On why bureaucracy is not a dirty word

Published: 12/08/2004, Volume II4, No. 5918 Page 23

Frontline staff have a mantra they recite every day - cut the bureaucracy and let us get on with the caring.What happens, then, when a trust apparently ignores this heartfelt protest and does exactly the opposite with the words: 'Here are some admission guidance notes. Use them wisely'?

How can an instruction to people not treating or working directly with patients to fill in a form in a certain way, to record some details and not others, to notify this person or that person and so on, make a difference to a patient?

I am convinced that the future of patient care improvement and sustainable delivery can best be assured with a system in which clinicians and other professionals are supported by administrators with the same knowledge of, and commitment to, the same standards. And I wanted patients and staff to know that things were better without having to bother about why they were.

That is when I developed the idea of administrative guidance notes (AGNs) to create a new culture at East Kent, by underpinning the clinical work with a coherent, consistent way of moving patients through our healthcare system.

Simply put, they are a means by which everyone involved in supporting patient care knows they are doing the right thing at the right time. There is no difference of opinion that might jeopardise patient care.

Although the notes were devised by me they were developed by staff. I wanted to capture the commitment and expertise of our frontline staff, and more than 200 people were involved in investigating best practice, researching and writing the notes - everyone from receptionists to booking clerks.

Now there are more than 100 different sets of guidance notes, covering every aspect of a patient's stay. Clinical and nursing colleagues tell me that the AGNs have reduced internal 'postcode' inequalities between sites, provide a corporate identity for all our staff and help create ownership of patient care by a much wider group of staff.Most importantly they smooth the flow of patients, reducing waiting times.

They take into account national guidance on best practice and will be reviewed annually. I sign off all 100 sets of notes and the clinical management board signs off those with a direct impact on patient care.

The Audit Commission has praised the effectiveness of the guidance and Kent and Medway strategic health authority is planning to introduce them.

The trust is getting more patients in faster and our did-not-attend rate has dropped dramatically. Consultant gynaecologist Dr Malcolm Stewart is a convert: 'It is fascinating to see how something which on the face of it is just another bureaucratic system has extended the understanding of patient care and patient needs to every corner of the trust. It is ironic that - so far - few doctors or nurses know much about this. The system is working so well that they do not have to.'

Kim Hodgson is deputy chief executive and director of operations at East Kent Hospitals trust.She won manager of the year at last month's Health and Social Care Awards for the AGN project.