Healthcare Friction Is Data
Patients call about the same issue again and again. Staff create unofficial workarounds to keep referrals moving. Families abandon forms at the same point. A handoff regularly stalls.
People keep asking, “What happens next?”
These moments are easy to treat one at a time. A call to return. A referral to chase. A form to fix. A question to answer. A workaround to tolerate because it keeps the day moving.
But at Living with SHAPE, we believe repeated friction is often more than inconvenience. It is information. Friction can show us where the system as designed does not match the system as experienced.
Not every difficult step should disappear. Some friction protects safety, judgment, consent, and appropriate oversight. But when the same effort keeps appearing in the same place, healthcare leaders should get curious.
A repeated call
A stalled referral
An abandoned form
A workaround
A question that keeps coming back.
Together, they may be showing us exactly where to look.
Friction Shows the Difference Between Design and Reality
A healthcare workflow can look clear on paper.
The patient receives instructions -> The referral is sent -> The form is completed -> The portal message goes out -> The handoff is documented -> The next step is technically available.
But once patients, families, and employees interact with that workflow, reality starts to show itself.
Maybe the instructions make sense to staff but not to patients. Maybe the referral was sent, but no one knows whether it connected. Maybe the form asks questions people cannot answer without help. Maybe the portal message contains information but not context. Maybe the next step exists but is hard to identify.
That is where friction becomes useful. It reveals the gap between what the process assumes and what people actually experience.
This connects directly to the idea in The Hidden Tax of Healthcare Complexity: every unnecessary step asks people to spend something. Time. Attention. Energy. Confidence. Money. Friction helps us see where that cost is being created.
Workarounds are Information
Healthcare professionals are incredibly adaptive. They keep personal resource lists. They build spreadsheets. They save direct phone numbers. They create shortcuts. They develop informal processes. They know which person to call when the official pathway gets stuck.
These workarounds often keep care moving. They are also signals.
Instead of seeing every workaround as a problem to eliminate, leaders can ask: What does this workaround provide that the official process does not?
Maybe it...
provides speed.
creates clarity
gives staff access to information they cannot find elsewhere
helps patients avoid repeating themselves
solves an ownership gap between departments or organizations.
A workaround may be showing the system what it actually needs. That does not mean every workaround should become permanent. Some create risk, inconsistency, or inequity. But dismissing them too quickly can cause leaders to miss the intelligence inside them.
The people closest to the work often know where the system is rubbing against reality. Their adaptations are worth studying.
Repeated Questions Deserve Curiosity
Some patient questions come up because healthcare is complex. But repeated questions often point to something more specific.
Who do I call?
Did you receive my referral?
Am I supposed to schedule this?
Which option applies to me?
How long should I wait?
What happens next?
If people keep asking the same question, the answer may not simply be “communicate better.” The question may reveal unclear ownership, weak orientation, or a poorly connected process.
In The Most Important Healthcare Question May Be: “What Happens Next?”, we explored the difference between information and orientation. Information gives people things to know. Orientation helps people understand where they are, what matters, and what action comes next.
Repeated questions often show where orientation is missing.
The system may have provided information. But if people still do not know what to do with it, the experience may not be designed clearly enough. That is not a failure of the person asking. It is a design signal.
Pay Attention to Where Journeys Stop
Healthcare organizations are often good at measuring completed activity.
Appointments scheduled
Forms submitted
Calls answered
Referrals placed
Visits completed
Instructions delivered.
Those measures matter. But there is also valuable information in what does not get completed.
Where do people abandon the process?
Where do they stop responding?
Where do referrals fail to connect?
Where do forms remain unfinished?
Where do patients switch to another pathway?
Where do families repeatedly need help?
Drop-off is not always a lack of motivation. It may reflect confusion, burden, fear, cost, mistrust, unclear instructions, technology barriers, or a step that requires more capacity than people have available.
The key is not to assume why the journey stopped. The key is to look closer.
A patient who does not complete a form may be telling us the form is too long, too confusing, too invasive, too hard to access, or too disconnected from what they believe they need.
A referral that does not connect may be telling us that the handoff relies too heavily on the patient to follow up.
A repeated portal message with no response may be telling us that the channel is not working for the person receiving it.
The absence of completion can still be a form of feedback.
Not All Friction is Bad
The goal is not a frictionless healthcare system. That would be too simple. Some friction serves an important purpose. Safety checks matter. Informed consent matters. Clinical judgment matters. Appropriate oversight matters. Thoughtful decisions matter. Privacy protections matter.
A system with no friction at all could become careless. The better question is: Is this effort serving an important purpose, or are people compensating for unnecessary complexity?
A consent process may require attention because the decision is meaningful.
A referral may require review because clinical appropriateness matters.
A medication change may require safeguards because safety matters.
But a patient calling three times to find out whether a referral was received may not be meaningful friction. It may be a coordination burden.
As we explored in Why Are We Asking Patients to Coordinate Their Own Care?, people often become responsible for connecting parts of healthcare that do not connect naturally themselves.
That kind of friction deserves investigation.
Friction Needs Human Interpretation
Data can show that something is happening. It may show high call volume, incomplete forms, delayed referrals, repeat messages, long waits, or low follow-through.
Data alone rarely explains why. Patients, caregivers, frontline professionals, navigators, community partners, and staff can help interpret the signal.
They can explain what the process feels like. Where the instructions become unclear. Which step creates hesitation. Why a workaround exists. What patients misunderstand. What staff are doing behind the scenes to keep things moving.
This is where human experience becomes part of system intelligence. Healthcare leaders do not need to choose between data and lived experience. They need both.
Numbers may point to the location of friction. Human experience helps explain what the friction means. That combination is where better design begins.
A Practical Leadership Practice: The Friction Signal Scan
Choose one common healthcare journey.
It could be a referral, discharge, intake process, portal message, insurance authorization, behavioral health connection, or community resource handoff.
Then look for six kinds of effort.
1. Search
Where does someone have to hunt for information, instructions, phone numbers, resources, eligibility details, or next steps?
2. Repeat
Where does someone have to provide the same information more than once?
3. Wait
Where does someone wait without knowing what is happening, who owns the next step, or when to follow up?
4. Interpret
Where does someone have to translate technical language, compare unclear options, understand rules, or figure out what applies to them?
5. Coordinate
Where does someone have to connect people, organizations, records, referrals, appointments, or approvals on their own?
6. Recover
Where does someone have to fix a missed handoff, restart a process, resend information, or find another way forward after something stalls?
Once those moments are visible, ask two questions:
Which of these efforts are necessary?
Which are signals that the experience could be designed differently?
The goal is not to remove every step. The goal is to understand what the friction is telling you.
Regenerative Psychology™ and System Learning
Regenerative Psychology™ encourages healthcare leaders to view behavior in context.
Instead of immediately asking: Why are people not following the process?
Ask: What might their behavior be telling us about the process itself?
If patients keep calling, something may be unclear.
If staff keep creating workarounds, something may be missing.
If families keep abandoning a journey, something may be too hard to carry.
If referrals keep stalling, something between the parts may need design attention.
The system should not only expect people to adapt to it. It should also be capable of learning from how people experience it.
Closing
Friction does not always mean something is wrong. But repeated friction deserves attention.
That is the opportunity. When healthcare leaders begin seeing friction as data, everyday experience becomes easier to learn from.
The question is not only: How do we fix this one issue?
It is: What does this effort tell us about the experience we have designed?
At Living with SHAPE, we help healthcare organizations see what everyday experience is revealing and use that understanding to make complex healthcare easier to live with.
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