How can hospital administration be so bad? Someone please explain it to me.(84 Posts)
I'm waiting for surgery as I have severe endometriosis, a large ovarian cyst and complications due to adhesions. As is common with many endo sufferers, it took me years to get a diagnosis (thanks to my GP and that good old IBS diagnosis), before a trip to A&E finally got me seen by the right people. I had surgery last year, but the cyst has returned and I've been referred to an endo specialist for extensive surgery.
I'm in constant pain, it impacts my life daily, and I'm nearly 40 and have been trying to conceive for years. So it's a shit situation which I'm desperate to sort out.
But I'm being held up and tripped over at every hurdle, seemingly by a combination of incompetent staff and a clunky administration system which has allowed me to fall through the cracks. My experience so far:
Cockup #1 - Secretary panics, delays my referral, and then forgets to send it
I saw the consultant in August, and was told I was being immediately referred. After several months of patiently waiting, I called and asked a couple of questions about my referral. The secretary panicked, and decided that my questions warranted a further appointment with the consultant (they didn't), told me that I had to see the consultant because he needed to talk to me about something (he didn't, she totally lied) and that he wouldn't send my referral until he had seen me (another lie).
I complained to the hospital and spoke to the consultant, who agreed with me and apologised that the secretary was a 'low grade staff member who didn't understand the questions I was asking'. Which begs the question how the fuck was she able to make decisions which directly resulted in further delays to my treatment.
I was then told that the hospital 'forgot' to send my referral to the specialist. The consultant had in fact dictated my letter within days of seeing me, but that secretarial staff never typed it up and it didn't get written or sent until I reminded them to do so.
I finally saw the surgeon in December, and was referred to a second surgeon for investigations (I need multi-disciplinary surgery so both surgeons have to see me). I saw surgeon #2 in February. I was told that all that remained was for surgeon #1 and surgeon #2 to liaise and come up with a date.
Cockup #2 - Fallen to the bottom of the in-tray?
I have been calling regularly to ask for progress, and there has been none. Until a couple of weeks ago. I spoke to yet another secretary who reviewed my notes, put me on hold for a few minutes, then came back with "All I can say is I'm so sorry, we'll be writing to you asap". I took this to mean that there had been a cock up, they had forgotten me and were about to rectify that immediately.
Cockup #3 - You've done WHAT with my file?
I waited for that imminent letter, it didn't arrive. So I called again... spoke to a different secretary who told me that they were trying to get my case reviewed but were having trouble locating my case notes. Yes, my case file was currently missing. They. Had. Lost. My. File.
I immediately contacted the customer complaints department, spoke to a wonderful man who made it his mission to find my file. He found it within a few hours. It was the day of the Jr Doctors strike, and I apologized to him for hassling him on what was surely a busy day. He said that it was a bit bonkers that day, but he couldn't do much about it, so he was happy to be able to focus on the things he could help with and felt that helping me was a job well done. I could have cried.
Cockup #4 - it takes how long to sign a form?
So my file has been located <Congratulations to me!> and I spoke to the secretary again this week. She said all that was needed for the consultant to sign my form and then it could go to the team to schedule a date for me. Yes that's right, it has taken 2 months (and counting) for a consultant to sign a form.
Then she launches into this spiel about how there are thousands of other women in the same position as me, and some of them have waited years for diagnosis (you don't say!) so I just need to be patient!
Please could someone come and explain to me how hospital administration works, how files can go missing, how a secretary can make decisions on whether you ought to be referred or not, and how it can possibly take so long to get a man to sign a form? And can someone please explain how the listing system works - is there a queue, and will I go to the bottom of it as of next week when they hopefully, finally, receive the instruction to put me on the list?
I'm exasperated. I am extremely grateful for the NHS and I have no doubt that many of the issues are caused by under-resourcing and clunky systems (I work in civil service, I get it). I think if I could just understand how the system works, it might help me calm down a little.
Nope. There are no excuses. (HCP)
I suggest you speak to your hospital's PALs team and lodge a proper complaint. This stuff doesn't change if no one mentions it.
You are quite rightly furious. Sorry you are having such a hard time.
Oh thank you Lila for getting through my epic post!
I thought HCPs would come on here and tell me off for being impatient and moaning. The secretary I spoke to yesterday was quite patronising and almost gently chiding me for daring to be upset that it has taken so long.
I get that the NHS is creaking under pressure, I really do. I fully support the Jr Drs issue 100%.
I also get that lots of other women are in the same position as me, and I'm no more important than anyone else and don't want to jump the queue ahead of anyone else. But none of that helps the fact that I'm 38, and highly unlikely to conceive until I get this surgery done. Or the fact that I'm in constant pain.
I should have added that these are 2 different hospitals under different health care trusts. The first one with the secretary forgetting to send the referral is a different one to the one i'm dealing with now. I did lodge a complaint about the first one, which is what lead to the consultant calling me to apologize - if I hadn't done that, god knows what would have happened to my referral.
This time, I'm not ready to complain yet... it's just a delay which I'm being told is normal and I have to put up with it. It's just so sad that the system just seems to be failing so badly.
This isn't normal. I work in hospital management and if you did complain to me (I don't work in gynae so it definitely WON'T be me) I would a) investigate how this happened b) apologise to you c) point out to the secretaries that they have a duty to act as patient advocates and that includes not losing referrrals d) address whether there were any system failures that could be fixed.
Two hospitals and three consultants is quite complicated yes. Hospitals have differing IT systems and my hospital has a pretty advanced system in that you would still be on what we call a referral to treatment pathway. You're supposed to be seen and treated in 18 weeks. On my computer system you would now be well in to the red as you must be at about 30 weeks by now. My colleagues and I check our lists and ask the secretaries questions about people who seem to be in limbo. So I would hope you would show up with us and what's happened to you wouldn't have happened. BUT a lot of hospitals still use paper for this sort of tracking I think.
If you complain it would be worth asking how they keep track of patients on the 18 week pathway.
You asked about how records got lost. The answer is that they don't get lost, we just don't know where they are. That sounds the same but it isn't. Again in my hospital we have IT tracking so you book notes to a destination but if somebody moves the notesfrom that destination without booking the notes to the new place then it will be harder to find. You can usually find them though by looking at who has had a need for them and searching piles in offices. ROLL ON THE DAY WHEN WE GO PAPERLESS!!! This is what your nice man will have done and it is very satisfying when you find something like that.
In terms of listing you need to insist you are on the position in the list that you would have been in if they had behaved in a timely manner otherwise there is a risk that yes they will put you at the bottom of the list. So PALS is your route to ask for that if nothing else.
HTH, good luck with your surgery and TTC
That was a helpful response Northern.
Can I ask please. I had a hospital appointment on 19th April. Lovely lovely doctor - polite, helpful, informative. Referral for treatment has come through more quickly than expected. But why oh why are the admin staff so unhelpful? Why are they allowed to stand chewing gum in front of people behaving as though doing their job is so tiresome, why are they so rude and off hand to people and why, oh why is signage so awful. And finally, why don't hospital managers notice this stuff and deal with it?
I have severe endometriosis and large ovarian cysts on both ovaries. The pain is awful.
I was supposed to have surgery 2 years ago. I was on the waiting list for 6 months, got the letter and my surgery was booked. I got a call the day before my surgery was booked to tell me it had been cancelled and the next available appointment was in 4 months time.
I called two weeks before my surgery to check everything was all in place and to check I didn't need any tests beforehand (I had another illness that made me high risk). I was told everything was fine and was ready to go.
Got a call 3 days before my surgery to tell me I hadn't had a blood or MRSA test (apparently I was meant to have it a week before, so I was too late to go in and have it), so surgery would again have to be rescheduled. They said they would send me a letter, but it may be up to 6 months.
A month after this, I got a call telling me that I hadn't turned up for my surgery. I explained that I hadn't received a call or a letter, so I didn't know the date.
The woman on the phone said "Well, we didn't send you a letter, but you should know what day your surgery is on."
I got removed from the waiting list.
Cut a long story short, I am still waiting. They have told me I wont be a priority until I am TTC, which I am not at the moment and wont be for a long while yet, so they wont put me back on the waiting list.
I know I can't help you, but I just want you to know that you aren't alone. The pain is awful and I truly hope that you get things sorted soon.
Best of luck
HH - I'm sorry, I have nothing to add except I hope you get treated promptly now. I just wanted to say yours, Lila's and Northern's posts are fantastic! I'm in awe. And that, when you feel able, I hope you do complain - you certainly have all the knowledge on this page to word it in such a way that you can't fail to get a solid reply. Best of luck with your treatment.
That's really interesting Northern the system is such a mystery to me, so it's really good to hear how it works in your place of work.
Your system sounds amazing and exactly what I imagined should be in place. Unfortunately it doesn't sound like my hospital is using that system. I think the only thing that flags up when a patient is in the red is the patient themselves making regular phonecalls to stop themselves falling through the cracks.
I had heard about the 18 week pathway, but I'm not clear whether Ive gone over it or not. I was referred in October I think. I was seen in December, but then had to be seen by the second surgeon, so would that have stopped the clock? If I have grounds to complain, then I may well do so once I understand it. I've been given the impression that if I get listed next week, my surgery will be 'in the next few months'. So that's clearly way over the 18 week pathway - but can they argue that it's acceptible because of the complexity of getting the 2 surgeons together?
Totally agree about the need to go paperless! I am constantly alarmed when I see my huge file of notes produced, like something from the 1980s. I had a laparoscopy last year, and after that they showed me full colour photos taken during the op, so I know they existed (presumably digitally!). However, when I saw the specialist consultant, he pulled up on his screen a grainy black and white photocopy of the images, in which you could barely see anything. That was all he had to go on - why, when the images exist and could have been emailed over to him in seconds, did someone have to photocopy a bloody photograph?
Sorry Toast, I am a slow typer. Best of luck with your treatment too and anyone else whilst I'm typing!
Toast that is appalling - I would certainly complain under those circumstances. And not TTC shouldn't be a reason not to treat your case the same as any other. You're in pain, and with cysts you're at risk of further complications if they don't get sorted.
Beau hear hear! My worst experience (at the first hospital, my local one) was with the receptionist at the scan unit. I was taken there from A&E - introduced by the healthcare assistant who had brought me there, and after she had left the receptionist looked me up and down and said "Do you think you can just walk in here and demand a scan?". I was stunned, but because I was traumatized having come from A&E, I just repeated "The Dr told me to come here" over and over.
I experienced more rude treatment from the same woman when trying to arrange a follow up scan and I wish I had taken her name and complained about her. The way she treated me, while I was clearly in distress, was appalling. To think that she's dealing with women who are having miscarriages etc makes me shudder.
Since then I realised that complaining is the only way to make the managers understand what's wrong so they can fix it. When I did complain about my messed up referral, I did so in a polite and factual way, and made sure I gave credit to the medical staff and wonderful treatment I had received. I'd hate for any of the criticism to be passed to them, when in fact it's the failing system and ultimately the managerial / directors levels that should be brought to task.
My 3 year old waited 18 months for a cardiac appointment due to admin cock ups. Thankfully his problem turned out to be non life threatening but I shudder to think what might have happened if it had been serious.
That sounds rotten. I used to work on NHS Projects in a relatively senior role. But between projects I would often take on short term NHS contracts for a bit of extra cash and something to do. It also helped me gain knowledge of operations which was useful in the project role. So I have quite a bit of experience in the working of admin.
The way the secretary spoke to you was absolutely unacceptable and she should know that. It's a customer facing role and the people you're speaking to are often in great distress. She's just not doing her job properly if she made you feel like that.
Regarding the other stuff: 9 .5 times out of 10 it is actually the consultant that causes these things. Leaving files on their desks, dictating letters but just leaving them in draft and not pressing the button to send them on to be processed, inaudible, unintelligible dictations, leaving out a bit of information (eg that a referral should be made). Unfortunately I think what the secretary did about the referral was correct. If that hadn't been passed on to her she would have had to refer it back to the consultant rather than just passing it on to be referred on the patients say so. And, yes, the consultant probably wouldn't remember and would just tell her to make you another appointment without looking at your file and probably only refreshed their memory when you called. And somebody probably even got a rocket up their arse you even got through to them.
The thing is, when you speak to an admin person, they can't say 'I'm very sorry this has happened, but Mr/Ms Consultant is a disorganised arse who takes 4 weeks to pass on his clinic notes and dictates his letters from the end of a wind tunnel with a sock over his mouth and ignores the letters with queries that we put on his desk'.
They have to be diplomatic and blame it on system errors. But absolutely every fucker in the rest of the hospital has carte blanche to blame their errors on 'admin' as a general cover all. It is a hard job, and they do take a lot of shit for other people's errors.
But that does not excuse the way you were spoken to in any shape or form. That was unacceptable.
Signage - The problem with that is that I know my way round my hospital blindfolded. I don't use the signs. We do try with new services to think 'how does this look from a patient's pov' but it's really hard to do when you know where everything is. So the answer to that one is for patients to complain. Because that tells us what to do and how to fix it.
Similarly rudeness from staff - this is not acceptable at all but I don't see my staff as a patient does. If I observe something unacceptable I act on it but again if people complain tht helps me see the team as patients are seeing it and act accordingly.
18 weeks - the main ways to stop clocks are through treatment or through a decision to 'actively monitor' a condition. So from what the OP as said I would guess her clock is still running. Needing to go to another hospital doesn't stop clock.
I have a chronic rheumatology condition and got a bit lost in the system earlier this year, saw a locum with bad English who didn't write up the notes, saw a very odd rheum nurse who ended up "leaving the trust". Basically my worsening condition never got actioned (a year of decline) and I had to complain. Polite complaint was written Wednesday morning consultant rang at eight a.m. Thursday and I had an appointment Monday. I feel awful for complaining but consultant said no don't feel bad, management don't listen to us, nothing gets dinner until patients complain. I think you are perfectly justified in writing a polite factual e mail of complaint.
I'll admit as a hospital secretary myself I came on here ready to explain and defend, but that's such a huge pile of failings! The manager of that secretary or team of secretaries needs to have a real look at how their office is being run. Referrals shouldn't be lost - I imagine a chaotic office with lots of disorganised paper piles contributing to that - and if the consultant disagreed with what the secretary said, that's a lack of communication which needs to be looked at. The delay in the letter being typed I could be slightly more forgiving of - I know in our department (3 consultants plus their juniors seeing patients in clinic) the number of letters waiting to be typed usually hovers around 80-100 and there are only us 2 secretaries typing them, which we often can't do as quickly as we'd like due to all our other duties, the phone ringing constantly etc. But that's a staffing issue, the other issues sound like they need to be dealt with by improving practice in the office itself. Sorry that was a bit of an essay!
I was shocked when I turned up for a hospital appointment to be told that the notes hadn't been FAXED over with the referral. FAXED!!
I had similar issues with my maternity care when I was expecting DS1, lost booking in appointment notes, then lost bloods twice, then a three hours wait for my scan (after which I was told that I had missed my midwife appointment. At my next scan (where I had no notes at all), I was told that I'd been booked in with the wrong person and she couldn't do a nuchal fold assessment, but that they didn't have any other appointments during my window of opportunity.
Not even an apology. DH and I decide that if no-one was able to get even the basics right, we were not trusting them with our precious baby and we went private.
Its very common, I often refer through the NHS as part of my profession and I'd say something goes wrong in 1 in 3 of the referrals I do. Usually notes being lost.
Faxed indeed! I imagine all the working faxes in the country exist solely within the NHS, the rest of us having got rid of them in the mid-90s when this newfangled idea called the Internet really got going.
wheresthetea I fully expected to have my arse handed to me by hospital secretaries telling me I was being unreasonable and impatient, so thank you. And thank you for painting a picture of just how under resourced these offices can be - I can fully imagine the chaos and stress that can cause.
And BillSykes yes I can well imagine how difficult it must be for the staff having to cover up for the Consultant's failings. When I was seen by Surgeon #2, he was late for my appointment (and I was first in after lunch, so it's not as if he was over-running with someone else, they told me so). I was lying on a hospital bed, prepped and ready to go for ages, and the nursing staff kept rolling their eyes and saying 'Mr Consultant is always late...'. So yes, I can certainly see that he might then have taken a while to write up his notes, and contribute to the delay.
I guess if no one complains, the hospital chiefs can carry on patting themselves on the back and paying themselves huge salaries with no one highlighting the failings in their systems. At least that's how I imagine it (it's certainly what happens in my civil service dept).
So the original failing in the referral, plus the rudeness of the scan unit receptionist were at my local hospital. I can leave that one behind me now, and concentrate on getting seen at the specialist centre.
That leaves me with the following plan of action: On Tuesday, I'll ring up the secretary to ask whether my form has been signed off by the consultant yet. If it hasn't, I'll ring every day until it has.
Once it's been signed, I'll give the appointments team a few days to get me on a list - that should take me to the end of next week. I'll ring them and point out that there was an admin delay and to please list me from the date of my consultation in Feb. Does that sound fair?
When all that is done - I have certainly gone well over the 18 week pathway - so is there any point in me complaining, if I've been given a date it's unlikely to change anything, but should I highlight it anyway?
I'd say that's a very good plan OP. But I would add that I think you should complain about the way she spoke to you as well, it really wasn't on. Maybe do that after you have the appointment? Through PALS perhaps?
Peppa, yes, in some cases things do still have to be faxed. Security of patient records is absolutely paramount so you can't just scan and attach. If you do that, you create a huge risk that things can be insecure (eg hackers) and can also be disseminated pretty quickly very widely. Likewise you can't just stick it on the cloud. There really are good reasons why fax is still used sometimes.
I'd just draft a timeline of errors with the click ticking from the start weeks pencilled in as it goes and send it to the ceo's office with a little covering note noting your disappointment with the time frame compared to the 18 week promise and gently say that if any clinicsl issues arise as a result that are to the detriment of your future health you will hold the trust responsible.
Northern seriously, the rafts of managers in the NHS need patients to complain about things like signage? Why so you can hire more managers to deal with the complaints? Likewise, seriously can managers not identify when staff are being rude or introduce some guidelines about the basics: Not chewing gum, smiling, saying please and thank you, treating people with basic respect, not chattering to two colleagues about Jack shit when there is a queue at the desk.
Seriously if NHS managers can only deal with stuff like that if patients complain, what on earth are you doing. Surely part of your job should be setting the,standards so the patients, customers, clients, etc., don't have to complain.
Only yesterday I got an appointment from St Georges which didn't specify what it was for. I phoned outpatients and they helpfully put me through to the doctor's secretary. She told me off because my call was supposed to have been put through to the IV unit and meant she had to look it up because she didn't know without doing so. Unbelievably poor response. It happens so often it's,about a culture of disrespect that managers either don't see or can't be bothered to put right. Why should patients take the time to complain when hospital managers should be doing their jobs and preventing this stuff from happening. It isn't new, it isn't acceptable, and it shouldn't be happening. No wonder some patients get cross and shout at these people but the underlying rudeness is almost on a par with a firm if coercive control because the majority of patients don't have choices.
What do you think would happen if the next time I face admin with a gob full of gum I ask them to remove it if they wish to speak to me or if I have to speak to them. Shall I refuse to deal with them if they don't comply and insist their manager comes to the desk and deals with it ir with my query?
Honestly, do you not see why the onus should be on hospital management rather than the patient.
Sorry BillSykesDog but when on two occasions in the last year a letter from the hospital or my GP has had a letter destined for another patient in the envelope, that is just lame.
That's fucking awful beau. That's why window envelopes are always supposed to be used, so the person on the letter is the person who receives it. It's a serious breach of confidentiality.
Sometimes it's a case of you get what you pay for. This a large generalisation of course and there are some total gems to be found. But the majority of NHS admin roles are at pay scale 3 or 4, which is shockingly low.
Managers (of which there are FAR too many) on the other hand... Some are paid ridiculously high amounts (pay scale 8, a, b, c).
It was in a window envelope (both times) with another letter behind mine.
I've got staff on low grades in the public sector. Some calls are recorded. If they were as rude as many NHS staff they would not keep their jobs so I think this is about the doing people a favour culture too. When was the last time an NHS manager reminded their staff (and indeed some of the clinics staff) that the NHS isn't free, it's only free at the point of delivery.
I agree with Zoobaby NHS admin is now so badly paid that it attracts very few able candidates. Good medical secretaries are like gold dust and it's a skilled job they should be able to prioritise referrals and have a good understanding of how the the hospital works , medical procedures and how to ensure the consultant is top of his caseload. Unfortunately the NHS pay rarely attracts these good candidates nowadays and often they end up with people who can do typing and filing but not much else.
I'd complain to PALS but ime you do have to constantly chase up referrals and appointments as in most hospitals there is big black hole where some referrals end up because admin don't know what to do with them and just hope no one chases them up.
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