Friday, 28 November 2008

Paperwork killing the health system

It's only taken an enormous inquiry and an 1100 page report to uncover what I discovered on a couple of hospital visits over the last few years - the health system in NSW is being murdered by paperwork. On every visit, either planned or unplanned, the amount of time that staff spent dealing with paperwork was truly mindboggling. J had to spend a few days in hospital once whilst all sorts of tests were run, and the way she was looked after was quite shocking.

It wasn't that the place was rundown or the staff useless - it was very modern, all the equipment was new and most of the staff were capable and nice. They simply had no time to spend at the bedside with patients, because they spent all their time at their desks shuffling files. In one ward with 10 staff, on each visit, I would count 8 or 9 of them doing paperwork everytime I came in - regardless of the time of day. That would leave 1 or 2 staff to attend to the needs to the 30 patients in that ward.

Would patient care suffer if 90% of that paperwork was blown away? Possibly. But how many die or suffer horribly at present because staff are spending all their time pushing files and little time prodding patients?

I was presented with a paper nightmare the other day. I am starting a new contract with a client that I worked for last year. Before I started there last year, I had to fill out 10 pages of background check information. I had to enter the same information in 5 different locations - name, date of birth, places I'd lived etc etc etc. I could have completed the paperwork in 1/5th the time if they had designed their forms sensibly.

I finished that contract a few months ago, but I knew there was a 90% chance I would be going back. I still have my ID badge from them, and clothes in their change rooms. However, before restarting, I had to fill out the same paperwork all over again.

When I did it last time, I scanned it and saved it. Since nothing had changed in the interim, I thought I could just print out the old stuff and send it in again.


The forms had been redesigned. I had to handwrite the same information into five subtly different forms. The information that they wanted was exactly the same - just the shape and location of the boxes had changed.

This is the sort of madness that infects companies once they reach a certain size and age. HR departments are notorious for generating mounds and mounds of forms. They always have a way of justifying why they need to waste so much of your day with useless paperwork. I am sure that our health system is infected with idiots of this ilk.

Some years ago, the company that I worked for was broken up. The bit that I went with threw out all the policies of the old company, and started again from scratch. We only wrote policies and procedures for the things that we really needed, or where we needed a paper trail (I somehow got stuck with the job of writing a lot of them). We ended up with a policy manual that was about 10 pages long, and almost every form that we thought we needed was web based on our intranet - paper forms were abolished.

Years later, I had to do some work in the company that we broke off from. In the years that had passed, they had added a multitude of policies and forms to their inventory of paperwork. Just for kicks, I counted their HR forms one day.

There were 130 of them. All had to be filled out by hand and submitted on paper.

Their policy manuals filled an entire shelf, six feet from end to end.

That company was an unmitigated, unrelenting disaster. It was a heap of shit from start to finish. The desks in head office were something to behold, groaning under piles of paperwork. Workstations were surrounded by bulging filing cabinets. Nothing could be done unless a sheaf of paperwork was produced, processed, lost, redone, rejected, redone again, eaten by a dog, filed, lost, found and approved.

Unfortunately, I bet that one of the recommendations in this new health report is that they computerise a lot of their paperwork. Instead, they should throw most of it out, and then computerise what is left. If they computerise the stack of crap that they have today, all they will end up with is a stack of electronic crap, and a total reliance on a computer system that will break down on a regular basis under the enormous load of crap being fed into it.

Paperwork probably also explains why morale always seems to be lower than whaleshit in most public hospitals. If I was a nurse or doctor, I would be doing that job because I want to fix people - not because I want to spend my days completing paperwork. How many get depressed and angry because their jobs are more clerical than clinical?

Paperwork - it can definitely kill you.


kae said...

I agree, Boy!

kae said...
This comment has been removed by the author.
1735099 said...

The same is the case in all public sector agencies. You can sheet the blame to a toxic combination of media beat-ups, plaintiff lawyers, and political reactionaries. Between them, they've set up a self-perpetuating system that has taken on a life of its own.

Boy on a bike said...

173, you have hit most of the nails on the head. I suffered mainly from the first in my last job - we used to call it "policy by Daily Telegraph". The people that ran our show were terrified of the Telegraph, and whenever we got bad press, we had to "do something".

If I was running the government, I'd cancel all contracts with Media Monitors and tell all senior public servants, policy advisors and MPs to pay less attention to the wham-bam of the media and more attention to making things work properly.