CoWs to bust bureaucracy

Junior doctors spend 66% of their time accessing or updating patient notes, a report by the Health and Social Care Information Centre has found.

The Busting Bureaucracy report, which carried out audits in 16 NHS trusts, found that too much time is spent on collecting, finding and entering data.

For instance, one trust reported that computers on wheels has reduced ward round times by 45 minutes, however, perhaps not surprisingly, most trusts have problems with systems working in silos.

“The audit findings confirmed that in all organisations there are examples of technology being implemented without process change, resulting in similar or increased levels of burden and bureaucracy due to a mixed economy of digital and paper,” says the report.

85% of maternity units surveyed in the report, responded that they use “local or bespoke electronic systems, none of which are integrated with other trust systems.”

The report adds that 77% of trusts record data on paper and then transcribe it into the electronic system, and without paper and electronic systems being integrated with each other, technology in itself does not actually release clinical staff time.

The HSCIC launched the ‘Let’s Bust Bureaucracy Together’ campaign in October last year to transform the way the NHS thinks about managing burden and bureaucracy.

The audit report sets out 13 recommendations, one of which is a concordat: “All approved external data collections must include details of how the data will be used and what tools and feedback mechanisms are available to contributing organisations.”

This concordat is also recommended to be extended to cover clinical commissioning groups and local area teams who are “introducing new burden on trusts by not conforming to national standards.”

The HSCIC also recommends that to ensure that investments are assessed against criteria “which drive clinical effectiveness” and improves processes, the progress should be measured against the Clinical Maturity Index developed by EHI Intelligence.

Commenting on the report, HSCIC chair Kingsley Manning said that high quality data is “crucial to transforming care,” but that unnecessary “bureaucratic burden” must be stamped out.

"Our first audit report and recommendations today, along with the new self-assessment toolkit, are steps towards ensuring the right data is recorded to support better care, but in a way that does not place an unnecessary burden on staff."

A key focus of the busting bureaucracy project is to establish a single dataset and move towards an electronic patient record to address the burden.

One of the biggest burdens reported is duplication of data, especially when recording patients’ past medical history.

External targets and data requests have added to this burden and the report says that one of the main issues is “disconnect between national standards and local demands which creates an unnecessary significant burden and bureaucracy which have been magnified by the number of commissioners.”

Health secretary Jeremy Hunt also commissioned the NHS Confederation to produce a report called “Challenging Bureaucracy” which was published in December last year.