The administration burden
Can we reduce the administration burden?
In the Netherlands it is estimated that care providers, both doctors and nurses, both in primary care and in homecare spent 1/3 of their time to administration. It thereby contributes to high costs, low job satisfaction and depersonalised care. Mistakes or omissions in the complex administration lead to quality and safety-issues and to higher accountability for caregivers.
Their is a wide quest for reducing administration. Attempts so far by the professionals, by the scientific committees, by the institutions and by the government have failed to do so.
The problem is that all administration, whether for documenting the given care, for financial reporting, for quality control, for transparency, etc, has been installed for a given reason. In most cases doctors and nurses themselves or their scientific committees impose this need for data on themselves by issuing regulations, guidelines etc. Not reporting certain information quickly conflicts with improving efficiency, being transparant, reporting necessary data to regulatory boards, insurance companies etc.
The opposite is true. We increasingly fast need even more information te be documented for improving the efficiency of our operations, to improve the care by assessing critical performance indicators, to compare ourselves to others, etc
How do we escape from this cycle or do we have to embrace the accumulating need for data, and how can we do so?
I completely agree with your viewpoint: there is already a lot of administration to be done, and it will increase.
However, I believe we need to push some of the administration away from the caregivers. Does the doctor or the nurse really need to do all of the administration they are doing? Or can we push part of this administration to an administrative workforce? When I started at my current job, the physiotherapists were making all the appointments themselves, rescheduling patients, taking phone calls, sending reimbursement requests to the payers,… This is often seen as a way to reduce costs or improve efficiency because an administrative workforce would cost extra money, but I believe the opposite is true. Those people are (apparently 1/3 of their time) not working on the maximum of their skill level and so they are a big cost to the organisation during their administrative tasks. I believe it is highly rewarding, both in job satisfaction for the individual caregiver as economically for the organisation, to invest in administrative support on the microlevel of (a part of) a department. I believe it is very important, especially in health care, to let people perform at the top of their skill level.
It is imperative that we come to terms with the fact that the current day hospital function is not limited to care givers alone. Stretching the care givers to do a multitude of non- care giving jobs would ultimately lead to a burn out. As there is always a dearth of qualified and skilled resources in healthcare, the optimal utilisation of their skill set , not pushing them to deliver to non- domain activities ( with a different skill set unrelated to their core domain ) that consumes their care giving time is of utmost priority. We have to ensure that the human resources of a hospital are clearly defined based on their core skill set followed by optimal recruitment and continuous training and utilisation. Such continual training and enhancement of domain related skill set has to be done both for clinical and non- clinical resources in the hospital thus improving the efficiency of delivery.
The above comments share the idea that care-givers should turn away from administration to cope with future increase in adminisatration and data collection. I fully agree with that viewpoint and it sounds logic. But how did we get where we are?
One: Docters are from the middle ages a protected profession end responsible for healthcare. So the system is build with them on top. For a lot of decisions the system turns to doctors to join, to talk, to decide, to prescibe, to fill in the form, to decide, to govern etc. Is we want to be successful in lowering the burden of administration and make them available for the care, we should turn around the system a bit by making others end-responsible for the administration, operational task and governing. I would be nice if some doctors turn to this tasks as professionals, while the rest are dedicated to the care. SO TURN AWAY SOME RESPONSIBILITIES FROM DOCTORS.
Second: A lot of data are recorded at the point where the interaction between care-giver and patient is. For this to solve I think the proces should be split in a more administrative part like taking the history, notes, questionaires etc and a part with pure interaction with the caregiver for talk, investigation, ordering tests, shared decision making, followed again by a more administrative part like explanation, planning etc. SO SPLIT THE PROCES.
Kind request to comment on this comment
Have you tried the option of a Scribe? So while the doctor can stay focused on care giving and uses the traditional method of notes taking and passes on to the scribe, whose responsibility is to put into the structure system. Of course, it needs good training and understanding. For example, i know my Dad and brother work with a Physician assistant or nurse practitioner who they have a very good sync with and viceversa where the PA/NP can understand them better and at times anticipate what the doctor is about to ask. Works well particularly in PCP settings and non-invasive settings and gains significant efficiencies over time. You will need upfront training and some initial time to build a great team with your assistant.
Thanks for Your comment.
Actually we tried. In ear-nose-throat outpatient care. The business case did not appear to be profitable. I think the scibes (PA/NP) should take over not only the note keeping, but also the rest of the administration and planning and thereby acts like a case manager for the patient in case of questions, request for information, sharing test results etc.
How to afford this expense or organize it in a profitable way?