Bureaucracy centric care. Patients Perspective

I believe I know what is killing healthcare innovations, digitalization, personalization and all other beautiful initiatives. It is bureaucratic rigidity.  Bureaucratic system is manifolded. It may include hospital management, health insurances as well as ministerial authorities. All those bodies  however multifaceted are united by one common goal: to justify their existence and financial stability by issuing the abundance of regulations.
For example, it is obviously hard for an insurance clerk to imagine that a patient could be transferred from one hospital department (e.g. neurology) to another (e.g. cardiology).  The insurance compensation schema requires separate hospitalization for each episode of care. Hence according to insurance regulations a patient has to be first discharged from the entire hospital  to be hospitalized later to another department of the same hospital.

54% of the German doctors complained that they spend more than enough time on administrative tasks such as account processing, insurance reimbursements and other procedures non-related to patients’ treatment.

Here are my observations after spending a day in one of the largest and acknowledged hospitals in Germany.

I have arrived to the hospital for a consultation with the well-known Professor. The appointment was set by a doctor from a polyclinic which is a part of the hospital campus. According to the guidance, I had to  first register myself at the hospital Main Registration Desk proceeding to the Professor’s Secretariat after. A nice lady at the Registration Desk handled me a piece of paper with many bar codes wishing a nice day. The day however, started badly.

The lady at the Professor’s Secretariat apparently was not happy with the paper I have delivered.
– “This is the wrong paper” she said. “What was the number of the cabin you were registered in”? My burning mind was desperately searching for the answer. Miraculously my memory fished out the number.
– “Cabin 2”.
The lady picked up the phone. After long and hopeless beeps she has arrived to the intelligent conclusion:
– “Seems nobody is responding. Can you return to the Main Registration Desk and fetch the right paper”?
I had no clue what the “right paper” should look like, but neither seems the lady at the Main Registration Desk. Now it was her turn to call back the Secretariat.

After some interactions I was instructed to go back to the polyclinic where  the appointment was initially set and clarify the matter there.
– “But how can I explain what we are looking for?” I had a nasty feeling that the appointment is at risk. The lady honestly confessed she was not quite sure herself hoping that people at polyclinic can provide some clarity.

If somebody was unlucky visiting a big hospital you may have an idea of its architecture:  chaotic connections of blocks chained by kilometres of twisted corridors and elevators with one purpose only: to  lock a visitor in its labyrinths forever.

I  was fortunate to noticed a Red Cross desk. An amiable Red Cross lady volunteered to show me the way to the polyclinic. I could not resist complaining. Patients as well as medical professionals should not be entangled in all these tricky bureaucratic procedures.

– “It will be even worse.” sighed the Red Cross lady. “ Our healthcare system  is sealing each medical department  within the silos of administrative processes. Doctors want to work together, but regulations consequently often prevent their cooperation”

Finally we have reached a polyclinic. The young girl at the reception was also very friendly. Unfortunately, the collection of bar codes meant nothing to her as well. There was again an urgent need to consult the Professor’s Secretariat .

Interestingly, that nobody in this gigantic hospital seemed to use any kind of internal communication system  that can reach a person everywhere by mobile phone or computer showing who is present or absent at the working place. Modern systems such as Skype for Business or at least WhatsApp or Viber were nowhere seen. Instead hospital staff was using traditional phone lines.

After a short conversation with the Secretariat the girl triumphantly announced that I can go back and have my appointment.
– “How about the papers?” – I have asked cautiously.
– “No need for ones. Just go!”

With a supersonic speed I have reached the Secretariat. Hardly catching my breath, I have informed the secretary that now everything was settled .
– “Perfect!” The lady was apparently relieved. “So where are the papers”?
I was speechless. The expression of my face clearly indicated that I was not moving anywhere from now.

The meeting with the Professor was constructive. Apparently, more investigations were necessary for which short hospitalization was required. The next step was to get a referral from a polyclinic. This polyclinic was also part of the hospital campus, but not the one I have just visited. Let us call it polyclinic number 2.

The lady in the Professor’s Secretariat handled me the referral signed by the Professor himself  and kindly offered to  set up the appointment for me. After 25 minutes she appeared looking somehow puzzled.
– “Nobody is responding to the call. Maybe you can just go there?”. I felt something like a déjà vu, and plunged into a new journey. After half an hour wondering through empty corridors, I was lucky to bump into a cleaning lady. I grabbed her hand pleading to  bring me to the polyclinic number 2. I was ready to clean all the corridors for her on the way there.

The reception at the polyclinic 2 was empty (no wonder the phone was not responding!). Although it was not a lunch break a girl appeared in a quarter of an hour.
– ¬“What do you want”- she asked roughly. I have silently handed the Professor’s letter.
– “So what?” her eyes were sliding through the lines with apparent indifference.
– “Well, this is the letter from the Professor from your hospital with the request for the appointment in your policlinic”
The girl looked at me haughtily.
– “After the first of October you need to get a referral from a medical practice”.
– “But your policlinic belongs to the hospital, right?”I still hoped the whole thing was a misunderstanding. “Why should I go to the unknown medical practice to get a referral from a doctor who never saw me before?”
– “Because this is the regulation from the first of October”. The girl’ s intonation presumed no discussions.

I had no choice, but to trudge back to the Secretariat. I have informed the Professors assistant that the referral from the Professor of this hospital from now on was not accepted by the policlinic number 2. Eloquent silence hanged in the room.  The thunderstorm was approaching, so I slipped into the corridor.

In the next 25 minutes Professor’s assistant was fluctuating between Professors’ cabinet and the Secretariat. Finally, the Professor himself appeared announcing that my appointment was scheduled for the next week. Obviously he was annoyed by  the whole story, but managed to control himself quite well. Apparently, after a couple of calls the Professor had fixed the issue.

Papers with bar codes  as well as the hidden regulations behind them are still a mystery to me. But are those regulations really worth doctors time and patients’ anxieties?

I am not naming nor blaming the hospital. It could be any hospital in the country. Despite all efforts of medical personals it seems extremely hard to penetrate the bureaucratic system barriers.




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