Busy Work

These days, it seems like everyone is being asked to do more with less...less money, less time, less staff, etc. The only thing that seems to grow is the number of clients and productivity requirements! 

However, even as caseloads continue to climb, along with stress levels, I rarely hear colleagues complain about the time they spend with clients (except to say that they don't always have enough time for each client!). However, I do hear (lots of) complaints about all the other tasks that don't involve direct service - in other words, the busy work.

And there is a lot of busy work. Most of it involves documentation. In fact, just about every social work joke I've heard makes some mention of paperwork. Other kinds of busy work involve meetings, insurance red tape, and phone calls (especially the amount of time on hold, or wading through automated response systems before you get to talk to a real person). 

When it comes to documentation, I'll be the first to say that good records are important. Keeping records is necessary because it helps to ensure a high quality of care (if you have to record it, you're more likely to do it), while protecting professionals from liability (provided they are doing what they're supposed to do). It's also useful to maintain continuity in treatment, remember details, and update other providers regarding treatment that has been provided. 

However, all of these potential benefits of documentation are diminished as the volume and redundancy of paperwork grows. Basically, the more there is, the harder it is to find the useful parts, and the lower the overall quality tends to be (because it is more rushed). 

I had hoped that the trend toward electronic medical records would streamline documentation and minimize the volume and redundancy. However, thus far, I have not experienced that to be the case. Part of the reason may be that I live and practice in Massachusetts. Why, you ask? Because of the Massachusetts Standardized Document Project. Basically, a committee created a full set of mental health documentation (assessments, treatment plans, progress notes, etc.), which agencies have been encouraged to adopt. I believe the goals were twofold: to standardize forms so that, when someone's records are shared with a different agency, the receiving clinicians can make sense of them; and to ensure that documentation meets the standards established by the government and third-party payors. 

While it is hard to object to these goals, the actual product - the standardized documents - leaves much to be desired. The result of committee work is often to make things more involved or complicated, rather than simpler and more concise, for the simple reason that people disagree, and both sides get something included so that everyone will be happy. Of course, in reality, no one tends to be fully "happy" with the result, and that is certainly true of these forms. I don't know anyone who likes them! The psychosocial assessment is a full 12 typed pages, before adding 7 possible addenda (e.g., education, military service, trauma, legal, substance use, etc.). Any useful summary, diagnosis, or risk information is buried somewhere inside the stack, making it time-consuming even if someone else completed it! It has drastically expanded the amount of time I have to spend on paperwork, while making the result less useful for actual treatment.

I can't blame it all on the MSDP, however. My full-time job does not use it, but still has a ridiculous amount of paperwork, which is frequently redundant...and mostly hand-written, so you can't even cut and paste (the only saving grace when using the MSDP forms). Each client has to have 9 treatment goals, so most of the time we have to spend with each client is focused on updating these, rather than really meeting clients where they are.

I don't have an easy solution to all of this busy work, but I think a priority across agencies needs to be streamlining the paperwork, and other busy work, so that more time and energy can be spent focusing on the people we're meant to be helping. Time is a resource, and in this era of resource scarcity, we need to be better stewards of staff time.