4 ms·

As someone who was embedded in the NHS for a number of years it has many problems, but counterintuitively one of them is actually a lack of paper pushers or at

As someone who was embedded in the NHS for a number of years it has many problems, but counterintuitively one of them is actually a lack of paper pushers or at least low level admin and other auxiliary staff. Because governments have constantly demanded the NHS spend less money, but have also been under pressure to preserve numbers of "front line" staff you've ended up with serious shortages of low level admins, medical secretaries, receptionists, finance officers etc. This means that more and more healthcare workers spend their time doing paperwork or customer service work that could be done by anyone. I worked out of one of the largest genomic diagnostic labs in the country with over 150 clinical geneticists, nurses, scientists and consultants and there were 4 admins. That meant nurses were staffing reception, consultants were managing their own diaries, geneticists were doing stock takes and clinical scientists were packaging up and booking samples onto DHL for collection. This was not an efficient way of working, but the lab had a hard ban on hiring any non "front line" staff. And it had been running like that for years. The trust as a whole had the same problem on a macro scale. There weren't enough finance officers so invoices didn't get paid or debtors chased (the NHS provides a lot of private services as well). Because of a lack of staff working in recruitment it could take months (4 in my case) between being given a job offer and the paperwork being in place to actually start. Payroll was a nightmare because of lack of staff and multiple unintegrated time recording systems, many of them to this day paper based. A large number of legacy patient records are still paper based and have to be physically moved around and digitised "on the fly" but because the NHS is supposed to be digital there aren't enough porters payed to literally push the trolleys of records around so you end up with nurses doing it. I could go on for a long time but you get the idea.

klabb3 4y ago
The shift in the western world into paper pushing in healthcare, education, construction, etc doesn't always come in the form of more bureaucrats. Sometimes it's teachers spending time with ever more frequent and granular grading and survey systems, and doctors filling forms for hours a day. It feels like the McKinsey-style design of large orgs has permeated the public sector just as much if not more than the private one. It always comes with a massive amount of procedure – employee surveys, follow-ups and meaningless 10-scale measurements, so that leadership can rest easy knowing that every decision they make is data driven. Somehow a spreadsheet analyst should be able to diagnose and fix every possible issue in an incremental manner, and conversely, all poor decisions are due to insufficient data.
- r_hoods_ghost 4y ago
  Yes the demand to have a documented policy, procedure and metrics for everything even if no one ever reads them, follows them or analyses them is insane. At the same time there's been this huge increase in the amount of useless correspondence and a cultural shift away from hiring people to help manage and filter this stuff so people can do actual work (aka old school secretaries and admin assistants). Harrumph
  - ethbr0 4y ago
    IMHO, every required documentation policy should have its opportunity cost measured against the decrease in actual work being done. E.g. "Do we think this form being filled out is worth someone not being able to see a doctor?"
    - klabb3 4y ago
      Yes it SHOULD be. But the anxious leaders want more data for no other reason than to look at it and think they're more informed, when in reality they are not. It's like being addicted to looking in the mirror. It's good if you can notice the chocolate around your mouth, but more than that isn't helping, it's just a hobby. Only in this case your hobby is destroying everyone else's joy and productivity.
benj111 4y ago
On the other hand, my ex worked for the NHS. To 'solve' the problem of long wait times after check in. They reduced staff at check-in to bottle neck the in flow of checked in patients.
naasking 4y ago
> This means that more and more healthcare workers spend their time doing paperwork or customer service work that could be done by anyone The obvious solution seems to be reducing the required paperwork rather than hiring more staff to handle the paperwork, and this seems to agree with your experience when you described "unintegrated time recording systems". That said, I wouldn't be surprised if too much bureaucracy was also partly to blame, because that's what happened here in Canada.
rightbyte 4y ago
Lack of administrative staff in operations is a mayor problem, pushing paper work to medical staff. Where I live we have the same problem in schools, pushing administration to teachers. Admin bloat seems to be at a higher level if it exists. Because ordinary secretaries are long gone.

klabb3 4y ago

The shift in the western world into paper pushing in healthcare, education, construction, etc doesn't always come in the form of more bureaucrats. Sometimes it's teachers spending time with ever more frequent and granular grading and survey systems, and doctors filling forms for hours a day. It feels like the McKinsey-style design of large orgs has permeated the public sector just as much if not more than the private one. It always comes with a massive amount of procedure – employee surveys, follow-ups and meaningless 10-scale measurements, so that leadership can rest easy knowing that every decision they make is data driven. Somehow a spreadsheet analyst should be able to diagnose and fix every possible issue in an incremental manner, and conversely, all poor decisions are due to insufficient data.

r_hoods_ghost 4y ago
Yes the demand to have a documented policy, procedure and metrics for everything even if no one ever reads them, follows them or analyses them is insane. At the same time there's been this huge increase in the amount of useless correspondence and a cultural shift away from hiring people to help manage and filter this stuff so people can do actual work (aka old school secretaries and admin assistants). Harrumph
- ethbr0 4y ago
  IMHO, every required documentation policy should have its opportunity cost measured against the decrease in actual work being done. E.g. "Do we think this form being filled out is worth someone not being able to see a doctor?"
  - klabb3 4y ago
    Yes it SHOULD be. But the anxious leaders want more data for no other reason than to look at it and think they're more informed, when in reality they are not. It's like being addicted to looking in the mirror. It's good if you can notice the chocolate around your mouth, but more than that isn't helping, it's just a hobby. Only in this case your hobby is destroying everyone else's joy and productivity.

benj111 4y ago

On the other hand, my ex worked for the NHS. To 'solve' the problem of long wait times after check in. They reduced staff at check-in to bottle neck the in flow of checked in patients.

naasking 4y ago

> This means that more and more healthcare workers spend their time doing paperwork or customer service work that could be done by anyone The obvious solution seems to be reducing the required paperwork rather than hiring more staff to handle the paperwork, and this seems to agree with your experience when you described "unintegrated time recording systems". That said, I wouldn't be surprised if too much bureaucracy was also partly to blame, because that's what happened here in Canada.

rightbyte 4y ago

Lack of administrative staff in operations is a mayor problem, pushing paper work to medical staff. Where I live we have the same problem in schools, pushing administration to teachers. Admin bloat seems to be at a higher level if it exists. Because ordinary secretaries are long gone.