Bureaucracy in Healthcare

A Barrier to Innovation?

Connecting frontline healthcare workers to leadership could be essential to unlocking innovation.

 

In a headline-grabbing recent report from Medscape, a survey of 15,800 physicians attributed the main cause of their burnout to “too many bureaucratic tasks”. Bureaucracy is overwhelming doctors and contributing to a sense of disconnection from their important work.  But bureaucracy isn’t just hurting our physicians, many argue that it also hurts innovation in healthcare.

Bureaucracy in its purest form is a vertical and organized management structure that dictates clear hierarchical relationship in a company. Chain of command is transparent and decision-making process follows a procedural pipeline from top to bottom.

While the bureaucratic system has its merit, as we progress away from the 20th century, we have seen an increasing amount of disruption across industries where innovative horizontal organizational structures have been implemented with great success. This disruptive new form of management structure is especially evident in tech firms such as Tesla and Amazon – as well as Scripps Health, a San Diego-based health system that saved $141M in just two years of implementing a horizontal management model.

Aside from a few exceptions in the industry, however, bureaucracy is still prevalent across the board – in hospitals, non-profit health care organizations, and health insurance companies. While the industry is changing from a volume-oriented to an outcome-oriented system, doctors are complaining about too much bureaucracy and patients are losing on potential benefit they may gain from innovation.

Bureaucracy and HIT Innovation

The challenges of a bureaucratic system might be especially apparent in cases of adopting new technology. Disconnected from frontline staff, health system administrators might be inclined to consider investments in new technology too costly, unnecessary, or risky, making health care organizations slow to adopt large-scale changes.

Nonetheless, administrative decisions to simply invest in “innovative” technology will not resolve barriers to successful innovation. While there are contradicting beliefs about whether or not technological innovation is an answer to some of healthcare’s most pressing problems, the challenge lies not merely in technology adoption– but in how it is implemented and how expectations are aligned.

For example, a  longitudinal study of family medicine, general pediatrics, and internal medicine attending physicians from the University of Michigan Health System found that that positive attitudes about an EHR system mostly declined after implementation to become more negative over time, including beliefs that EHRs could improve workflow, communication, and safety. These findings suggest that the problem with some technological innovation in healthcare isn’t always resistance against implementation but also unsatisfactory experiences.

What can help organizations overcome these barriers to successful innovation? Some healthcare organizations are turning to lean management and design thinking approaches for answers.

Lean Management

Lean management systems designate clinicians and frontline staff who help and/or interact with patients as key decision-makers, and some see this type of system as a game-changer for healthcare organizations.  John Toussaint, the CEO of Catalysis and former CEO of ThedaCare, a health system based in Wisconsin, is a thought leader in healthcare management and advocates for lean management systems. He argues that, when a lean management system is designed and operated effectively, every leader will have explicit work they must do on a daily basis in order to help understand frontline problems and identify improvement opportunities. This way, leaders’ efforts help rather than hinder the frontline work necessary to meet organizational goals.

One can see how a lean management system allows frontline staff to directly feed their expectations, needs, and concerns on a real-time basis to decision makers, thus not only improving the effectiveness of decision make, but reduce the risk of ideas problems worsening due to sensitive timing. For example, if a clinician in the referenced study had concerns regarding the new EHR system, instead of channeling his/her concern up the corporate ladder to be discussed in the next scheduled management meeting, the clinician would be able to communicate directly to the responsible management. Advocates argue that this approach not only saves time, reduces unnecessary additional personnel involved, and will also minimize the loss of key information while the message is passed on from one person to another.

Design Thinking in Healthcare

Another complement method to combat unhealthy bureaucracy is by implementing the design thinking in key decision-makers. Design-thinking at its core, is a systematic innovation process that prioritizes deep empathy for end-user desires, need, and challenges in order to develop a more comprehensive and effective solution.

This approach can create diverse teamwork and can supplement healthcare management in terms of innovation and practice. For instance, when decision-makers debate about the next course of action in their organization – whether to invest in developing an AI/robotics to reduce error in surgical procedure, to invest in new EHR in the earlier example, or to introduce a new record policy, the action revolves around frontline staff at its core. This way, while a bureaucratic system of vertical organization structure still exist, frontline staff are given considerations and assist in making their job easier.

Conclusion

While bureaucratic systems can be successful in the right circumstances, the growing financial, social and political pressures, require that health organizations must develop a more robust capacity for better addressing current and future services.

According to Jesse Roberts and colleagues, “Successful health systems will have the ability to innovate in delivering services that cut across organizational, political, geographical, and sectional boundaries”. While the concept is certainly not new, robust but easily accessible practice frameworks remain limited. It is  the responsibility of management and key decision-makers’ to transform their healthcare systems to survive changes in a competitive, evolving landscape.

Nat Tangpipith is originally from Yonkers, NY. She studied civil engineering at Syracuse University and proceeded to work as an engineer in NYC, delivering a variety of designs in bridge rehabilitation and underground utility systems. Passionate about traveling, Nat has been to 15 countries and counting. In her spare time, Nat likes to explore international cuisine with her friends as well as look for new and fun activities to do.

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