Saturday, April 05, 2008

Lies, damned lies....

I had a little stab of empathy this afternoon while reading the letters page of the latest Listener. Someone in my household works at APN so I still read bits of it, even though the covers frequently make me roll my eyes (and so do a number of other things). In the letter in question, the chairman of the Otago DHB, Richard Thomson, is responding to an earlier letter (by Ian Ritchie and John Davies) which stated that there are "12,000 hospital beds and 9840 managers" and that DHBs spend 60-70% of their budgets on administration.

In his response Thomson points out that the writers have conflated administration and management in their head count, which has boosted enormously the claimed proportion of managers to beds "If I include every receptionist, telephone operator, typist, records clerk and the like as a "manager" and multiply that by 20 to scale it up to the national level, I can almost get up to his figure."

However what really prompted my sympathetic response was the information Thomson supplied about what money reserved to pay administration costs is spent on: such "optional extras" as feeding patients, paying phone and electricity bills, cleaning, laundry, computer removal and transporting Dunedin-based doctors to Invercargill for clinics. The services are essential, and the roles involved are often thankless but without both the hospital would cease to function.

Administration is also often a thankless task, and yet numerous previous work experiences have taught me that good administration is the difference between an organisation or project functioning efficiently (or at all), and falling over. Organisation of people, tasks and finance has to be done - and logically if someone isn't paid to do it, then clinicians, nurses and other healthcare professionals have to take it on. Indeed, Thomson states that clinicians were the ones who resisted a final round of admin reduction at the Otago DHB on the grounds that it would affect their ability to do their jobs optimally.

Efficient systems that reduce the time and labour required for admin are essential, but there seems to be a lot of a fetishisation of frontline healthcare professionals in discussions about healthcare. This devalues the other very essential roles involved and ignores the reality of what it takes to provide sustainable healthcare in an environment where those with medical expertise are free to practice medicine and leave as much of the rest of the deal to people with different skills.

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