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Workflow Bribery

Publication date: Sep 15, 2006

A while ago the Economist magazine published an article [1] in which the author stated that "Since April, General Practicioners (GPs) [in England] have received 96p [about EUR 1.5, or USD 2] every time they use Choose and Book, a controversial electronic system for referring outpatients. Fed up with the doctors' resistence to newfangled information technology the National Health Service (NHS) has resorted to bribery."

To me this rang a bell. I remember someone from a Danish healthcare standardization (probably MEDCOM) who expressed similar sentiments (although not using wording with such negative connotations) based on experiences with the exchange of electronic messages within Denmark. Within Danish healthcare the amount of electronic messages (percentage wise, of overall communications) is very high. In order to motivate providers to participate in the project they were forced to pay a coiuple of Euro those that generated the electronic messages. Those that recieve the data have to pay a couple of Euro to ensure that the entire process is neutral in terms of costs.

When one thinks of it this makes perfect sense from a workflow perspective. For a GP to go the extra mile he'd have to be properly motivated. Assisting a patient in booking an appointment in a hospital may benefit the patient, but it carries an associated cost for the GP in terms of time. It takes a certain amount of time to enter and send information in an electronic fashion. The receivers of electronic communication benefit the most from that information: it saves them from having to re-enter the data or they may achieve cost savings elsewhere. To offset this unequality in terms of cost/benefit, one may indeed have to resort to "bribery".


[1] The Economist, "The NHS and IT", June 17th 2006

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