The importance of secretaries in health care organisation
Part 1 Sarah
The importance of secretaries in health care organisations is poorly understood or recognised. This month our unit said goodbye to Sarah who has been working with us for the past sixteen years. Sarah has effectively been the front end of our business. She received telephone calls from patients and clinicians alike and in a kind, caring and compassionate manner navigated them through an otherwise potentially scary pathway. Sarah did not have a script nor was she trained to do this; she was a natural. We looked for a voice for a narrator for our patient information video. An independent expert identified her voice as quiet yet authoritative and reassuring with a comforting quality. I noted this many years ago when I had the privilege and pleasure of interviewing Sarah.
Service organisations teach and train people these skills as they understand the importance of the front line and first impressions. It is true you never get a second chance to make a first impression. That conversation, what is said and especially how it is said, set the scene for the rest of the pathway. Sarah pleased all the patients and received outstanding feedback and gifts of chocolate and wine from patients. People coming to my outpatients wanted to meet the person belonging to the voice.
Sarah coordinated all the information regarding all the patients including the referrals, angiograms, notes and investigations to ensure they were all together in the right place, at the right time to enable me to make the right decisions especially in outpatients. This removed delays, duplication and uncertainty. Moreover I had all the information to enable me to make decisions. Sarah then typed the notes and letters. She ensured all the relevant people in the patient’s specific pathway received the information regarding the forthcoming treatment and status.
Sarah’s typing was exemplary and accurate in contrast to digital voice recognition systems. This was further enhanced by her ability to take shorthand (a skill that will soon disappear from use like the slide rule). Although this was to me a luxury, it was not as important as the collation, correction and presentation of all the information to all the people in the pathway. This is the inimitable role of a ‘secretary’ and in Sarah’s case it was supplemented with a unique understanding and connection to the operations network of the whole hospital garnered over thirty eight years of service to our hospital.
Concomitantly, Sarah entered every patient’s details on the patient admission administration system and entered basic details on our clinical database for audit. The time of admission and discharge was collected at the point of contact and confirmed by myself when I entered the clinical data. This happened on a daily basis. In essence, we were counting the admissions and defining my finished consultant episodes. Together we cross checked the discharge summaries and the accuracy of the data that I had entered into the database system. This was all prospective and real time and has resulted in a very accurate record.
Sarah served two important functions; firstly, Sarah was the meet and greet of our service and secondly, Sarah’s knowledge of the hospital enabled her to expertly navigate through a complex system to ensure the individual patient pathway ran as smoothly as possible. She received many compliments from other clinicians and junior doctors who always found her extremely helpful in locating details about patients and where they were in the pathway or who to call if there was a problem. Sarah – thank you very much for sixteen fantastic years – I could not have done half the things I have without your expertise.
David J. O’Regan
MBA (Distinction) MD BM FRCSEd (C-Th) FFSTEd
Thesis –‘Why can’t Dinosaurs Boogie?’
Part 2 – The importance of the ‘Secretary’
The first role of the secretary is a Patient Care Navigator. The secretary navigates the patient through the clinical pathway keeping them and the clinicians informed at each stage from home to home. This is critical to ensuring that all the right information is escalated and presented to ensure the right decisions are made at the right time. Furthermore, the secretary, through telephone conversations with each patient, often understands their individual needs and social circumstances. The patient’s own priorities often change and are communicated to the secretary. Their knowledge of individual patients and the nuances of their social support often prove integral to the clinical decision-making and timing of intervention.
In keeping with the principles of service, the character, tone and manner in which the secretary answers telephone enquiries sets the tone for the unit as a whole. You never get a second chance to make a first impression and whilst most secretaries are good in this aspect of their role, it is not scripted, rehearsed or taught in health care unlike in other service sectors and call centres.
The second role of the secretary is the ‘concierge’ of the unit. This is a very important role especially at the time of changeover of the junior staff. They often have a huge knowledge of the workings of the organisation. The secretary is the part of the mobile Retrieval at Notification Administrator (mRNA) of the organisation. Using the cellular metaphor, the mRNA connects the nucleus of the cell (the management interior) to all the other organelles (departments) to ensure a smooth coordinated function. The mRNA of our organisations can be found in the network of secretaries, ward clerks and schedulers in each and every department. They ensure the information about the patient flows through the system. mRNA is critical to the survival of the cell and likewise these people are critical to the survival of the hospital. This essential communication affords flexibility and adaptability.
The third function of the secretary enables the hospital to realise the business of health care. The secretary ensures that the patient admission and discharge details are correct and therefore the finished consultant episode (FCE) and SPELL in hospital is accurate. Clinical details are collected at the time of admission and discharge by clinical staff but cross checked by the secretary with the consultant on a daily basis. This means clinical and operational data is collected as near as possible to point and time of clinical contact with patient thereby maximising the accuracy of the data. This is essential monitoring of the business, the flow and clinical status of the patient.
Despite all this, mapping of our patient pathway revealed seventeen independent IT systems collecting data about our patients with little or no communication between systems or feedback to the frontline. The organisation continues to collect data at every level adding layers of duplication with escalating inaccuracies.
The secretaries are the ‘micro’ operational managers of the patient pathways for every consultant team. They often are sharing the same corridor or space. Nobody is better positioned to realise accurate clinical and operational data. Sadly the importance of this is underestimated. We could have all the data available immediately if we could just link all the secretaries in the organisation and entrust them with this role.
I believe the hospital would run a lot more efficiently if it extended the role of the secretaries and recognised and rewarded their real potential. Many of the secretaries are doing all this already but I do not think that our healthcare organisations quite appreciate their valuable contributions at every level. Typing is no longer the imperative as this can be done by voice recognition systems. What is essential is accurate clinical and operational data reflecting the time intervals along the pathway and the use of investigations, drugs and consumables. Patient Level Information and Costing (PLICS), the holy grail of a hospital, will not really be achieved by creating a digital warehouse. It can, however, be realised bottom up, from the patient-secretary-consultant clinical interface by examining the valuable contribution and extended role of ‘secretary’.
Perhaps we should consign the term ‘secretary’ to history and rename these unsung heroes with an appropriate and modern eponym – they are the mRNA of our complex systems who have the potential to realise the business of health care by navigating the patient through a pathway effectively, efficiently and with a kind, compassionate service focus. I do not have one name for such a person but I do recognise how valuable they are to my clinical practice. Join me in saying thank you.
David J. O’Regan
MBA (Distinction) MD BM FRCSEd (C-Th) FFSTEd
Thesis –‘Why can’t Dinosaurs Boogie?’
