What is an Appropriate Task?

Posted on November 22, 2010


Of the myriad examples of ways to make healthcare more efficient and thus more affordable, I keep coming across the idea of clarifying job duties. Strangely, I have read two strategies that appear to be contradictory.

The first calls for hospitals to assign tasks appropriately; that is, individuals should do only the work for which they are credentialed. This keeps nurses from doing tech work and doctors focused only on care.

The second approach, most prominently put forth by Clay Christensen in Innovator’s Prescription, calls for the less credentialed to take on more advanced tasks and skills, with the aid of technology and training, and displace the more credentialed professionals. This would free up doctors and nurses to focus on only highly technical, high value care giving.

At first these seemed in contrast, but actually the ideas work together. Keeping “expensive” professionals doing highly billable work makes sound financial sense. And increasing professional skills and productivity of the support and tech staff is extremely important, especially when it works in tandem to free up doctor and nurse time to get in more highly billable procedures accomplished.

There is a rub with this approach, though. It takes fairly precise staff ratios to have the right number of support and tech personnel to pass off all non-essential tasks to. The delegation of tasks is not a clear line when it comes to things like dictation and charting.

Yet, the law profession has solved the problem quite well. Efficiency and task division differs from law firm to law firm; I know of a small practice that shares a paralegal and one admin among four attorneys, but I also know large firms that have four support personnel for each attorney.

Such strict task delineation flies in the face of modern business theory where most businesses today train everyone and empower everyone to answer the phone when it rings and provide customer service. In most cases, no one is above making a pot of coffee or running a photocopy. Organizations have been trending flatter in management structure, less egalitarian, less stratification, rank, and imposition of task command-and-control. The efficiency of time use is a separate argument.

In a design environment, where we too have licensed professionals and support and technical staff, the work assignment generally follows credentialing—at least on a macro job description level. But in the heat of battle, for example, it may be quicker (more efficient and cost effective) for me to do some Photoshop work, though it is not my forte, than to hand it off to a graphics whiz. This is the gray area in which we operate, in the trenches.

These are the scenarios hospitals will have to choreograph to the point they are satisfied socially among their staff, and financially on the balance sheet.