The work behind the work
Series: Caring Costs. Newsletter 3 of 4.
This is the 3rd newsletter drawn from the work behind my book Caring Costs - Addressing the cost of caring in healthcare and the wicked problems facing the health workforce.
I hope these reflections help name what is structural and systemic, and provide practical support for the day-to-day work.
Can you relate to this?
It is 11.15am and your next session starts in five minutes. In those five minutes you need to write up the last session's notes, return a call about a cancellation, reply to two emails that came in while you were with the last client, check the eligibility status of an afternoon referral, and clear the mandatory training reminder pinging in the corner of your screen. You are unlikely to finish any of them. They will join the other tasks on the after-hours “to do” list.
Maybe you have been told that the problem is your time management skills. Often it is not.
The squeeze we are working inside
Administrative load is not one thing. It is several things, layered on top of each other, with no single point at which any of them was scaled to fit a working day. It can include:
The flow of the day itself: travel between locations, resource preparation, managing cancellations and no-shows, multidisciplinary coordination and communication with families, carers and other professionals.
Client complexity: safeguarding, planning, coordination across multiple services and supports, and the documentation that follows.
Fragmented digital systems that require information entered in several places.
Funding, billing and reporting requirements.
Professional support and registration compliance: CPD, mandatory training, supervision etc.
A working day is rarely designed for any of this. Clients can be back-to-back, with limited or no time allocated to the admin work the role actually requires.
When these arrive together, the response usually falls on the individual. You stay later. You work weekends. You build a system for yourself to keep on top of it. None of that changes the load. It moves it from the system onto you.
What the research shows
What I notice in the conversations I have, and what burnout research in this sector consistently shows, is that administrative load is not simply extra paperwork. It is cognitive load and emotional exhaustion. It is one of the strongest predictors of who leaves the sector. It affects clinical quality, and the access the people we work with have to good care. And it competes, slowly, with the relational and therapeutic work that drew us to this work in the first place.
The administrative load we are working inside has been documented for years.
Excessive workload, particularly when it leads to low autonomy, is one of four key factors associated with burnout in the sector. The SafeWork NSW Evidence Check: Burnout in the Health Care and Social Assistance Sector (2024) identified reducing administrative burden has the strongest evidence for reducing burnout and noted changes in the way a workplace operates has more impact on burnout than requiring individuals to cope on their own.
Administrative burden was identified by Robson and colleagues (2025) as one of four recurring barriers for allied health practitioners staying in aged care and disability work, alongside underutilisation of skills, deficit-focused funding, and professional isolation.
Four themes contribute to workforce strain according to Gilroy and colleagues (2023), in their scoping review of the NDIS planning process in regional, rural and remote Australia. Bureaucracy and administrative burden was one and the disproportionate workload carried by providers was another. They reported practitioners feeling overwhelmed by the planning process, with bureaucratic processes contributing to burnout.
The shift
Documentation, planning, coordination and reporting are not extras. They are how quality care is planned, communicated, funded and made safer. The problem is not that admin exists. The problem is what happens when the volume, the duplication and the lack of protected time turn necessary work into a load that no one in the system has resourced.
The load is the design. It is not a shortcoming.
The pressure is not only that administrative work eats into time with clients. The load is complex and pulls in several directions at once: notes from one session, planning for the next, communication with families and other professionals, coordination across multiple services. The professional work that keeps practice safe and current has to fit around all of this, while reporting and funding requirements keep growing and the day does not. Over time this becomes a matter of professional integrity, not a workflow one. You cut corners you would not normally cut, delay work you would rather do well, and feel the gap grow between the standard you trained for and the standard the day allows.
Reflect on the following
If you are early in your career:
Am I assuming this load is normal, or am I assuming it is mine to manage alone because I am still learning?
Where could I bring this to a supervisor or more experienced colleague so I can work out what is mine to learn and what the system is asking too much of?
What habits am I building now in how I respond to work that does not fit the day, and are those habits ones I want to carry through my career?
If you are working directly with clients:
How much of my week is spent on the work behind the work, and where is it accumulating?
What would I bring to supervision about the admin load I am carrying, and what support would I ask for?
If you supervise or lead a team:
Where is my team carrying an administrative load that I am not seeing, and how am I creating space in supervision for them to discuss?
What in our systems, workflows or reporting requirements is creating duplication or pulling people in multiple directions, and what could be simplified, delegated or stopped?
What part of this load could I take to the senior leaders in my workplace on behalf of the team, rather than leaving it for them to absorb?
If you sit in senior leadership, governance, or run a practice:
Which administrative tasks in our service genuinely improve care quality, and which do not?
Are reporting requirements proportionate to the value they create?
How much unpaid administrative labour exists in our workforce, and how do we make that visible?
Where to start
1 Distinguish the necessary from the unnecessary. Not all administrative work is the same. Some of it is essential to safe, ethical care: clinical documentation, planning, supervision notes, communication across a team. Other parts of the load have grown over time without being questioned: duplicate entry across fragmented systems, reporting requirements that no one reads, processes that have lost their purpose. Knowing the difference gives you and your team something concrete to advocate around, rather than asking for less admin in general.
2 Name administrative work as labour, not character. Tracking what is spent on documentation, system maintenance, compliance, and contradictory reporting requirements gives supervisors and leaders something concrete to take upstream. It also stops the load reading as personal disorganisation.
3 Move from individual workarounds to collective representation. Personal systems and clever templates do not change the design. Submissions to consultations, contributions to peak bodies, internal cases for redesigning workflow, and briefings to funders on what current requirements actually cost, these are what shift the design.
A closing word
The administrative load we are working inside was designed, in pieces, over time. It can be redesigned the same way. That will not happen while we absorb the cost in our own time.
You are not behind on your paperwork. The work was built to be un-finishable inside a working day. Protecting the time with the person you work with, and naming the rest as system labour rather than personal failing, is one of the most useful things you can do.
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Relevant previous newsletters you may be interested in…
Maybe you have been told that the problem is your time management skills. Often it is not.