Work patterns and time allocation in multidisciplinary home hospice: a time-motion study

Abstract

Abstract Introduction : The delivery of home hospice care involves complex logistical and clinical demands. Standard administrative metrics fail to capture the nuanced workload of this distributed ecosystem. This study aimed to characterize the workday structure and identify operational constraints within a multidisciplinary palliative care team in Singapore. Methods : A time-motion study was conducted in late 2025, through continuous observation to quantify individual durations of discrete tasks. Over 28 staff days, a research assistant shadowed three physicians, seven nurses, and four medical social workers for two days each. Activities were coded across six domains, ranging from direct care to travel, with periodic multitasking captured through concurrent coding. To reconcile multitasking with scheduled clock time, task durations were normalized within 15-minute blocks. Results : The dataset included 2336 distinct activity entries. Observation revealed a sustained intensity marked by concurrent workloads rather than discrete episodes. Across the service, indirect care occupied 39.8% of normalized time. Direct care accounted for 26.8% of the shift. Specifically, clinical documentation alone consumed 24.6% of the workday. Movement between locations required 15.6% of total time. Regarding specific roles, medical social workers experienced peak workload density in the morning. Conversely, nurse workloads peaked in the mid-afternoon. Discussion : Geographic distribution and practice norms heavily influence home care workflows. Standardized morning meetings foster team alignment. At the same time, this synchronization compresses the available window for field visits. Joint clinical visits ensure safety but reduce scheduling flexibility. To mitigate capacity constraints, clinicians frequently use travel time as an interstitial workspace. This practice reclaims productive minutes but eliminates cognitive recovery periods. Future service redesigns could explore decoupled visits for stable patients or protected documentation time to improve workforce sustainability.