Faisal Zain brings a seasoned perspective to the intersection of clinical operations and medical technology. With years of experience in medical device manufacturing and diagnostic innovation, he has seen firsthand how the tools intended to save lives can sometimes become the very barriers that stifle efficiency. Today, we explore the “hidden queue” of healthcare IT—a backlog that quietly drains resources while frontline staff navigate a sea of manual workarounds. We will dive into the rise of the workaround economy, the true cost of administrative friction, and why the next great healthcare revolution might not be a new drug, but a shift in who holds the keys to system change.
How do hidden IT backlogs compare to highly visible metrics like prior authorization in terms of their impact on health system performance?
While prior authorization and denial rates are benchmarked, dashboarded, and scrutinized in every committee meeting, the IT change request exists in a sort of digital purgatory. We have developed sophisticated tracking for administrative drag, yet the IT backlog remains a queue that almost nobody outside the department ever opens. This lack of a “denial rate equivalent” for IT means there are no regulatory consequences or quality scores attached to how long a workflow fix sits waiting for implementation. In my experience, what doesn’t get measured doesn’t get managed, leading to a situation where the cost of these unmanaged delays compounds quietly across the entire organization.
When IT requests stall, staff often build manual workarounds like spreadsheets or checklists. What specific metrics or warning signs should leadership look for to identify this “workaround economy” before it compromises patient care?
The most telling sign of a failing system is when you see “resourceful” staff managing scheduling conflicts through a shared spreadsheet or passing manual checklists between billing team members. These aren’t just clever fixes; they are a diagnosis of a broken workflow where the system has shifted its friction onto the people. Leadership should look for the “blueprint that never passed,” where every manual checklist represents a change request that was never even submitted because the staff didn’t believe it would move fast enough to matter. When you see analysts and billing leads designing their own fixes outside the EHR, it’s a clear indicator that the IT queue is backed up and the operational agility of the hospital is at risk.
The data suggests only 21% of process activities in diagnostic referrals actually add value to the patient. How can we bridge the gap between what a system requires and what a physician actually needs to do their job?
Bridging this gap requires a radical reassessment of where we spend our energy, as currently, a staggering 79% of process activities are swallowed by data entry, verification, rework, and reminders. These “low-reliability concepts” create a environment where the physician is more of a data entry clerk than a healer. We must move toward systems that prioritize the 21% of activities that actually impact patient outcomes, rather than forcing clinicians to absorb the friction of an inefficient EHR. By empowering the people who live these problems every day to drive the fixes, we can start to eliminate the rework and delays that currently define the diagnostic referral process.
Physicians spend nearly two hours on EHR tasks for every hour with a patient. What does this “documentation tax” feel like for frontline staff, and how does it manifest in the culture of a hospital?
This documentation tax creates a culture of exhaustion, where the “pajama time” spent logging another one to two hours of documentation each night becomes the standard rather than the exception. For every hour a physician spends looking a patient in the eye, they spend two more hours staring at a screen, a ratio that is fundamentally unsustainable for the human side of medicine. Registered nurses feel this even more acutely, often spending less than a third of their shift with patients while the rest of their time is devoured by coordination and administrative tasks. This shift doesn’t just lower productivity; it drains the emotional reservoir of our caregivers, making them feel like cogs in a machine rather than essential healthcare providers.
You mentioned that governance and tooling need to evolve together. How can health systems empower analysts and process owners to implement changes without creating a “wild west” of ungoverned workflows?
The solution lies in giving formal weight to the voices of analysts, process owners, and department leads within the IT prioritization process. We need to move away from governance models designed before operational agility was a clinical necessity and toward platforms that allow governed workflows to be deployed without a heavy IT lift. It is no longer a question of whether we have the capability to build these fixes, but whether we are willing to shift the control away from a central bottleneck and toward the operators who carry the necessary knowledge. By bringing metrics like the average time-to-resolution for workflow changes into the same room as denial rates, leadership can maintain accountability while allowing for the speed that modern healthcare demands.
If we look at the “double cost” of the IT backlog—the original inefficiency plus the manual workaround—how can executives reframe this as a budget priority rather than just a technical delay?
Executives need to realize that every month a legitimate workflow improvement sits in a queue, the organization is paying for the problem twice: once for the inefficiency and again for the labor-intensive workaround. This math isn’t complicated, yet because the backlog doesn’t show up as a single line item on a budget, it often gets ignored while it bleeds resources from every other department. If we started measuring how long it takes to change the system with the same precision we use for clinical outcomes, the financial argument for clearing the IT backlog would be undeniable. The most expensive queue in healthcare is the one no one is held accountable for, and until that changes, the “workaround economy” will continue to be a hidden tax on the entire health system.
What is your forecast for the future of healthcare operational agility over the next five years?
I believe we are on the cusp of a major shift where the bottleneck moves away from technical capability and toward organizational control. In the next five years, we will see health systems adopting governed platforms that allow non-IT staff to deploy fixes in real-time, finally matching the tooling to the knowledge that operators have carried for decades. We will see the “workaround economy” start to shrink as the time-to-resolution for IT tickets becomes a key performance indicator for senior leadership. Ultimately, the successful health systems will be those that stop measuring only what moves through the system and start measuring how quickly they can improve the system itself.
