It is popular amongst many politicians and the public to say we need to spend more on more nurses and doctors, and less on managers and administrators. We need to spend more on medicines and treatments, and less on expensive computer systems.
This may be true, but it should not go unchallenged. A hospital or doctors’ surgery does need managing. Someone has to make sure there are the right staff doing the right things, that the medical supplies turn up on time, the meals are served and the floors scrubbed. In the 1980s when the NHS was reviewed, the Report concluded that the NHS was then undermanaged.
Maybe now we have too many managers and too many layers of management. Part of the aim of the current government’s reforms is to simplify and reduce the management overhead, which is a worthy aim.
A successful hospital also needs good administration with excellent computer records. A nurse or doctor reviewing a patient’s progress, administering continuing treatment or preparing a patient for an operation needs quick and easy access to the patient record. It is important they have the full background so they know what to administer, which treatment to pursue, and what to watch out for. One of the surprising things in some hospitals is how much is still done manually or with written records after years of high budget spending on computerisation.
Some hospitals still have handwritten notes at the patient’s bed end. They dispense drugs based on the patient written notes. A proper computerised system would be better at ensuring the right drugs were administered at the right time, as the computer would remember it had already dispensed a given drug, and could check that it was the right drug against a bar code prior to the drug being offered to the patient. Some hospitals I am told now have these properly computerised systems, with the necessary checks against wrongful dispensing or overdosing, and with proper audit trails created by each action in the system.
Sorting out the balance of work between medical professionals and adminsitrators is part of good management. Nurses and doctors do have to be involved in note making and recording, as it is their judgements which need to inform the system based on the evidence assembled from tests, talks with the patient and visual inspection of the problem.