A surprising finding is that improved efficiency, which may also mean seeing more patients, can increase job satisfaction by removing the pointless work staff have to do to fix broken systems, look for missing equipment or deal with failure to get care right first time.
As we see in the case study from Mozambique, sometimes quality and costs can be improved by training workers to take on tasks that have only previously been done by doctors.
While there are many opportunities to shift tasks to lower paid and less extensively trained staff it is a mistake to assume that this is always the answer. In emergency care it seems that having the most skilled and experienced decision maker as early in the process as possible produces better results and lower costs. In the example from Buurtzorg efficiency is maximized by integrating tasks. The extra costs incurred by using better educated professionals for tasks that could be done by lower paid and less qualified staff are offset by the reduction in travel times, the costs of hand offs and the improved decision making by staff who can use their judgment to decide what is required and identify problems. There are unexpected benefits from this, for example, while the home care nurses are doing less demanding tasks they can talk to the patients and identify risks and issues that can reduce future costs.
The need to match the right skills to the task is one of the reasons why the use of pathways is a key strategy for improving processes. As the case studies from Aravind Eye Care and Circle show they are also important as tools for improving performance, eliminating waste and in engaging clinical staff in design and improvement. This is an example of how leading organizations have started to treat knowledge management as a key organizational competence. Best practice can be designed into processes rather than having to rely on hiring the most knowledgeable individuals.
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