01.06.15
Patient administration – the weakest link?
Source: May/June 15
Andrew Prince, director of health at Serco Consulting, discusses the problems with administrative processes in the NHS.
The NHS can be justly proud of the clinical care it provides. At its best, NHS clinical care stands comparison with the finest anywhere in the world. But are patients and clinicians let down by the administrative processes, whether in acute or community settings?
Serco has undertaken two substantial insight studies to frame the experiences of patients, clinicians and administrators. They tell a challenging story.
Almost 40% of patients we surveyed would like to be able to use email or website to manage their appointments. More than a quarter have been told they will be called back, and it hasn’t happened. A similar proportion find it difficult to reach the person they want to talk to.
The good news is appetite for change
In hospitals, we see clinicians have taken control of key parts of the administrative process and, yes, they are reluctant to let go while they cannot trust the alternative. Yet they begrudge the time they have to spend on unnecessary administration: between three and seven hours per week. They do not think patients get the information they need. Contrary to popular opinion, many consultants would like to vet referrals electronically.
Administrative staff know they are not providing a good service, but are doing their best with poor operational processes and lack of investment in technologies that could help. They are frustrated and would like to offer a better service.
Good administration can both improve quality and, with the right investment in process and technology, cost less.
Even better, we know good administration will improve the productivity of clinical staff, access times and the utilisation of front line clinical assets: theatres, outpatient clinics, etc. That is a source of substantial financial benefit.
How can this be achieved? First of all, calibrate the challenge for your organisation: what is the current patient experience; how do clinicians perceive the service to themselves and patients; what is their appetite for improvement?
Then define the improvement options: lean/standardised processes, technology investment, and workforce development. Evaluate the options and set out a roadmap to the service outcomes you aspire to achieve. In our experience, the business case for change can be compelling.
As with all change, addressing administrative weakness brings some risk as well as opportunity. So an unvarnished assessment of the current state and a solid business case for change are essential. Working with an experienced partner can help by bringing in skills which complement the NHS’s clinical care excellence. Some risks can be transferred to a partner who is better able to manage and mitigate them.
Care co-ordination in community healthcare
While the case for better patient administration in an acute setting is clearly strong, this is also true for community healthcare where the challenges are different and may seem more complicated. Serco has direct experience of this from Suffolk Community Healthcare, where it has been providing care for patients since 2012.
In Suffolk, we have created a Care Co-ordination Centre (CCC) which provides a single point of contact for patients, carers and GPs. Patients, especially, value the way this simplifies the way they can find out about their care from community nurses and therapists. Referring clinicians are also supported by dedicated staff, including clinically qualified staff, who provide the CCC service.
Increasingly, the CCC is taking responsibility for planning the care provided by the Suffolk community clinical teams: making appointments, managing diaries and so on. Naturally, some mobile clinical staff have been reluctant to ‘give up’ this administrative activity, but we have found that some clinical teams find it attractive and welcome the additional time this change allows them to spend up to 20% more time with patients. Other teams are persuaded by the experience of their colleagues.
But the productivity of frontline clinical teams is not the only benefit. More transparency about community care activity allows good practice to be identified and promulgated. It allows the CCC to keep patients informed about day-to-day care scheduling. This form of care co-ordination is exactly what is needed to support more integrated care across local NHS providers, social care and even interventions by voluntary and charitable providers.
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