Recently, I visited my mom in the hospital on a unit that specializes in patients with cancer. Hospitals are currently experiencing staffing shortages, and it was clear the nurses on this unit were overwhelmed. But despite this, 24-hours a day, a line of nurses sat in front of their computers entering data. The famous surgeon and author Dr. Atul Gawande complains he spends more time in front of his computer than seeing patients–“I’m a glorified data-entry clerk.” From what I saw, so are the nurses.
In general, I found the nurses at the hospital to be incredibly caring, wonderful people trying to do their best under incredibly difficult conditions. But a bad system will beat a good person every time. As a behavior analyst, I instantly think in terms of contingencies. I’m sure the nurses are under tremendous pressure to input everything just right on the computers so that the hospital can bill insurance companies. And, I’m sure it is also helpful to have good documentation of medications and treatments for clinical care. Yet, it seems clear that they could dramatically improve care if the nurses spent more time with the patients and less time on their computers.
As an old BCBA, I remember the days of sitting down after work to document client progress with a pencil and graph paper. We used paper data sheets, mechanical counters, stopwatches, and timers during sessions. Sure, it was a hassle to graph the data after sessions, but in general, it worked. Now, we have electronic data collection systems that were supposed to save time, but in some cases, make things worse. Even before electronic data was a factor, we knew that collecting too much data could hinder client progress if it disrupted using the best procedures available. A data collection system that requires nurses to spend so much time on their computers violates that rule– it forces the nurses to focus on the data much more than the patients. Wonderful people in a terrible system will surely lead to burnout.
I’m not so old that I’m complaining about all this newfangled technology. I understand the huge benefits technology has already given us and how much more is possible. I know that the good ‘ole days weren’t always good, and tomorrow ain’t as bad as it seems.
I admit I felt a little better hearing that a prominent physician such as Dr. Atul Gawande struggles with this issue, too. I believe significant improvements in the available technology would lead to substantial Poogi for BCBAs and the medical field.