Administrative procedures
Errors have a tendency to compound themselves, so it is worth taking the time to ensure that essential tasks are carried out carefully (see Box 11). Many complaints arise from simple mistakes that could have been easily avoided. The most common administrative failures are:
- Failure to pass on important information.
- Failure to arrange appointments, investigations or referrals with the appropriate degree of urgency.
- Failure to review the results of investigations.
- Failure to arrange follow-up and monitoring.
- Mislabelling, misfiling and failure to check labels.
Develop appropriate systems
In a busy practice, it is easy to dispense with protocols or overlook a crucial administrative procedure in the interests of speed. If your staff are unaware of the rationale for introducing a protocol, they are less likely to adhere to it. The best way to gain their compliance is to involve them in drawing up the protocols in the first place (that way, you also ensure that they are workable from the staff’s point of view).
Carry out an assessment of your routine procedures and protocols to identify potential problems, and develop systems for averting them. Particular risk elements are:
- Telephone use – eg, logging and passing on messages, discussing patient-identifiable information within hearing range of other patients, non-professional staff giving medical advice, documenting telephone advice.
- Communicating results of investigations.
- Following up missed appointments.
- Prescription renewals and reviews.
- Maintaining medical records – filing, tracking and security.
- Making and following up on referrals.
- Keeping relevant people informed about changes in a patient’s condition or circumstances.
Box 11: Suggestions
- If a test or a referral is urgent, make sure the request is marked “urgent” and that you make a diary note to check that it has been actioned. Telephone the laboratory or department if necessary.
- If a letter needs to be typed, mailed, faxed or e-mailed urgently, impress the need for speed on the secretarial staff.
- Make sure there is a formal system for recording and passing on telephone messages – scraps of paper and post-it notes are easily ignored or mislaid.
- Arrange a foolproof system for reviewing results of investigations: if a test result is abnormal, deal with it promptly and appropriately.
- Make sure records are filed properly.
- If you tell a patient you will do something – such as sending further information, or making a referral – record it in the case notes, and either do it before seeing your next patient or make a note of it on a “Things to Do Today” list.
- Write or dictate referral letters, clinic letters and discharge summaries promptly, and make sure that appropriate individuals receive copies.