A third pillar of patient safety: exploring the critical role of administration and clerical staff

Abstract

The contribution to patient safety made by administration and clerical (A&C) staff, a major staff group in healthcare, is inadequately described or under-recognised with few relevant or systematic studies. This review seeks to provide insights into the role of A&C in this area, describing risks, causation and potential mitigations. Evidence relating to A&C and patient safety discovered in indexed publications and 'grey' literature (public and statutory inquiries, special interest group reports, policy documents) is reviewed, before addressing specific challenges to safe 'backroom' or office-based activities. There is sufficient evidence to conclude that A&C staff and associated tasks are important to patient safety. Risks can be organised into themes. These include: team working and shared understanding; departmental stability and memory; responding to change and innovation [especially information technology and new electronic health record (EHR) systems]; healthcare emergencies or fluctuations in demand [such as the coronavirus disease 2019 (COVID-19) pandemic]; human factors and repetitiveness of tasks; just culture. Mitigations are presented in each area, encompassing departmental organisation, culture and an emphasis on applying the theory and learning from clinical practice (such as human factors) to this staff group. The contribution by A&C to patient safety should be clearly acknowledged and consciously considered when recruiting and inducting staff, and in designing the environment in which they work. Arrangements should be put in place to encourage close co-working between A&C and clinical staff. There is a potential for ongoing digital transformation and artificial intelligence (AI) to improve workflows and reduce risks.