How can bureaucrats be improved dramatically

Marabu / magazine

Hardly any other industry in Germany is as strictly regulated as the healthcare sector. Doctors now spend up to three hours a day filling out forms or documenting their work. This is the result of the current study by the Rhein-Main Healthcare Industry Initiative. The study was based on interviews with managers in hospitals, nursing homes and medical practices.

The results are clear. From the point of view of those surveyed, the number of regulations and rules has increased noticeably in recent years. Many of the respondents describe the intention to achieve quality through a flood of controls, sanctions, quantity restrictions and discounts on remuneration as the wrong path. In this way, instead of the desired better quality and specialization, politics rather promote leveling and mediocrity. That is also not in the interests of the patient. Good performance is punished in this way, according to the current press release from the Rhein-Main health economy initiative.

"The present study makes a valuable contribution to the discourse by questioning the bureaucratic requirements for service providers in the health sector, what is necessary and indispensable and where this can be relieved and organ structures capable of acting", explains Professor Dr. Harald Schmitz, CEO of Bank für Sozialwirtschaft AG, who supported the study. It becomes critical when excessive bureaucracy obstructs one's view of one's own business. The original task of doctors and nurses, i.e. the service to people, must always be in the foreground and it is important to use resources as sensibly as possible.

A team from the Institute for Health Care Business GmbH led by the experienced health economist Professor Dr. Boris Augurzky evaluated numerous documents in the summer and autumn of 2017, scrolled through law books and interviewed around two dozen senior doctors and health managers from practices, rehabilitation clinics, care facilities and hospitals in the Rhine-Main region and other parts of Germany. The overwhelming opinion: The density of regulation in the health system has gotten out of hand.

What are the causes?

Numerous institutions have been identified as causing bureaucracy. First and foremost is the MDK, which now subjects 15 to 20 percent of all hospital cases to an examination. That's about three million exams a year. In many cases, it is a question of individual examinations in the written procedure, which entails a high degree of paperwork on both sides. The newly introduced discharge management, which is intended to ensure seamless patient care after a hospital stay, was also mentioned frequently. The associated increasing documentation requirements create a high level of bureaucratic effort for those surveyed who do not have a functioning electronic patient record.

The outpatient-inpatient sector boundary also causes bureaucratic burdens due to the lack of digital interfaces. Overall, the low level of digitalization is a bureaucratic driver for many service providers because this means that processes have to be handled manually or in paper form. In addition, the increase in documentation requirements is criticized in many areas. In the area of ​​quality management, in addition to internal quality management, external quality measurement and certifications as proof of quality are playing an increasingly important role. These require a high level of documentation, some of which is also not in digital form.

Recommendations for action to politicians

Professor Augursky and his team derived ten recommendations for action for politicians from the study. Among other things, they are calling for the creation of a uniform telematics infrastructure, cross-sector communication channels and efficient data protection. To do this, patients must be authorized to own their data. A lifelong patient ID is to be introduced in order to simplify processes and enable clear allocation of patient data across all sectors.

Another recommendation is the creation of more efficient test procedures of the MDK. Instead of examining individual cases, tests should be bundled and carried out as statistical sample tests. In addition, the independence of the auditors should be ensured in order to avoid interest-based audits.

Specific regulations in the outpatient and inpatient sector make data exchange and communication between the sectors more difficult. Debureaucratisation is called for here. In addition, according to the authors, the introduction of a cross-sector patient record is imperative.

Recommendations to service providers

However, according to the study, service providers can also reduce bureaucratic work independently with the following measures:

  1. Consistent sifting through and streamlining of your own processes as a permanent management task.
  2. Investments in digital technologies that are suitable for automating bureaucratic activities or avoiding redundancies, e.g. voice-to-text, smart technologies, "online check-in" to simplify patient registration.
  3. Use of documentation assistants in nursing and medical services.
  4. Expansion of cross-sector care offers within the framework of the current legal possibilities.
  5. Harmonization of both the IT systems in medical practices and the hospital information systems, seek cooperation with the manufacturers.

In addition to this study, it can be stated that the processes can be effectively supported by suitable software in order to drastically reduce the processing in paper form. This can be, for example, an electronic patient file for treatment documentation, QM software for documenting internal quality management or a tool for the effective processing of MDK tests. In this context, the required harmonization of the IT systems is also useful so that documents can be exchanged across applications without any problems.