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

Most of us know what ‘bad’ admin looks like in the NHS – appointment letters arriving late, not being able to make or change an appointment, or a referral getting lost. But what does ‘great’ admin look like? Great admin is often hard to see and tricky to describe.

It's designed to be invisible – often operating behind the scenes – smoothing the processes that enable patients, staff, information and equipment to all be in the right time and place. Great admin just works, and it works for everyone.

In our earlier research, ‘Admin matters’, produced in collaboration with Healthwatch and National Voices, we argued that high-quality admin has the potential to improve patient experience, reduce inequalities and promote better care. It can also contribute to a better working environment for staff.

‘Admin matters’ represents one of the few publications that focuses on the role admin plays in patient experience. We showed how people’s experience of admin can affect both their access to care and its quality. For some patients, poor admin can play a significant role in exacerbating pre-existing health inequalities. As such, we argued that patient experience of admin should not be overlooked.

'Our aim is to continue making the case for patient-focused admin – and for recognition of the role it plays in the delivery of inclusive, high-quality care.'

Usually, when admin does get attention, the focus tends to be on reducing bureaucracy, increasing efficiency, and making the system better for staff rather than patients. Staff are traditionally viewed as the users of admin – not patients. This is why we've decided to do more work on admin. Our aim is to continue making the case for patient-focused admin – and for recognition of the role it plays in the delivery of inclusive, high-quality care.

We're on the hunt for examples of great admin, and our definition requires both patients' views and health inequalities to be addressed. We want to understand how, and in what situations, NHS organisations manage to deliver great admin that is inclusive, accessible and designed by patients and staff working together. We want to showcase what is possible and share any learning about how it can be achieved.

It is not always obvious what drives change. You might expect organisations to pay greater attention to patient experience of admin when complaints are high or new digital platforms such as online booking systems are introduced. Other factors that have led to a focus on patient experience of admin include a desire to reduce the number of people who don’t attend appointments, implementing the accessible information standard or transforming pathways of care for specific groups such as people with dementia or cancer. More recently, patient experience of admin has come under greater scrutiny because of wider pressures on the NHS such as managing the backlog of patients waiting for care, or because of the critical role admin plays in the successful implementation of new policies such as patient-initiated follow up.

We want to understand better what it takes for organisations and individuals to shift their mindset and recognise the value of putting patients experience at the heart of admin. How is the NHS taking up Laura Wade-Gery’s recommendation that patients should ‘expect services to be designed with them in mind’?

'NHS organisations need to recognise their responsibility to remove as much of the burden as possible that poor admin places on patients who are anxious about their health'

And when we talk about patients and their experience of admin, we include explicitly an understanding that patients and carers have very different capacity and abilities to compensate for poor admin. This means that NHS organisations need to recognise their responsibility to remove as much of the burden as possible that poor admin places on patients who are anxious about their health, have communication disabilities, English is not their first language, poor (health) literacy and are digitally excluded. 
 
Finally, I end with 3 Rs: a reminder, a rallying call and a request.

• A reminder: patient and user experience of admin deserves greater attention, particularly if the aim is to deliver integrated, seamless care that addresses health inequalities.

• A rallying call: it’s easy to be inspired by what others have achieved when it comes to delivering great admin – here’s just one example of how the Covid-19 vaccine booking system was designed to with inclusion in mind.

• A request: please get in touch. Share your examples of great admin (patient-focused and inclusive) either as a patient, or a professional. We would love to find and learn from more.