By Joshua.Chambers

06 Apr 2011

An NHS worker wonders why her hospital has a complex IT system but also uses paper records


"I’m a patient administrator acting as the main point of contact for cancer patients in my hospital. I help them receive treatment as quickly as possible, ensuring we reach the national 18 weeks target, by providing both patients and doctors with all the information they need throughout the process.

Often, I’ll be dealing with about 20 patients a day. I’m the person that patients can phone up and say: ‘This doesn’t make sense.’ It’s my job to get their medical queries answered quickly. On other occasions, they’ll ask me administrative questions such as why their appointment has been changed. Patients benefit from speaking to someone they know, and can feel uncomfortable asking questions of a doctor because they worry they’re wasting the doctor’s time.

I have been doing this job for 18 months, and now it’s about to be combined with a managerial role: taking charge of the secretaries in the department. Inevitably it will make the job more stressful because it will be more work, but I think it’s a good idea for people who interact with patients to manage staff.

Currently, the people who are managing services get pulled back and sit in an office somewhere rather than interacting with doctors and patients on a day-to-day basis. This means that we at the frontline have constant meetings where we explain things to them in great detail, because they have become out of touch. Every time there’s a problem with our processes, I have to go to my boss and explain it to him and try to get him to do something about it. This is frustrating, and when I have managerial responsibilities I will be able to do something about the problems I encounter.

I find my job fulfilling because it’s rare that you get to interact with patients in the context of senior NHS administrative work. I can build the service from the ground up, identifying where problems are and moving things forward. Secretaries and appointments staff would benefit from more face-to-face interaction with patients in order to identify problems with our processes.

It would be useful to have in-house training on how to interact with patients – this also could be given to receptionists in GP surgeries and in hospitals. Currently, when you get an administrative job you only get given a basic staff induction. Doctors and nurses are taught advanced communication, whereas if you’re an administrator you don’t necessarily have those skills.

However, I do think that the level of human resources support in the NHS is generally too high. We’re very well protected, which is a good thing because people can get mistreated in the workplace; but equally, if somebody isn’t doing their job properly it can be difficult to remove them. Some people think they get paid less than in the private sector and therefore should be given more leeway, but this isn’t always true.

A frequent problem is that people will repeatedly take time off sick because of stress. This may be legitimate, but if you work in the health service you should expect it to be stressful. Maybe I’m being harsh, but my initial reaction is that if you’re finding the job stressful you should try a different profession, because someone else could do your job instead. It takes a long time for abuse of sick leave to be identified.

Another problem is our IT system: We have a computer system in place, but we also still use paper records. Only some of our patient information is put online, and not everyone has access to the data: there’s an appointment system for secretaries and administrators, but doctors don’t use this. So if someone cancels an appointment the system is updated, but doctors still won’t see it and have to be told separately.

Also, some doctors don’t like to access online patient records, and prefer to look at paper records instead. They are resistant to using computers because they have set ways of doing things which involve using paper notes. Some NHS trusts have embraced computer systems, as have some GP surgeries. However, doctors in this hospital will dictate a letter, which is backed up electronically, and then post it to a GP surgery. There’s a lot of time spent filing paper records and maintaining parallel systems. This costs extra money because the NHS has to pay both IT and medical records staff, as well as buying the expensive software.

I don’t know why a better system wasn’t developed in the first place. This problem arises when people from IT companies don’t sit in clinics and observe doctors at work. They rely on the opinions of senior clinicians, who may be set in their ways and prefer to maintain the status quo. Unfortunately, this means they don’t always know what’s going on."

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