It was our pleasure to attend the 40th Annual Education Conference of the National Association of Health Unit Coordinators (NAHUC) in mid-August this year. The program was “open to all healthcare support team members and their supervisors, educators, and administrators.” This broad classification includes health unit coordinators; unit and medical secretaries; unit and ward clerks; business service, healthcare support, and patient-care associates; health unit, medical, and nursing assistants; patient-access staff; and unit customer service representatives.
The conference was held in Evanston, Illinois, peaceful home to Northwestern University and its Big Ten Wildcats on their way to Dublin, Ireland to kick off NCAA’s football season against the much-favored Nebraska Cornhuskers.
When my co-author of this op-ed (Patty Rice) asked me (Paul Rockey) to speak at the conference, I wasn’t sure what a “health unit coordinator” was (let alone that they referred to themselves as “HUCs”). “Health unit” is a problematic appellation and I thought it better described a personal health metric, like one’s pulse, height, cholesterol, or hematocrit. Patty reminded me that HUCs were called “ward clerks” when I was a resident. So, I titled my talk, From “ward clerks” to “health unit coordinators”: a half century of personal reflections.
Now, we have both had time to reflect on the conference, attended by nearly 60 HUCs, most at their own expense, and we have decided to tell their stories to a broader audience.
A health unit coordinator facilitates the activities in a health unit and acts as the liaison between all the various departments in the healthcare facility, including nurses, physicians, other professional staff, ancillary staff, patients, and visitors. A HUC maintains patient and unit records, orders supplies and services, and manages the physician’s orders.
Conference attendees were receptive and engaged. Some were there to meet continuing education requirements, others to network with peers and friends, but all because of their commitment to quality healthcare and dedication to being skilled team members.
The verb “coordinate” is not opaque. The meaning most applicable to a health unit coordinator is to bring into common action; to harmonize tasks, schedules, and responsibilities. Likewise, the noun “coordinator” can be defined as: one who organizes people or groups, activities and schedules so that all work together efficiently.
The role evolved during World War II. Due to a shortage of nurses and physicians on the home front, “non-clinical” personnel assumed duties such as assembling charts and answering phones. The title “floor secretary” appeared in a medical journal in Pennsylvania in the 1940s. Over the years, the title has evolved from “ward secretary,” “ward clerk,” “unit secretary,” and “unit clerk” to the present “health unit coordinator,” which more aptly describes connecting and integrating the non-clinical aspects of patient care.
Health unit coordination is essential. HUCs work among a broad spectrum of personnel with significantly diverse levels of education, knowledge, and skills. And each patient has unique needs. The personal hygiene demands required during COVID increased the complexity of care, risks of error, and severity of consequences for mistakes. Navigating this intricate environment requires consummate social skills. The indispensable work of HUCs should demand the respect of highly specialized physicians, clinical team members, and housekeeping staff alike, but HUCs are relatively unnoticed unless they get sick and are unable to work. It is time to recognize these team members in their presence rather than by their absence.
We all benefit from HUCs’ knowledge and experience and should allow them to work to the full scope of their skills. Employers should welcome HUCs’ voices in shared governance. Opportunities for professional growth should include career ladders that address certification, continuing education, and self-governance.
In a 2020 Brookings Report, Molly Kinder, MPA, summarized these points by saying, “Employers should provide low-wage health workers with respect, appreciation, more equitable pay and support, and opportunities for training, advancement, and better job quality.” It is long past time, she said, that they be treated with dignity by employers, colleagues, policymakers, and the general public.
Using social network analysis, my (Rockey) talk at the conference described HUCs as “hot hubs.” Social networks can be weak or strong, and connections between individuals (hubs) can be few or many. A competent HUC maintains connections to all relevant clinical and non-clinical staff and juggles priorities. Further, HUCs must be adept at communicating in multiple modalities, including intercom, smart-phone voice and text messaging, and electronic medical records, as well as face-to-face conversations. Their transactions must be as error-free as is humanly possible. If a medication order is misinterpreted or wrongly transcribed, if a patient’s call light or alarm goes unnoticed, if the cardiac code kit is not maintained, patients suffer or die.
Communication is a crucial component of patient satisfaction and is a benchmark of quality. HUCs are the center of open communication and trust, fostering a sense of teamwork between all disciplines and departments. Certification as a HUC recognizes essential knowledge and skills in coordination of the unit, communication/customer service, order management, and professional development.
We believe HUCs must be recognized and appropriately compensated for the complex and crucial roles they play. Most human resources systems don’t recognize social network complexity as an asset. Many HUCs are classified as “medical secretaries” as if they were simply taking shorthand and typing letters, like secretaries in the TV series Mad Men set in the 1960s.
Interestingly, and by contrast, a “coordinator” is a highly respected member of an American football team: a defensive/offensive coordinator is a coach who is responsible for overseeing a team’s defensive/offensive players and strategies. The average salary for an NFL coordinator is around $1 million. The University of Nebraska’s football team’s offensive coordinator’s salary this year is $875,000. Despite these big bucks, the Nebraska Cornhuskers were defeated by the Northwestern Wildcats in the season opener in Dublin. Alas, nobody died for Nebraska’s poor offensive coordination.
Paul H. Rockey, MD, MPH, is professor emeritus in internal medicine and medical humanities at the Southern Illinois University School of Medicine. Patricia N. Rice is a certified health unit coordinator and executive director of the National Association of Health Unit Coordinators.
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