Hidden costs of enterprise email may top $4M per year per hospital

E-mails sent to the full workforce at hospitals and health systems are costly due to the time they take away from recipients’ other essential duties and tasks. How costly? Researchers have done the math.

Assuming all-staff emails are read through for one year by every worker across 7,250 job descriptions in five key roles—doctors, nurses, administrators, allied health professionals and operational support staff—the estimated payroll outlay for all that email reading lands at around $4.3 million per year at the hospital level and $10.2 million at the health-system level.

Those are U.S. dollars. The figuring is from a study conducted in Australia and published Feb. 3 in ANZ Journal of Surgery, official journal of the Royal Australasian College of Surgeons.

For the project, corresponding author Adam Frankel, MD, PhD, and co-author Arthur Samoylovich, MD, both of Princess Alexandra Hospital and the University of Queensland, audited one year’s worth of emails sent to all staff across a single public hospital and its (also public) umbrella Hospital and Health Service system. 

Total message count was 506, with a median length of 622 words. 

To estimate a year’s worth of time and financial cost, the researchers clocked 75 randomly selected volunteers, one from each of the five major occupation groups, as they read a representative reference text.  

“With fairly conservative assumptions, the hidden costs of all-staff emails are high, and there is potential for large cost savings with even a modest reduction in all-staff email burden,” Frankel and Samoylovich remark in their discussion. “Savings could be reallocated towards clinical endpoints and may also improve staff wellbeing.”

What practical steps can be taken to moderate the negative consequences of all-staff email in hospitals? 

Frankel and Samoylovich ask the question and offer three suggestions.

1.  If you can’t measure it, you can’t manage it. 

Measurement of “excess” all-staff emails could include raw numbers, length, appropriate targeting of recipients—does the information really need to be delivered to all staff?—and complexity, the researchers note. 

“Modest changes to each of these areas could considerably reduce the burden of all-staff email, bringing a number of advantages,” they write. Not least among the benefits, they point out, would be reducing “opportunity” cost—by which they mean freeing recipients to perform duties other than reading emails of questionable applicability and value. 

2.  Various non-economic means to reduce all-staff email burden have been tried outside of healthcare. 

Results have been mixed, the researchers acknowledge, but the lessons in both directions are generalizable to nearly any workplace. 

Frankel and Samoylovich cite a Harvard Business Review article that recommended setting limits on who is authorized to send all-staff emails, protocolizing email lists for workforce subpopulations and educating senders as well as recipients on best practices for broad-consumption messaging.  

“While these strategies may already be used to some extent, strict adherence to these principles should be demanded,” the authors state, “as well as enforceable limits on word count, readability and number of attachments (including prior email chains).” 

3.  A price signal for all-staff emails—such as a cost per recipient or cost per word sent—would apply strong downward pressure on the all-staff email burden. 

Acknowledging that such a step might prove “controversial,” Frankel and Samoylovich cite the proven effectiveness of tobacco taxation in curbing smoking.

The median word count of a single all-staff email in their study’s dataset was 620. If printed on paper, the authors note, this would require two pages at 12-point typeface and 1.5-line spacing. Given the studied umbrella health system’s headcount of more than 17,000 workers, a paper-based equivalent would ring up 34,000 printed pages along with 17,000 stamps and envelopes.

“We hypothesize that reinstating even a fraction of this cost would have a considerable impact on the volume and length of all-staff emails,” the authors write. 

 

Getting real about reducing ‘for everyone’ email 

In their discussion section, Frankel and Samoylovich allow that taking a major bite out of hospitals’ and health systems’ all-staff email burdens won’t be accomplished overnight. 

“[S]ome all-staff emails will be necessary and can be a simple and effective way of mass dissemination of information,” they write. “For example, using all-staff emails to communicate ‘system downtime’ for critical infrastructure such as imaging or pathology systems helps clinicians to optimize workflows.” 

Still, even in these cases, room for improvement is ripe for realizing, they suggest.  

Such emails as downtime alerts “should be succinct,” the authors write. However, in the study sample at hand, these all-staff emails were often “written to the length and complexity of formal academic texts.” One effect of such obscurity is likely to be recipients missing the central point the sender intended to convey.  

“From a clinician’s perspective, any time spent reading emails is time not spent providing clinical care,” Frankel and Samoylovich underscore. They cite prior research showing that a single all-staff email sent to 10,000 staff members, taking them away from their work for just one minute, would equate to 4.5 person weeks of organizational time lost—regardless of any need for follow-up actions. 

Thus email burden “can negatively impact patient outcomes via drowning of other priorities,” they write, “especially where content is unrelated to patient care.” 

The study is available in full for free.