Is WOMBAT the right tool for me?

Is WOMBAT the right tool for me?

The WOMBAT tool may be of benefit to you if you are seeking to undertake a direct observational study, particularly to quantify aspects of work and workflow. The use of WOMBAT as a reliable method for quantifying work continues to grow. WOMBAT has been used by research teams from several countries, including: Australia, United States, United Kingdom, Canada, New Zealand, South Africa, Italy, Finland, Sweden and Norway.

WOMBAT allows researchers to design their own data collection templates that can be tailored to answer a particular research question, or to focus on the work of a specific professional group. Thus, WOMBAT affords the ability for researchers to undertake observational studies of different health professionals in different settings and to answer a wide range of questions using a rigorous approach. Examples include:

  • examining hospital ward nurses’ time in medication related tasks [1] and interruptions during medication related tasks [2, 3]
  • assessing hospital doctors’ and nurses’ patterns of work and communication [4, 5] and measuring the impact of health information technologies [6-10]
  • quantifying how and with whom doctors on hospital wards spend their time [11]
  • examining intensive care unit nurse workflow during shift change [12]
  • quantifying the work patterns of doctors in intensive care units [13-16]
  • assessing the rate of interruptions and multitasking by intensive care doctors and nurses [17-19]
  • investigating work patterns, interruptions and multitasking in surgical wards [20, 21]
  • measuring the work patterns of hospital pharmacists’ [22, 23] and the impact of electronic medication management systems [23-25]
  • examining pharmacists’ workflow in community pharmacy [26]
  • quantifying work and interruptions experienced by nuclear medicine technologists [27]
  • quantifying junior doctors’ work practices after hours and on weekends [28, 29]
  • evaluating the impact of a drug monitoring system on nurses’ work in ambulatory care [30]
  • assessing interruptions and multitasking by doctors in emergency departments [31-35] and their impact on prescribing errors [36]
  • examining work patterns and the use of electronic health records in ambulatory care [37]
  • quantifying renal dietitians’ time [38]
  • examining medication management work processes of nurses in home healthcare [39]
  • assessing hand hygiene in birth attendants [40].

Alternatively, researchers can elect to use data collection templates, as applied in previous studies, to allow findings from different studies to be compared. One of the greatest advantages of using the WOMBAT tool is the potential to compare your findings with other WOMBAT studies. Thus, we suggest that, where possible, you consider using existing definitions of work tasks which will allow you to compare your findings with those from other WOMBAT studies. WOMBAT also provides the opportunity to undertake multi-site and cross-country studies.


[1] Ampt A, Westbrook JI. Measuring nurses' time in medication related tasks prior to the implementation of an electronic medication management system. Stud Health Technol Inform. 2007;130:157-67.

[2] Reed CC, Minnick AF, Dietrich MS. Nurses’ responses to interruptions during medication tasks: a time and motion study. Int J Nurs Stud. 2018;82:113-20.

[3] Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. Effectiveness of a ‘do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Quality & Safety. 2017;26(9):734.

[4] Westbrook JI, Ampt A. Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians' patterns of work and communication. Int J Med Inform. 2009;78 Suppl 1:S25-33.

[5] Westbrook J, Duffield C, Li L, Creswick N. How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Services Research. 2011;11(1):319.

[6] Westbrook JI, Ampt A, Williamson M, Nguyen K, Kearney L, editors. Methods for measuring the impact of health information technologies on clinicians' patterns of work and communication. Medinfo 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics; Building Sustainable Health Systems; 2007: IOS Press.

[7] Westbrook JI, Creswick NJ, Duffield C, Li L, Dunsmuir WTM. Changes in nurses’ work associated with computerised information systems: opportunities for international comparative studies using the revised Work Observation Method By Activity Timing (WOMBAT). Proceedings of the 11th International Congress on Nursing Informatics. 2012;2012:448.

[8] Westbrook JI, Li L, Georgiou A, Paoloni R, Cullen J. Impact of an electronic medication management system on hospital doctors’ and nurses’ work: a controlled pre–post, time and motion study. JAMIA. 2013;20(6):1150-8.

[9] Graham TA, Ballermann M, Lang E, Bullard MJ, Parsons D, Mercuur G, et al. Emergency physician use of the Alberta Netcare Portal, a province-wide interoperable electronic health record: multi-method observational study. JMIR. 2018;6(3):e10184.

[10] Georgiou A, McCaughey EJ, Tariq A, Walter SR, Li J, Callen J, et al. What is the impact of an electronic test result acknowledgement system on Emergency Department physicians’ work processes? A mixed-method pre-post observational study. Int J Med Inform. 2017;99:29-36.

[11] Westbrook JI, Ampt A, Kearney L, Rob MI. All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Med J Aust. 2008;188(9):506-9.

[12] Shaw NT, Ballermann MA, Hagtvedt R, Ho S, Mayes DC, Gibney N. Intensive care unit nurse workflow during shift change prior to the introduction of a critical care clinical information system. eJournal of Health Informatics. 2011;6(1):5.

[13] Hefter Y, Madahar P, Eisen LA, Gong MN. Relationship of ICU strain factors and allocation of physician time in the ICU.  C103 Optimizing Limited ICU Resources: Am Thoracic Soc; 2015. p. A5233-A.

[14] Hefter Y, Madahar P, Eisen L, Gong M. A time motion study to describe workflow of attendings and residents in medical and surgical ICUs.  C94 High Impact Clinical Trials in Critical Care. American Thoracic Society International Conference Abstracts: American Thoracic Society; 2015. p. A5126-A.

[15] Hefter Y, Madahar P, Eisen LA, Gong MN. A time-motion study of ICU workflow and the impact of strain*. Critical Care Medicine. 2016;44(8):1482-9.

[16] Li L, Hains I, Hordern T, Milliss D, Raper R, Westbrook J. What do ICU doctors do? A multisite time and motion study of the clinical work patterns of registrars. Critical Care and Resuscitation. 2015;17(3):159.

[17] Ballermann M, Shaw N, Mayes D, Gibney R, editors. Intensive care unit health care providers spend less time multitasking after the introduction of a critical care clinical information system. HIC 2010: 18th Annual Health Informatics Conference: Informing the Business of Healthcare; 2010 24-26 August 2010; Melbourne Convention and Exhibition Centre: Health Informatics Society of Australia.

[18] Ballermann M, Shaw NT, Mayes DC, Gibney RN. Impact of a clinical information system on multitasking in two intensive care units. eJournal of Health Informatics. 2012;7(1):2.

[19] Ballermann MA, Shaw NT, Arbeau KJ, Mayes DC, Noel Gibney R. Impact of a critical care clinical information system on interruption rates during intensive care nurse and physician documentation tasks. Stud Health Technol Inform. 2010;160(Pt 1):274-8.

[20] Bellandi T, Cerri A, Carreras G, Walter S, Mengozzi C, Albolino S, et al. Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses. Ergonomics. 2018;61(1):40-7.

[21] Göras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, et al. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ Open. 2019;9(5):e026410.

[22] Lehnbom EC, Li L, Prgomet M, Lam W, Westbrook JI, editors. Little things matter: a time and motion study of pharmacists’ activities in a paediatric hospital. Digital Health Innovation for Consumers, Clinicians, Connectivity and Community: Selected Papers from the 24th Australian National Health Informatics Conference (HIC 2016); 2016: IOS Press.

[23] Westbrook JI, Li L, Shah S, Lehnbom EC, Prgomet M, Schofield B, et al. A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. Int J Med Inform. 2019.

[24] Lo C, Burke R, Westbrook JI. Electronic medication management systems' influence on hospital pharmacists' work patterns. Journal of Pharmacy Practice and Research. 2010;40(2):106-10.

[25] Schofield B, Cresswel K, Westbrook J, Slee A, Girling A, Shah S, et al. The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals. BMJ Open. 2015;5(10).

[26] Cavaye D, Lehnbom EC, Laba T-L, El-Boustani E, Joshi R, Webster R. Considering pharmacy workflow in the context of Australian community pharmacy: a pilot time and motion study. Research in Social and Administrative Pharmacy. 2018.

[27] Larcos G, Prgomet M, Georgiou A, Westbrook J. A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety. BMJ Qual Saf. 2017;26(6):466-74.

[28] Arabadzhiyska PN, Baysari MT, Walter S, Day RO, Westbrook JI. Shedding light on junior doctors' work practices after hours. Intern Med J. 2013;43(12):1321-6.

[29] Richardson LC, Lehnbom EC, Baysari MT, Walter SR, Day RO, Westbrook JI. A time and motion study of junior doctor work patterns on the weekend: a potential contributor to the weekend effect? Intern Med J. 2016;46(7):819-25.

[30] Callen J, Hordern A, Gibson K, Li L, Hains IM, Westbrook JI. Can technology change the work of nurses? Evaluation of a drug monitoring system for ambulatory chronic disease patients. Int J Med Inform. 2013;82(3):159-67.

[31] Walter SR, Li L, Dunsmuir WTM, Westbrook JI. Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours. BMJ Quality & Safety. 2014;23(3):231-41.

[32] Westbrook JI, Coiera E, Dunsmuir WTM, Brown BM, Kelk N, Paoloni R, et al. The impact of interruptions on clinical task completion. Quality and Safety in Health Care. 2010;19(4):284-9.

[33] Raban MZ, Walter SR, Douglas HE, Strumpman D, Mackenzie J, Westbrook JI. Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol. BMJ Open. 2015;5(10):e009076.

[34] Walter SR, Raban MZ, Dunsmuir WTM, Douglas HE, Westbrook JI. Emergency doctors' strategies to manage competing workload demands in an interruptive environment: an observational workflow time study. Applied Ergonomics. 2017;58:454-60.

[35] Walter SR, Raban MZ, Westbrook JI. Visualising clinical work in the emergency department: understanding interleaved patient management. Applied Ergonomics. 2019;79:45-53.

[36] Westbrook JI, Raban M, Walter SR, Douglas H. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study. BMJ Quality & Safety. 2018.

[37] Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Annals of Internal Medicine. 2016;165(11):753-60.

[38] Hand RK, Albert JM, Sehgal AR. Quantifying the time used for renal dietitian's responsibilities: a pilot study. Journal of Renal Nutrition. 2019;29(5):416-27.

[39] Holmqvist M, Ekstedt M, Walter SR, Lehnbom EC. Medication management in municipality-based healthcare: a time and motion study of nurses. Home Healthcare Now. 2018;36(4):238-46.

[40] Gon G, de Bruin M, de Barra M, Ali SM, Campbell OM, Graham WJ, et al. Hands washing glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar. American Journal of Infection Control. 2018.

Content owner: Australian Institute of Health Innovation Last updated: 03 Jul 2020 12:32pm

Back to the top of this page