The Trusts records and appointment services into one central department to reduce costs: Understanding People in Organisations Case Study, UOL, UK

Patient Experience and Facilities Management Department

In the Medical Records Department changes have been implemented to bring all of The Trusts records and appointment services into one central department to reduce costs. Staff have relocated from two community hospital record departments to a new purpose built administration and records library. In the community hospitals, records staff covered all jobs in the department, preparing medical records for clinics, sending out appointments, setting up new clinics on the computer system, filing, and answering telephone queries from hospital staff and patients. In the new department, these functions have been separated out so each employee can specialise in one area and build their expertise.

Detailed procedures have been drawn up for each function to help improve consistency of service, for example when dealing with patient enquiries staff now follow a script on the computer to ensure they cover all the necessary information. Staff have been carefully briefed on the procedures relating to their own jobs and trained on the new computer and telephone system. The records manager also holds daily team briefing sessions with staff to cascade information to them about the department’s performance. She appears to be in firm control of the department giving clear directions about what needs to be done each day, allocating each task to a member of staff. She has also completed all the staff appraisals and set every team member the same performance objectives to meet the departments key performance targets (KPT).

However, this department has also experienced some difficulties. One of the biggest complaints from the clinics has been the loss of patient records. Clinics have been held up and some patients have had to have medical tests repeated as a result. This has led to a lot of ‘in fighting’ in the team with divides appearing between staff from the old hospitals. When the records manager investigated she found a number of the missing files had been withheld by the doctors and consultants themselves revealing a problem with the overall process rather than with the ability of any of the team members. She is working on designing a new process to tackle this but her discovery has done little to heal the rift in the team. Two of her best staff have left the hospital to take jobs elsewhere and remaining staff have been reluctant to move their shifts around to cover the service. Friday afternoons and ‘out of hours’ (evenings and weekends) are particularly difficult to cover so staff who do work those shifts come under considerable pressure to keep up with answering queries and dealing with problems.

Medicine Division

Staff relationships appear to be better in the Accident and Emergency Department despite increased levels in the number of patients attending the Royal George A&E department to nearly 1,000 patients a day, as a result of limited GP capacity. The average waiting time in the department is currently 8 hours and 20 minutes, breaching the target of 4 hours from arrival to admission, transfer or discharge. Staff prioritise patients with the most severe injuries but the long waiting times are increasing customer complaints. They may even be behind higher-than-average reports of staff personally experiencing physical violence from patients in the department. At 1 in 5 this is the highest level reported in the Trust.

The new Clinical Manager has spent a lot of time in the department talking to patients and staff and observing its day-to-day operations. She set up a number of action teams and asked them to look at developing and putting in place solutions to a number of the key problems including speeding up the patient booking in service, the treatment and discharge of minor injuries and the completion and return of results from blood and radiological tests. Each team consisted of a mix of staff including doctors, nurses, administrative staff, and porters and was asked to spend 15 minutes, twice a week working on their solutions. These have been popular in the department and are now moving on to examine problems around wellbeing in response to staff suggestions. The manager told the staff she thinks this is a great idea and has offered to help the team by talking to the other Clinical Managers to see if they would be willing for the A&E teams to visit and talk to their staff to identify any examples of good practice which they could use.

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