Multimedia, Analytics February 18, 2023

When Bean Counters Manage Patient Care

by Barry P Chaiken, MD

My nurse colleague with more than 20 years of experience in patient care started working at an ambulatory care clinic about two years ago. Soon after she joined, a large for-profit healthcare company purchased the non-profit clinics. Initially, work went on as usual. Patients were well-served, and clinicians were happy.

Over the last four months, things changed. Management put controls in place to track the effort of every nurse. For example, if assigned to phone triage, each nurse needed to log in at the start of their shift. If interrupted to assist a physician with a procedure, the nurse was required to log out. If a nurse failed to do so, the IT system logged the mistake, and the nurse received an email or verbal reprimand. Failure to log out hurt productivity numbers by lowering the number of calls per hour per nurse.

The system’s deployment rigidity does not account for clinical judgment, even as justifiable as leaving phone triage to assist a physician in treating a patient. Unfortunately, the reporting system also makes clinical workflow burdensome and inefficient.

Rather than focus on patient care and clinical outcomes, senior management focuses on questionable productivity reports. And for what purpose? With provider organizations struggling to hire nurses, creating such a disrespectful and oppressive work environment seems illogical. Yet it exists. And I hear stories from colleagues of similar ill-advised productivity tracking schemes in other industries.

The ability to collect data does not mean it has a valuable purpose. And only some of us think the number of patients seen or the number of calls taken is a good measure of clinician productivity. We should consider using our IT tools more responsibly and focus on reworking clinical workflows to achieve productivity gains. Demoralizing nurses and physicians is a poor strategy that ultimately hurts patients.

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