A Case Study in Leadership-Caused Harm
My colleague Paul DeChant, MD, MBA often invokes the term “Administrivia” to refer broadly to the many tasks, processes, and requirements that take Clinicians away from direct patient care.
Entering data into — or searching about — the EHR; tilting with insurers about prior authorizations; or managing the message in-basket — these are all examples of Administrivia.
While these activities may be noisome and time-consuming, they are not deliberately or knowingly intended to inflict harm (although that often results from the sheer accumulation of these non-clinical tasks).
But what about a change in policy or practice issued by senior leaders that almost certainly will result in harm to clinicians? What if the prudent person principle — ie, any reasonable person could assess the situation and predict with confidence that there would be adverse consequences — was seemingly ignored?
Well, in that instance, we’re no longer talking about “Administrivia” but rather “Administrative Iatrogenesis”. In short, harm — even if inadvertent or unintended — results from a single Administrative decision.
I offer as Exhibit A of Administrative Iatrogenesis the recent decision by New York City Health and Hospitals to require its physicians to now see patients every 20 versus 40 minutes.
The ostensible goal is to increase access for NYC patients. According to Becker’s Review (August 25), the key factor behind this decision was an increase from 11 to 21 days in adults waiting for an appointment.
Clearly there’s an access issue in NYC, especially among the uninsured, underinsured, and Medicaid populations as is true in many communities. But this short-sighted, ill conceived decision will not only lead to increased burnout among the entity’s physicians but also a likely exodus of caregivers, thereby exacerbating the patient access issue.
A much better choice would have been to hire more RN’s to do initial screenings and assessments, perhaps augmented by an increase in APP’s, thereby allowing physicians to see — and manage the care of — the more complex cases.
I suspect — and am hoping — this ill-advised decision originated in the Mayor’s Office, and not within the leadership of NYC Health and Hospitals.
Either way, I predict whatever short-term benefits accrue to patients — and to Mayor Adam's political standing — will be more than offset by the long-term adverse impact of this object lesson in Administrative Iatrogenesis.
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