The Hidden Cost of Healthcare Workarounds

A process technically exists, but everyone on the team knows it is not the easiest way to get the work done.

So someone creates a spreadsheet. Another employee keeps a personal list of reliable contacts. A team starts tracking something manually because the system cannot. Someone develops a shortcut for a task that takes too many steps. Another person learns exactly who to call when the official pathway stalls.

The workaround works. And because it works, the underlying problem can become harder to see. At Living with SHAPE, we believe healthcare workarounds deserve more curiosity than criticism. Most are created by people trying to keep care moving, protect patients, meet deadlines, and compensate for tools or processes that do not fully support the work.

That adaptability is a strength. The challenge begins when temporary adaptations quietly become permanent infrastructure.

A workaround can solve today’s problem while preserving tomorrow’s.

Workarounds Are a Sign of Human Adaptability

Healthcare professionals work in environments where conditions change quickly, and perfect processes rarely exist. When the formal workflow does not match what the moment requires, people adapt. They build trackers, save useful phone numbers, create side lists, develop informal handoffs, keep personal reminders, duplicate information between systems, and find faster ways around a difficult process.

Usually, the purpose is not to ignore the system. It is to make the system work.

A navigator may create a personal resource list because the official directory is difficult to search. A nurse may keep a reminder because the existing workflow does not reliably surface the next task. A coordinator may track referrals manually because there is no clear way to see whether they actually connected. These adaptations can prevent important work from falling through the cracks.

The problem is not the creativity. The problem is when the organization begins to depend on the workaround without addressing what made it necessary.

At that point, adaptation stops being a temporary bridge and starts becoming part of the operating model.

The Better the Workaround, the Easier the Problem Is to Miss

Strong teams are remarkably good at making weak processes look functional. If experienced employees know how to compensate, leadership may see that referrals are moving, patients are being contacted, information is getting where it needs to go, and deadlines are being met. From the outside, the process appears to work.

What may be less visible is how much human effort it takes to make that outcome possible.

A five-minute task may actually require checking three systems. A referral may appear complete only because someone followed up twice by phone. A resource list may look current because one employee spends hours maintaining it manually. A handoff may seem reliable because two staff members have built an unofficial relationship that bypasses the standard process.

The result is successful. The system underneath it may still be fragile.

This is one reason operational problems can persist for so long in healthcare. When skilled employees compensate well enough, the consequences of poor design become less obvious. Success can hide inefficiency.

Workarounds Create Invisible Work

Every workaround requires someone to carry it. That may mean copying information between systems, checking whether something happened, updating spreadsheets, searching for missing details, maintaining personal lists, correcting errors, or following up manually when the normal process does not provide enough visibility.

Much of that work never appears clearly in the formal workflow. But someone is still spending time and attention doing it. This connects directly to The Work Healthcare Keeps Adding Without Taking Anything Away. Healthcare administrative burden is not created only by formal responsibilities. It also comes from the additional work people perform to keep incomplete systems functioning.

A process may look simple on paper: Send referral → referral received → patient connected.

The actual experience may be: Send referral → check whether it arrived → call the receiving organization → resend information → update personal tracker → call the patient → clarify next step → check again next week.

The organization may measure the referral. The employee experiences the workaround. That difference matters when leaders are trying to understand workload and workforce capacity.

A Workaround Is Also Information

The most useful response to a workaround is not necessarily to eliminate it. It is to understand it. A workaround exists because someone encountered a gap between what the formal process provides and what the work actually requires.

That makes it a source of operational intelligence.

Ask:

• What problem is this workaround solving?

• Why does the official process not meet the need?

• What information or visibility does the workaround provide?

• How often do people use it?

• Who depends on it?

• What would happen if it disappeared tomorrow?

Sometimes the answers reveal something important about the process underneath.

• A spreadsheet may exist because staff cannot see status across systems.

• A personal resource list may exist because the official directory cannot filter information in a useful way.

• An unofficial phone tree may exist because ownership is unclear.

• Duplicate documentation may exist because two systems cannot exchange information.

• A manual reminder may exist because the workflow does not reliably surface the next action.

In Healthcare Friction Is Data, we explored how repeated friction can reveal where the system as designed does not match the system as experienced. Workarounds are one of the clearest forms of that signal.

Employees may already have designed part of the better solution. The organization first has to notice what they are solving.

Temporary Fixes Should Not Become Permanent Dependencies

Workarounds are sometimes exactly what healthcare needs.

• Unexpected situations occur

• Technology fails

• New programs launch before every process is mature

• Regulations change

• Staffing shifts

• Community resources evolve

A temporary fix can be practical and responsible. The risk is when temporary becomes: This is just how we do it here.

A spreadsheet created for a short-term need becomes permanent. One employee remains responsible for maintaining it years later. New work is built on top of it. More people depend on it. The original system gap remains unresolved.

Over time, the organization accumulates operational debt.

The process still works, but only because additional layers of manual effort have been added around it. That debt can be difficult to see because each individual workaround may appear small.

• One spreadsheet

• One extra phone call

• One duplicate entry

• One personal checklist

• One manual follow-up

Together, they can consume significant workforce capacity. And because they sit outside the formal process, they can be especially vulnerable when employees change roles or leave.

As we explored in What Healthcare Loses When Experienced People Leave, organizations can become dependent on knowledge and processes that live inside individuals rather than the infrastructure around them.

A workaround known only by a few experienced employees creates exactly that kind of dependency.

Better Systems Should Absorb Repeatable Work

Not every workaround needs a software solution. Some need clearer roles. Some need a simpler process. Some need better communication. Some need outdated steps removed. Some need stronger relationships between departments.

But when employees repeatedly perform the same search, tracking, filtering, routing, or coordination task, it is worth asking whether the system could carry more of that work.

Imagine a navigator who repeatedly searches a directory, compares eligibility details, checks locations, verifies age requirements, and maintains a personal list of reliable resources.

The important human work is not the searching itself. It is understanding the person’s situation, interpreting what matters, exercising judgment, explaining options, and helping someone decide what comes next.

Better infrastructure can reduce the repetitive search work without reducing the navigator’s value.

The same principle applies across healthcare.

• If employees repeatedly move the same information between systems, better integration may help

• If they repeatedly check whether a task happened, better visibility may help

• If they rely on unofficial lists because formal information is difficult to use, better information design may help

The goal is not maximum automation. It is making sure scarce human capacity is spent where human capability adds the greatest value.

The Real Question Is What Should Become Easier

Healthcare workflow improvement is often framed around efficiency.

• How can we do this faster?

• How can we process more?

• How can we reduce time per task?

Those questions can be useful, but they can also miss something important. The more meaningful question is: What should people no longer have to compensate for?

A well-designed system should gradually absorb predictable, repeatable burdens that people have been carrying manually.

That does not mean work becomes effortless. Healthcare is complex, and many tasks genuinely require attention, coordination, and judgment.

But there is a difference between effort that creates value and effort required only because the infrastructure is incomplete. Healthcare leaders should protect the first and continually look for ways to reduce the second.

A Practical Leadership Practice: The Workaround Review

Choose one workaround that everyone on a team knows about. Do not begin by asking whether it should be eliminated. Begin by understanding why it exists.

1. Describe the workaround as it actually happens. What does someone do outside the formal process? What spreadsheet, list, phone call, reminder, duplicate entry, or informal handoff has become part of the work?

2. Identify the problem it solves. What would become harder, slower, less visible, or less reliable without it?

3. Measure the hidden effort. How often is the workaround used? How many people depend on it? How much searching, checking, tracking, or rework does it create?

4. Ask what the organization can learn from it. Does the workaround reveal missing information, unclear ownership, a technology gap, a poorly designed workflow, or a need for better coordination?

5. Decide what should happen next. The answer may be to formalize a useful practice, improve a tool, redesign a process, remove an unnecessary step, or keep the workaround temporarily while building something better.

The goal is not eliminating every adaptation. It is preventing useful adaptations from becoming invisible dependencies.

Regenerative Psychology™ and Operational Capacity

Regenerative Psychology™ asks whether a system learns from the adaptations people make inside it.

A workaround can be evidence of creativity, commitment, and practical intelligence. People see what is not working and find a way forward.

A regenerative organization values that creativity. But it does not depend on people continually solving the same system weakness forever. It notices the pattern, learns from it, and strengthens the conditions around the work.

People should not have to continually compensate for the same system weakness.

When the system learns, human adaptability becomes a source of improvement rather than a permanent substitute for improvement.

Workarounds Should Help Systems Evolve

Healthcare teams will always adapt. That is part of what makes them effective. Unexpected situations will always require creativity, judgment, and flexibility. No organization should try to engineer every workaround out of existence. But adaptability should help systems evolve. It should not give systems permission to remain difficult forever.

A workaround can keep today’s work moving. The larger opportunity is making sure tomorrow’s team does not have to invent the same workaround again.

For healthcare leaders, one familiar workaround is often enough to begin.

Ask: Why does this exist?

Then ask: What would have to change for people to no longer need it?

The answer may reveal a hidden source of administrative burden, operational fragility, and lost workforce capacity.

It may also reveal that the people closest to the work have already shown the organization where the better design begins.