Doctor Clerk Implementation in Rural Community Hospitals for Effective Task Shifting of Doctors: A Grounded Theory Approach

Abstract

With the diversification of medical care and work reform, doctor clerks play a major role today and are recruited to mitigate the burden of doctors worldwide. Their recruitment can improve the working conditions of physicians, facilitate task shifting in rural community hospitals, improve patient care, and help address the lack of healthcare resources. This study used a qualitative method to investigate difficulties in the implementation of doctor clerks and ascertain the features of effective implementation by collecting ethnographic data through field notes and semi-structured interviews with workers. We observed and interviewed 4 doctor clerks, 10 physicians, 14 nurses, 2 pharmacists, 1 nutritionist, and 2 therapists for our study. We clarified the doctor clerk process in rural hospitals through four themes: initial challenge, balance between education and expansion, vision for work progression, and drive for quality of care. We further clarified effectiveness, difficulties, and enhancing factors in implementation. Doctor clerk recruitment and bridging of discrepancies among medical professionals can mitigate professional workloads and improve staff motivation, leading to better interprofessional collaboration and patient care.

Effectiveness of Doctor Clerks Supporting Physicians’ Work in Japan: A Systematic Review

“…Regarding effectiveness in task shifting and workload reduction of physicians, the predominance of document support as the primary task among doctor clerks (94.1%) aligns with the initial intent of their role to alleviate the administrative burden on physicians [28]. This task shifting is evident in the reduced paperwork time and physician overtime work, as reported in several studies [18,21,27]. Expanding roles to include consultation and ordering support also signifies the evolving nature of the doctor clerk's responsibilities, potentially leading to a more holistic approach to assisting physicians [26,27].…”

“…This task shifting is evident in the reduced paperwork time and physician overtime work, as reported in several studies [18,21,27]. Expanding roles to include consultation and ordering support also signifies the evolving nature of the doctor clerk's responsibilities, potentially leading to a more holistic approach to assisting physicians [26,27]. Doctor clerks can be involved in health promotion, vaccination, and primary to tertiary prevention for better quality patient care [27].…”

“…Expanding roles to include consultation and ordering support also signifies the evolving nature of the doctor clerk's responsibilities, potentially leading to a more holistic approach to assisting physicians [26,27]. Doctor clerks can be involved in health promotion, vaccination, and primary to tertiary prevention for better quality patient care [27]. To promote their effective working of quality of patient care, doctor clerks should participate in the discussion of quality improvement of patient care.…”

“…However, it is essential to balance the expanded roles of doctor clerks with the need to maintain the quality of administrative tasks, ensuring that the shift in responsibilities does not lead to a decline in the quality of these tasks [18,19]. In addition, in community hospitals, the collaboration among doctor clerks and family physicians is essential for better patient care because family physicians are the main stakeholders in interprofessional collaboration for health prevention and promotion [27,29]. For enhanced evidence to clarify the effectiveness of doctor clerks, the collaboration between family physicians and doctor clerks should be investigated in the literature.…”

Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis

“…Interestingly, previous studies have considered the facilitating role of specialists (e.g., dietitians or general practitioners) in guiding patients to healthy diets [ [36] , [37] , [38] , [39] , [40] , [42] , [43] , [44] , [45] , 55 ], but we found that some “specialists” could be a barrier to intervention implementation for not being able to give adequate and effective guidance promptly if they lacked sufficient competence, played weak roles or the intervention stopped abruptly. This is particularly pronounced in primary care settings where healthcare resources are relatively scarce [ 38 , 39 , 68 ], which puts higher demands on the adequacy, professionalism and timeliness of interventionists. Furthermore, we found that the level of intervention is important.…”