Why Healthcare Teams Keep Building Workarounds (And What That Tells Us)

There is a spreadsheet in almost every hospital. You probably know the one. It lives on a shared drive, or in someone's email, or on a laptop that only one person knows how to find. It tracks discharge status, or prior authorization approvals, or consult requests — depending on the unit, depending on the organization. It gets updated manually, inconsistently, and under time pressure.

Everyone knows it's not a real solution. Everyone uses it anyway.

That spreadsheet isn't a sign that a team is behind. It's a sign that the team recognized a coordination gap and built something to fill it — with whatever was available. That's not a failure of sophistication. That's a reasonable response to an unreasonable situation.

Workarounds are coordination infrastructure

When we look at how clinical and operational teams actually manage complex workflows, a pattern appears: wherever the formal systems don't provide accountability, structure, or visibility, people build informal systems that do.

The shared tracking document is one version. The whiteboard in the nursing station is another. The standing end-of-shift message the charge nurse sends to herself so she remembers to follow up in the morning. The case manager who calls pharmacy directly rather than waiting for the system to route the message, because she knows from experience that it won't get there in time.

These are all coordination infrastructure. They exist because the need is real and the formal systems didn't meet it. The question worth asking isn't whether these workarounds are good or bad — they're clearly necessary. The question is whether they're durable.

What makes a workaround fragile

Informal systems share a structural vulnerability: they depend on the people who built them.

When the case manager who maintains the tracking spreadsheet goes on leave, the spreadsheet stops being current. When the charge nurse who knows to call pharmacy directly transfers to another unit, the informal loop breaks. When the team that built the whiteboard system gets reorganized, the institutional knowledge that made it work doesn't transfer automatically.

This is why the same coordination failures tend to resurface after personnel changes, after leadership transitions, after mergers and acquisitions. It's not that the new people are less capable. It's that the coordination infrastructure that existed was personal, not systemic — and personal infrastructure doesn't survive organizational change.

There's also a visibility problem. Workarounds are, by nature, invisible to anyone outside the team that built them. When a manager wants to understand why discharge times vary across units, or why prior authorization turnaround is inconsistent, the data isn't there — because the workflow lived in a spreadsheet, or in someone's head, rather than in a system that captures it.

The upgrade conversation

Moving from informal coordination infrastructure to structured coordination isn't primarily a technology decision. It's a decision about what kind of system your workflows deserve to run on.

The teams that are most ready for this shift are usually the ones whose workarounds are most elaborate. They've already done the hard work of understanding what the workflow requires — they mapped the stages, identified the owners, figured out what escalation looks like. The workaround is proof that the team knows how the workflow should run. What's missing is a system that runs it for them, consistently, without depending on any one person's memory or availability.

Structured coordination gives a workflow configurable stages, defined owners at each one, automatic escalation when something stalls, and completion confirmation that closes the loop. It takes what the team already knows and makes it durable — visible to operations, resilient to personnel change, and available as data for the continuous improvement work that informal systems can never support.

The spreadsheet was a reasonable response to an unreasonable situation. It's worth asking whether the situation still has to be unreasonable.

Backline Pathways is built to replace the workaround with something that lasts. If you're ready to have that conversation, a Workflow Assessment is the right place to start.