Bad Workflows are Horrible, but We Love Them So!

Craig Joseph, MD
By: Craig Joseph, MD
Date: May 29, 2018

One of the goals of software developers must surely be to require no training to use the software. That’s the dream! Just open the app and start using it. Maybe there will be a brief introduction via a short video or some graphics overlaying the screen, then off you go. This works for straight-forward software, too. Most apps on our phones don’t require training, and we all love the apps on our phones.

Even for easy-to-use software applications, we can run into problems with no user training. The biggest problem is also the goal: for users to just figure it out. It’s great when users figure out their workflows: they can get to work fast and get done whatever they need to achieve. I’d argue it’s also horrible when users figure out their workflows: they often create the most tortured way to get from point A to point B. Users may not notice the Select All button or realize that they must press and hold to see other hidden options.

My experience with bad workflows is that they stick. They stick hard! Once someone learns the 17 clicks they believe they need to help them get their work done, muscle memory kicks in and those clicks are frozen in their fingers. At some point, I believe the Stockholm Syndrome activates, and then our beloved user starts to enjoy the clicks. They want the clicks; they need the clicks. And when help arrives from IT or operations, it is almost universally shunned.

“No, no thanks. I’m fine. I’m using the computer just fine. Maybe Bob needs some help. He’s just over there.” I work in healthcare, so perhaps other IT and software folks don’t hear this. Maybe healthcare is different. I suspect not, but I’ll hold out hope. The comfort we establish in the way we do things seems hardcoded into our DNA. Essentially, inertia is the law of the land, and all change is to be dismissed out of hand.

How can we fight this inertia, this desire to keep even bad things the same? Here are two thoughts, one of which I guarantee will work.

First way to fight inertia and bad workflow: change the software! If the inefficient workflow involves unneeded clicking in certain boxes, just make those boxes go away. That’ll solve your problem! I see software developers doing this more and more, and I for one love it! Except, of course, when they get rid of the boxes I like checking. Then I complain to everyone within earshot, but that’s only because I’m always correct and others are usually wrong. But I digress.

Second way to fight inertia and bad workflow: data and competition! Again, perhaps I’m incorrectly extrapolating from healthcare to the regular world, but I’ve found data often moves the dial. When a physician sees a pop-up in the electronic health record that tells her that 63 percent of her colleagues in hospital medicine are more efficient than she when admitting a patient, you now have that doctor’s attention. You might think that our wonderful doctor wants to be more efficient so she can spend her time doing things other than interacting with the computer, and that’s why we have her attention. You may be partially correct, but I’d bet that most of the interest comes from competition! I might dislike change, but I dislike being second-best even more.

Being ensconced in the healthcare IT world, I might be expected to beg and plead with you to stop clicking around so much and misusing the beautiful software I place in front of you. But I’ve been around the block too many times to think that’ll work. So I’m busy begging my software vendors to make the software more usable and figuring out ways to show my users how they compare to their peers.

Craig Joseph, MD, is the Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.

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