Beyond ‘bad admin’ exploring what great admin looks like and how it can be achieved

We all know what ‘bad admin’ looks like in the NHS. Appointment letters that arrive late, being unable to change or cancel an appointment, and referrals that get lost. What does ‘great admin’ look like? Great admin can be difficult to define and hard to spot. It is designed to be hidden – it operates behind the scenes, smoothing out processes to ensure that patients, staff, equipment, and information are all at the right place and time. Great administration works and works for all.

In our previous research, “Admin Matters,” produced in collaboration with Healthwatch and National Voices, we argued high-quality administration has the potential to improve patient experience, reduce inequalities, and promote better care. It can also improve the working environment of staff.

Admin Matters is one of few publications to focus on the role that admin plays in the patient experience. We demonstrated how the experience people have with admin can impact their access to and quality of care. Poor admin can have a major impact on the health of some patients. We argued, therefore, that the patient’s experience with admin is important.

We will continue to advocate for a patient-focused administration and the importance of its role in delivering high-quality, inclusive care.

When admin gets attention, it is usually to reduce bureaucracy, increase efficiency, and make the system better for the staff rather than the patients. Staff, not patients, are traditionally seen as the primary users of admin. We’ve decided to focus more on admin. We want to continue to make the case for a patient-focused administration and the recognition of its role in delivering inclusive, high-quality care.

Our definition of great administration includes both the views of patients and the need to address health inequalities. We’re looking for examples of great admin that is accessible, inclusive, and designed by both patients and staff. We want to show what’s possible and share learnings about how this can be done.

Change is not always easy to predict. When complaints are high or when new digital platforms like online booking systems are launched, organizations should pay more attention to the patient experience of administration. The desire to improve the patient experience in admin is also a factor. This could be due to the need to reduce the number of people who miss appointments, implement the accessible standard, or transform pathways of care better to serve specific groups like people with cancer or dementia. In recent years, the patient experience of administration has been scrutinized more due to the pressures placed on the NHS, such as managing a backlog of waiting patients or the role that admin plays in the successful introduction of new policies, such as Patient-initiated follow-up.

We are interested in understanding what it takes to change the mindset of organizations and individuals and put the patient experience at the center of administration. How has the NHS responded to Laura WadeGery’s recommendation for patients to ‘expect that services will be designed with their needs in mind.’

NHS organizations must take responsibility for removing as much burden as they can from patients who are worried about their health.

When we discuss patients’ experiences of administration, we also include the explicit understanding that both patients and caregivers have different capacities and abilities to compensate for poor admin. NHS organizations must reorganize a responsibility to reduce the burden that poor administration places on patients with communication difficulties, English as a second language, low (health) literacy, and digital exclusion.

Last but not least, I will end with three Rs: a reminder, a rallying cry, and a request.

  • A Reminder: The patient and user experiences of the admin deserve greater attention. This is especially true if you want to provide integrated, seamless health care that addresses inequalities.
  • A rallying cry: It’s easy for us to be inspired when we see what other people have done in the field of administration. Here’s an example of how The COVID-19 vaccination booking system has been designed with inclusion as a priority.
  • Please get in touch with me. Please share your experiences of good admin, both patient-centered and inclusive. You can do this as a patient or professional. We’d love to learn more about great admin.


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