomes. The Philippines is faced with health workforce challenges including shortages, inequitable distribution and inadequate skill mix which hinder health service delivery. Evidence-based workforce planning is, therefore, critical to achieve universal health care.MethodsThe Philippines adopted the World Health Organization’s workload indicators of staffing need methodology. Using a multistage sampling method, nine regions with poor health indicators in tuberculosis, family planning, and maternal child health were identified. Physicians, nurses, midwives, and medical technologists were prioritized in the study from 89 primary care health facilities (barangay health stations, rural health units, and city health offices). Data was collected using in-depth interviews, document reviews, observations, and field visits. The workload indicators of staffing need software were used for data analysis to determine staffing requirements and analyse workforce pressure.ResultsThe study showed varied results in terms of staffing requirements and workload pressure across cadres and facility types. Some health facilities exhibited staff shortages and high workload pressure. Out of the 40 rural health units and city health offices, only three had the required physicians needed and 22 facilities had a shortage of physicians working under high workload pressure. Other facilities had excess staff compared to the calculated requirements. Nurses at the rural health units showed high workload pressure. Ten rural health units had no medical technologists. Midwives at barangay health stations exhibited extremely low workload pressures.ConclusionThe study identifies the need for the Philippine Health System, both through the Department of Health and the local governments to efficiently optimize the available health workers by revising the services offered at the primary health care facilities. The results provide evidence for staffing requirements at various levels of care based on workloads, scope of practice and time taken to undertake specific tasks at the barangay health stations, rural health units and city health offices to be integrated into the human resources for health management systems.

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Cross-level effects of health-promoting leadership on nurse presenteeism: The mediation and moderation effect of workload and performance pressure

This study examines the cross-level influence mechanism of leaders’ health-promoting leadership on subordinates’ presenteeism among nursing industry. A multilevel mediated moderation model was hypothesized to explore whether health-promoting leadership is associated with subordinates’ presenteeism via the workload of subordinates, and how leader’s performance pressure plays the role in the model. Questionnaires were distributed to 110 nursing teams, which including 110 chief nurses and 660 subordinate nurses. Our findings showed that although health-promoting leadership has no direct impact on presenteeism, health-promoting leadership has an indirect impact on presenteeism via workload, and workload acts as a complete mediator. Meanwhile, performance pressure moderated the relationship between health-promoting leadership and workload. With an increase in performance pressure of leaders, the negative impact of health-promoting leadership on nurse workload gradually weakened. In this multilevel mediated moderation model, the mediated moderating effect of performance pressure was significant and the moderating effect was completely mediated, which means that the interaction between health-promoting leadership and performance pressure can affect presenteeism through workload. When leaders were under high performance pressure, the protective effect of health-promoting leadership on workload would be inhibited. These findings contribute to enriching the research on presenteeism, providing insight into how the health development of employees and performance demands of leaders may be balanced, and affording fresh thoughts for effective prevention and treatment of nurse presenteeism.

Understanding of employees’ performing professional duties at home: A qualitative study

Purpose. The purpose of this study was to determine the eustress and distress of employees during the pandemic. Method. The participants of this study were the employees who work from home during COVID-19. Semi-structured interviews were applied to 21 employees from various public institutions and private companies in the Jakarta area. This study is qualitative research; the choice of this design is to study the phenomena that occur among employees when faced with a pandemic condition and are required to change the way they work and maintain the independence of research results. Findings. Workload, poor communication, and work pressure are types of distress experienced by participants. The way how employees perceive and how to adapt these parameters of distress depends on setting work priority scales. However, they also have the influence of positive stress in sharing time with family and flextime. The participants, little by little, can divide their time and finish the work ontime. From this study, it can be concluded that most of the participants chose the work priority scale asan essential part of this issue vital in this case. With the passage of time, the workers will be more activein the way they solve problems. The pandemic will not end soon, but the ability to start a new life (new normal) is a necessary to survive.

Adopting workload-based staffing norms at public sector health facilities in Bangladesh: evidence from two districts

BackgroundBangladesh’s Health system is characterized by severe shortage and unequitable distribution of the formally trained health workforce. In this context, government of Bangladesh uses fixed staffing norms for its health facilities. These norms do not always reflect the actual requirement in reality. This study was conducted in public sector health facilities in two selected districts to assess the existing staffing norms with the purpose of adopting better norms and a more efficient utilization of the existing workforce.MethodsTo carry out this assessment, WHO’s Workload Indicators of Staffing Need (WISN) method was applied. Selection of the two districts out of 64 and a total of 24 health facilities were made in consultation with the formally established steering committee of the Ministry of Health. Health facilities, which were performing well in serving the patients during 2016–2017, were selected. This assessment examined staffing requirement of 20 staff categories.ResultsBased on the computer-generated WISN results, most of the staff categories were found to have a workload pressure of Very High (seven out of 20 staff categories), followed by Extremely High (five staff categories). Two staff categories had high, three had moderately high, two normal, and one low workload. Nurses were found to be predominantly occupied with support activities (50–60% of working time), instead of actual nursing care. Regarding vacancy, if all the vacant posts were filled, understandably, the workload would reduce, but not yet sufficient to meet the existing staff requirements such as consultants, general physicians and nurses at the district and sub-district/upazila-based hospitals.ConclusionThe existing staffing norms fall short of the WISN staffing requirement. The results provide evidence to prompt a revisit of the staffing policies and adopt workload-based norms. This can be supplemented by reviewing the scope of practice of the staff categories in their respective health facilities. In the short term, government might consider redistributing existing workforce as per workload. In the long term, revision of staffing norms is needed to provide quality health services for all.

A Study on Teacher’s Perception towards Working Environment in Educational Institutes

Workplace conditions can include both positive and negative aspects, such as positive reinforcement from management, positive feedback from coworkers, and positive workload pressure. It's also been found that experience and education level have an impact on the variables studied. Using a quantitative-based cross-sectional survey, the researchers examined teachers' impressions of their workplace. In order to collect people's responses, we employed a questionnaire that contained 34 questions with only one possible answer each. The questions were meant to be as specific as possible. An educational institute's favourable atmosphere can be improved by fostering a positive work environment, notably by fostering good ties with the director. The least essential part of organisational encouragement was the physical infrastructure, whereas the most important was supporting positive conduct by avoiding conflict and assuring equity. Disruptive and violent students are the most common obstacle to effective teaching. There was a general consensus among teachers that excessive after-school meetings, unrealistic deadlines, and inspections by administrative personnel added to the already heavy burden. The more experience a teacher had, the more favourable the institute's climate was seen by him or her. Policymakers and managers of educational institutions can use the data to help them figure out which aspects of the educational setting require immediate attention and improvement.

Evaluation of the Adequacy between the Workload and the Number of State Midwives and Maieuticians Practicing in the Gynecology-Obstetrics Departments of the University Hospitals of Burkina Faso

Objective: To evaluate the adequacy between the workload and the number of midwives and state midwives practicing in the gynecology-obstetrics services of the university hospitals of Burkina Faso. Methodology: This is a multicenter study conducted in 4 university hospitals representing this country (for brevity referred here to as A, B, C, and D) from May 1, 2018, to April 30, 2019. The Workload Indicators of Staffing Need (WISN) method was used to analyze the workload. Results: Dystocic delivery was the activity that took the most time. Inpatient activities were the most performed in terms of volume. At the University Hospitals D and C, there was an over-staffing of midwives and maïeuticians with a ratio of 1.93 and 2.12 respectively. At University Hospital B, the workload was in line with the existing number of State midwives and maieuticians. A low workload pressure (04%) was found at the University Hospital A. Conclusion: In most of the University Hospital Centers, there was no match between the workload and the number of midwives and maïeuticians. These results highlight the need for redeplayment of midwives and maïeuticians in order to ensure good health coverage for midwives and maïeuticians.

Assessment of staffing needs for registered nurses and licensed practical nurses at primary care units in Brazil using Workload Indicators of Staffing Need (WISN) method

BackgroundThe balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method.MethodsThe Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019.ResultsThe WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019.ConclusionThe assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Application of workload indicators to assess the allocation of orthopedists in a national referral hospital in Brazil

BackgroundThe study analyzes the allocation of specialized doctors’ orthopedists in a high-complex hospital, using the WHO’s Workload Indicators of Staffing Need (WISN) methodology and approach, which measures the workload pressure on the healthcare team (positive, negative, or well-adjusted).MethodsIn the first phase, the hospital’s operations and activities were analyzed using the information system. The duration of the tasks performed by the specialist physicians was observed and directly measured in the second phase. Finally, the indicators were analyzed, and the workload was calculated using the WISN application. The measurement was made using the available work time per year divided by the time unit over the previous 12 months.ResultsThe hand surgery care unit was WISN 1.0 and the ratios for the spine surgery care unit was 1.22, indicating enough physicians and no work overload among the groups surveyed. The ratio in the knee unit was 1.69, indicating that there was an excess of staffing for the workload.ConclusionThe workload findings and staffing calculations were useful in supporting and orienting the design and implementation of measures to increase the efficiency and effectiveness of health services.

Recruitment and retention of the rural podiatry workforce in Aotearoa New Zealand: a qualitative descriptive study of podiatrist perceptions

BackgroundPast research into the Aotearoa New Zealand (NZ) podiatry workforce has indicated a shortage of podiatrists, particularly in rural NZ. However, there has been no research investigating the characteristics of the NZ rural podiatry workforce. This study aimed to explore the factors which contribute to recruitment and retention of primary care podiatrists in rural NZ.MethodsA qualitative descriptive approach was implemented for data collection and analysis. Semi-structured interviews were conducted with 15 podiatrists who currently, or previously, worked in a rural podiatry practice. Manifest content analysis was used to analyse participant’s responses. A deductive approach was used where data were identified and coded according to predetermined themes from the literature.ResultsFour themes that influenced recruitment and retention were derived from the interviews: (1) professional factors, (2) economic factors, (3) social factors, and (4) external factors. Interviews revealed that clinical inexperience, a sole practice environment, professional and social isolation, and workload pressures combined to affect recruitment and retention. Strong community bonds, family ties, and a rural background were crucial to thrive in the rural setting.ConclusionA sustainable rural podiatry workforce is required to reduce health disparities that exist in NZ rural communities. The study identified that most practitioners entered the rural workforce into self-employed positions, often shortly following graduation from university. They soon reported feelings of professional isolation due to limited support networks. Practitioners established in the rural workforce noted significant workload stresses. Stresses stemming from an inability to source locums, take time away from work, or recruit new staff to fill vacant positions. Research examining support mechanisms for inexperienced practitioners and targeted strategies to grow the rural workforce and reduce attrition is required.

The art of delegation: integration of the veterinary nursing assistant into New Zealand veterinary practice

Background: In 2016 veterinary nursing assistants (VNAs) were introduced as an additional tier to New Zealand veterinary practice. Aim: This study explores the utilisation of VNAs in New Zealand veterinary practices to ascertain the impact of an additional staffing layer to patient outcomes, workload management and staff wellness. Method: Through focus groups and semi-structured interviews with 30 participants, three themes emerged allowing evaluation of the Allied Veterinary Professionals Regulatory Council (AVPRC) Scope of Practice (SP) (AVPRC, 2020) and development of delegation guidelines (DG). Results: Analysis identified weak processes in delegation. The practice-based perspectives of VNA staff utilisation supports the AVPRC SP. Conclusion: Effective communication of the SP and DG for veterinary practice utilisation could contribute to reducing workload pressure. Additionally, individual practice staff discussions regarding own and colleague job expectations, along with review of contractual job descriptions, could further evolution of multi-tiered practices leading to improved patient outcomes, team wellness and business success.

Teachers’ Perception of Their Work Environment: Evidence from the Primary and Secondary Schools of Bangladesh

The work environment includes conducive aspects such as (1) organizational encouragement, (2) supervisory encouragement, and (3) workgroup support, as well as toxic conditions like (4) teaching impediments and (5) workload pressure; the objective of the research is which of the factors and what are the elements of those factors teachers perceive as constituting the conducive and toxic environment. The research also outlines the effects of years of experience and the level of teaching on the specified factors. The study used a quantitative-based cross-sectional survey to analyze teachers’ perceptions of their work environment. A questionnaire comprised some background information, and 34 close-ended questions were used to elicit the responses. About 368 (230 males and 138 females) teachers participated in the survey. Structural equation models were constructed, where the five mentioned factors were part of two second-order formative constructs. Independent sample t-test was estimated to outline gender-wise and teaching level-wise (primary and secondary) variation, whereas Pearson correlation coefficients were calculated to check whether the experience was correlated with any of the perceived factors of the work environment. It is found that workgroup encouragement, particularly having good relations with the principal, is the most important factor in the conducive environment of the school. The physical facilities were the least, whereas promoting positive behavior by avoiding conflict and ensuring fairness was the most important aspect of organizational encouragement. Teaching impediments were mostly shaped by how often teachers require dealing with disruptive and violent pupils. Teachers perceived too many after-school meetings, unreasonable deadlines, and office staffs’ inspections enhance their workload pressure. The more a teacher became experienced, the more he or she positively perceived the conducive environment of the school. The findings can serve as a guide for educational policymakers and school administrators to identify which factors in the school environment need urgent attention and modification.

The Relationship Between Perceived Leader Busyness and Perspective Taking and Interaction Behavior of Followers.

How leaders influence followers have been a hot topic in both research and practice. Yet, prior studies have primarily focused on the impact of one leadership style, while overlooking how a leadership role may influence behavioral expressions of leaders. Particularly, being a leader means having to face time demands and workload pressure, and thus, busyness becomes a common phenomenon for leaders. Focused on perceived leader busyness, we had examined how it may influence employee interactions with leaders and how those interactions influenced leader evaluations of the performance of followers. Based on sensemaking theory, we propose that when followers have a high level of perspective taking, they are more likely to take avoidance behavior when perceiving leaders as of high busyness. Further, when followers engage in interaction avoidance behavior, leaders may consider followers as hiding errors or intentionally concealing their work process, which reduces positive evaluations (i.e., task performance and conscientiousness evaluation) while enhancing negative evaluation (i.e., deviance behavior) toward followers. We conducted two studies. Study one was conducted with a 25 participants interview and data of 297 employees to show scale validity of perceived leader busyness. Study two was conducted with 377 employees and their direct supervisors. Applying the complex modeling method, we found that followers with low-level perspective taking are less likely to engage in interaction avoidance behavior, even when perceiving leaders as high busyness; interaction avoidance behavior of followers has a positive relationship with counterproductive behavior evaluation of leaders, but a negative relationship with conscientiousness behavior evaluation. This study enriches the dyadic interactions between leaders and followers. In addition, it also shows the burden of perspective taking.

Student Behavior Analysis and Research Model Based on Clustering Technology

Now, entering the 21st century, with the continuous improvement of my country’s higher education level, the enrollment rate of all colleges and universities across the country is increasing year by year. Faced with the information management of a large number of students, the workload and work pressure of consultants at various universities have doubled. The rapid and effective development of modern computer software and hardware has also initiated and effectively developed the informatization process of universities. The student management system is the core and foundation of the entire school education management system. This study mainly introduces the application of student behavior analysis and research models based on clustering technology. This paper uses the application research of student behavior analysis and research model based on clustering technology, uses clustering technology to analyze student behavior, and reasonably analyzes the feasibility of KMEANS algorithm and campus data mining. The cluster analysis algorithm is used to divide students into different groups according to the characteristics of the students, and then, data analysis and data association rules’ mining are performed on each group of students. At the same time, the decision tree algorithm is used to predict the future of students based on the historical data of the students and the current data of the students. The development status of the school helps the school to understand the situation of the students in real time, make predictions and warnings for possible situations, provide personalized applications for teachers and students, and provide decision-making support for the management. It can be seen from the experimental analysis that the application of student behavior analysis and research models based on clustering technology has increased the efficiency of student education by 17%. The limitations of student behavior analysis and research on clustering technology provide good applications for the KMEANS algorithm. Analysis, discussion, and summary of the methods and approaches are obtained to enrich the academic research results.

Balancing school improvement strategies with workload pressures: a participatory action research case study

ABSTRACT This participatory action research case study describes how one secondary school aimed to improve staff culture. Although pre-test data showed the school as performing consistently well in terms of their organisational health, the school chose to implement a line management intervention over 12 months to target three low-rating factors: appraisal and recognition, professional growth, and supportive leadership. Quantitative evaluation showed that while the improvement strategy had no effect on the intended targets, there were unanticipated effects on other factors. Staff reported a mixture of positive and negative effects from the intervention; however, a core issue was its impact on teachers’ workloads. Participants reported burnout and stress as a consequence of school leaders driving continuous change. This case study argues that quality school improvement needs to be supported by a clear vision, with due consideration and attention to sustainable work practices.

Development, implementation, and evaluation of Sit Less at Work interventions in diverse organisations: a mixed-methods study

BackgroundIncreasingly, workplace health initiatives have targeted workplace sitting with mixed results, suggesting that effectiveness depends on context. This study aimed to explore contextual factors that influence the development, implementation, and evaluation of Sit Less at Work interventions, and to test and refine an operational framework. MethodsIn this mixed methods study, we recruited four diverse UK-based organisations to co-produce bespoke Sit Less at Work interventions with staff volunteers using the socioecological model as a framework via two workshops per organisation. Initiatives included communications from senior leaders, incorporating sitting less into policies, step competitions, and regular sitting breaks. Only three organisations (a small business, a charity, and a local authority) went on to implement the co-produced interventions between Sept 10, 2018, and May 5, 2019. These organisations all participated in a mixed-methods implementation and process evaluation of these interventions. Data collection included questionnaires, objective measures of workplace sitting time, focus groups, and interviews. Convenience samples of participants were recruited by email to measure sitting time before and after implementation and all participants were also invited to take part in focus groups. We analysed both the quantitative and qualitative data and identified key themes relating to contextual factors. All participants provided written informed consent. Ethical approval was obtained from the School of Health and Related Research Ethics Committee at the University of Sheffield (ref no 019368). Findings57 participants initially volunteered to provide intervention measures (small business n=5, charity n=11, and local authority n=41). 52 provided sitting times as baseline, 40 at 12 weeks (during the final week of the intervention), and 31 at 3 months post-intervention. 57 participants completed the questionnaire at baseline, 46 at 12 weeks, and 34 at 3 months post-intervention. 16 participants attended the focus groups (small business n=3, charity n=3, local authority n=10), and six were interviewed (n=1, n=2, and n=3, respectively). Process evaluation found none of the interventions was implemented as intended, with no consistent reduction in sitting: for the small business the mean proportion of time spent sitting at work was 82% (SD 11) at baseline, 77% (7) at 12 weeks, and 83% (7) 3 months post-intervention; for the charity it was 75% (9) at baseline, 77% (6) at 12 weeks, and 72% (15) at 3 months post-intervention; for the local authority it was 72% (14), 73% (14), and 68% (16), respectively. Contextual and cultural barriers to implementation included ingrained social norms that assume working involving sitting, the workplace being designed for sitting, workload pressures, lack of management buy-in, and perceptions of where the responsibility for behaviour change should come from. InterpretationDevelopment, implementation, and evaluation of initiatives designed to encourage workers to sit less require careful consideration of important contextual factors that influence the modern workplace. To ensure effective implementation of future initiatives, deeper organisational-level change requiring buy-in from all levels of management and staff might be needed to shift organisational culture and associated social norms. The operational framework can be used by researchers and practitioners to ensure consideration is given to these contextual factors and to support the development and delivery of more effective interventions. FundingUK National Institute for Health Research (NIHR) Doctoral Research Fellowship Programme.

THE INFLUENCE OF AUDIT EXPERIENCE, WORKLOAD, AND TIME PRESSURE ON AUDITOR'S ABILITY TO DETECT FRAUD (Case Study of Auditors who Work at KAP Surabaya)

This study aims to test and analyze the factors that affect the ability of auditors to detect fraud. This research is motivated by the many issues regarding the inability of auditors to detect fraud in carrying out their audit work.&#x0D; Factors that are very important for auditors in detecting fraud are audit experience, workload, and time pressure. Therefore, the problem examined in this study is whether audit experience, workload, and time pressure affect the ability of auditors to detect fraud either partially or simultaneously.&#x0D; The population in this study were all auditors who worked at 43 public accounting firms in the city of Surabaya. The sample in this study was determined using purposive sampling method. The sample selected in this study were 17 KAP where each KAP had 5-8 people who were used as respondents. A total of 74 questionnaires were distributed, but only 57 questionnaires were returned and could be processed.&#x0D; The analysis technique used to test the hypothesis is multiple linear regression analysis. The results showed that audit experience, workload, and time pressure had a positive and significant effect on the ability of auditors to detect fraud either simultaneously or partially.