For this post, I thought I’d tackle an interesting question: What does the word “clinical” mean, exactly?
This is an interesting challenge. When people hear the word clinical, they usually think of someone taking care of a patient, usually in scrubs, often with a stethoscope around their neck.
While that may be true, it’s also an incomplete definition. There is more to the story. What about people who don’t wear scrubs, like social workers, case managers and registration, who all have a great deal to do with clinical care and patient safety? Or people without stethoscopes, like pharmacists?
If we ask Google for a definition of “clinical,” it gives this result:
Interestingly, it includes the description of “efficient and unemotional; coldly detached.” (How exactly did that happen?)
Anyway, what I find more interesting is the part that reads, “… relating to the observation and treatment of actual patients.” To me, this is more relevant, because it brings into focus the connection with “actual patients,” who are what clinical care is all about.
Unfortunately, in some healthcare settings, the word “clinical” is sometimes used to distinguish, incorrectly, between two ‘types’ of workers in healthcare:
- Those people who directly or indirectly take care of patients (clinical)
- Those people who don’t directly (or indirectly?) take care of patients (administrative)
When compared to the term “administrative,” the word “clinical” becomes meaningless and confusing. This confusion is sometimes perpetuated by policy manuals which generally describe two sets of policy standards commonly found in healthcare operations:
It may not be that big a deal, but in my opinion, this older terminology division sets up an unnecessary and incorrect misunderstanding in healthcare, leading some to wrongly believe that a healthcare organization is essentially made of two tribes:
- The “Administrative” Tribe: Finance, HR, IT, and legal/compliance workers who are necessary to help the organization run but don’t really understand or get involved in patient care.
- The “Clinical” Tribe: Doctors, nurses, pharmacists, and others who are taking care of the patient, but don’t need to understand administrative functions.
- And maybe a few people who fall somewhere in between these two tribes, to help the tribes understand each other (e.g. Clinical leaders)
Conceptually, this old-fashioned thinking might be thought of as a Venn diagram, with a few key “clinical leaders” who might fall in the middle:
In this context, the word “clinical” only helps reinforce an outdated notion that creates unnecessary antagonism. It incorrectly implies:
- There are “clinical staff” who know intimately well what patient care needs are, but no need to understand administrative functions.
- There are “administrative staff” who know intimately well what the organization needs, but don’t need to understand patient care, or have any responsibility for patient safety.
Both of these are misleading and incorrect. We in healthcare can do better.
For this reason, I’d propose a new way of thinking about healthcare operations, using a different way of categorizing operational standards:
In this way, we avoid the unnecessary “Clinical” versus “Administrative” distinctions, and encourage teamwork, collaboration, and understanding. Organizationally, I believe this would help both sides to better understand each other:
- As the Google definition of “clinical” implies, almost everyone in a healthcare organization has a relationship (direct or indirect) with patient care.
- The traditionally “clinical” workers (those with a direct relationship with patient care) can benefit by learning more about the needs of the traditionally “administrative” workers (those with an indirect relationship with patient care).
- The traditionally “administrative” workers (those with an indirect relationship with patient care) can benefit by learning more about direct patient care, and their own indirect but real relationship with good, safe, efficient patient care.
So perhaps a newer way of thinking about this could be presented in a new Venn diagram:
While changing this thinking may not be a high-priority issue, I do hope it stimulates discussion and helps encourage understanding, collaboration, and teamwork. Whether you are direct or indirect — in healthcare, we are all clinical.
This piece, authored by Dirk Stanley, MD, a board-certified hospitalist, informaticist, workflow designer, and CMIO based, on his blog, CMIO Perspective. To follow him on Twitter, click here.
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