When Andrew Lansley first pursued his NHS reform bill one of his key objectives was to cut the level of bureaucracy in the NHS. This wasn’t a revelation, anyone and everyone who has ever worked in the NHS knows that it is mired by middle management and form filling.
Given the complexity of managing a universal healthcare system we clearly need effective record keeping and clinical governance. I often wonder though how we decide what needs to be measured when more often than not the results aren’t used to pursue any form of change.
Now, this isn’t without the best will in the world as NHS managers have attempted to create clinical forms which must be completed by doctors and nurses in an attempt to enforce best practice. For example, every patient receiving a prescription of antibiotics has to have the reason and the duration of the course filled in. Also, all patients need to have a checkbox form completed detailing their risk of developing a blood clot (sometimes useful, if not mind-numbing).
To date these forms are often completed incorrectly or not at all.
So what did management decide was the solution? Fine, name and shame of course!
Let’s improve relations by using innocuous forms as a method by which to withdraw the limited resources from doctors and nurses who are already struggling on the frontline. Why don’t we make a spreadsheet with all senior doctors ranked according to their ability to have the aforementioned forms completed? Sure, excellent!
Here’s the problem though.
The managers lack the insight to understand the application of their own forms. Recently, one hospital in question had clear guidelines for first line antibiotic therapy for most infections. In the intensive care setting, there are daily meetings between the doctors and the microbiologists who write the guidelines. They discuss all their patient cases which are often complex leading to the prescription of non-first line antibiotics (heavy duty, less drug resistance problems).
So what did the magic spreadsheet say? Bottom rank!
“The ITU department prescribes non first line medications on a regular basis without clear, documented justification.” (paraphrased)
Errrr, actually no. In fact, the decisions are made by the clinical guideline authors, are thoroughly documented and actually the fact that these patients have reached intensive care indicates their condition is so severe that often first line therapies have tried and failed.
This example reflects the misuse of data gathering and the subsequent, scandalous misinterpretation of it in an attempt to seemingly improve clinical practice. Now multiply this a thousand fold and you can only imagine the scale of form-filling, target meeting and governance that are being applied up and down the land without a shred of clinical insight or forethought.
The solution as ever is to include clinical staff with management to rationalise the bureaucratic mess we are in. You need people with insight to explain whether your best laid management plans actually are realistic.
Who knows between management and willing clinical staff you might improve flow, efficiency, improve clinical care and maybe even meet all those targets you long for!
You see I made a point about willing clinical staff. Well, that’s a different problem altogether.
So are we willing to let misguided form filling define the system processes and care our healthcare systems provide?
Not on my watch.
Agree or Disagree? Tweet me @Saif_Abed
Dr Saif F Abed
AbedGraham Healthcare Strategies Ltd