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The Role of Bureaucracy in Modern Health Care


"The purpose of a bureaucracy is to successfully implement the actions of an organization of any size (but often associated with large entities such as government, corporations, and non-governmental organizations), in achieving its purpose and mission, and the bureaucracy is tasked to determine how it can achieve its purpose and mission with the greatest possible efficiency and at the least cost of any resources."[1]

I have a physician friend practicing in a rural hospital in South Africa although trained in UK. The hospital is fairly new and modern, as it was built to meet the FIFA traffic in a nearby city.  There are computers in strategic locations, however as a network was never established sit unused. There is a sophisticated lab offering many of the needed tests.  However, there is no process to deliver the results to physicians in a timely fashion.....hence there is a great amount of duplicate ordering. And results are rarely charted resulting in stakes of thousands of pieces of paper no one looks at. There are abnormal tests that are never followed up and treated.  There are patients who are sent home without test results and who come back in a much more acute condition.

She has had to deal with ventilators that broke down during a surgery, running out of oxygen, running out of common medications having to break into the pharmacy after hours to retrieve needed medication. After being told a needed filter was not in stock, she even rummaged through the "stores" to find what she needed as the worker there had no idea what she was talking about.  Nurses won't take needed vitals, refuse to give scissors to cut off patient clothing in fear of dulling them and so on and so on.

There are no non-clinical leaders, consequently, all decisions are made at time wasting meetings where little is resolved.  There is total disregard to efficiency and productivity.  My friend who I have dubbed "super Doc" often has to chase her own lab results, take her own vitals, and find interpreters to understand one of the 11 national languages in SA. As the physician in charge of ICU and Anesthesia, much time is wasted doing work that non-clinical trained personnel should be doing.  And did I mention she has to get on the phone (sometimes for hours, assuming the phone are working) and arrange for transfer to another facility or program? An EHR? Are you kidding? She even "invented" CPAP for a patient who needed positive continuous airway pressure......and it wasn't for sleep apnea. Recently there was a near riot as outpatient care closed leaving close to 25 patients unseen.

The over-all effect of the lack of bureaucracy is poor patient care.

Practice management there is absent , and while we may lament the slow-down of efficiency and productivity that bureaucracy may create; we take for granted the advantages it brings.  Practice management to be efficient takes a business mentality, not just a clinical one.

Every time I hear one of her new horror stories, I more and more appreciate not only the clinical advantages we have here, but also the business mentality brought to healthcare that values my time and the time/skill of the physician.

Can bureaucracy be a stumbling block to progress?  Sure, but without it, little progress is seen.



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Posted @ Wednesday, April 09, 2014 2:41 AM by Obat Angin Duduk
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