When systems slow people down - and what to do about it

I spent a few days in hospital recently, which included two admissions and two discharges. Before anyone gets worried – I’m fine now, I genuinely am, but the experience gave me a chance to observe the NHS from a different angle. For years my contact with the NHS has been entirely through delivering training and policy events for NHS staff - experiencing it as a patient was different.

The first thing anyone notices on a ward is the human element. The NHS is one of the few places in British life where people from completely different backgrounds share the same space, with the same dignity, and receive the same care. In a short period I met people of different ages, origins, circumstances and stories. That alone says something about the NHS as a national institution: it is a meeting place, an equaliser and a quiet expression of shared values. I always knew that but experiencing it first hand made it real and rather personal.

The staff were remarkable throughout - compassionate, calm and deeply committed. There was a confidence in their clinical work and a warmth in the way they interacted with patients and with one another. Spending time in that environment makes it clear that the human foundation of the NHS is exceptionally strong.

Only after a day or two did another pattern start to become noticeable: the amount of time and attention staff spent managing the system around them. Conversations at the nurses’ station, interactions between departments and even casual remarks between colleagues all pointed in the same direction: the clinical work was solid, but the workflow that supported it was heavy. This was not a criticism of the people doing the work - it was an observation of how the work was structured.

From a patient perspective, this shows up as waiting, repetition and delay. Two of the clearest examples were discharge timing and A&E flow. In both my discharges, the clinical decision was made in the morning, but the actual discharge happened late in the day. The bottleneck was medication from pharmacy, which operated on a set workflow that released discharge medication only at certain times. Several nurses mentioned that patients routinely stay hours longer than clinically required because of this step. While waiting, I stayed in a bed, received meals, had regular observations and used resources that could have served someone else.

In A&E the pattern looked similar. Some delays were clearly about demand and capacity, but others stemmed from the sequencing of tasks and approvals. Nurses required doctor sign-off for tasks that were routine and seemed entirely within their competence. Patients already referred to wards waited in A&E for hours because the handover steps were slow or fragmented. The shared frustration was not about clinical uncertainty - it was about the mechanics of getting things done.

This tension - highly capable people working inside clunky processes - is not unique to healthcare, it appears across the public sector. In the UK asylum system for example, it is widely recognised that applicants can wait many months and in many cases over a year for an initial decision. The first response is often to increase staffing or funding to clear the backlog. That can help, but it sometimes skips an earlier question: why does the process take so long in the first place? The frustration there is not only felt by applicants; caseworkers, legal advisers and tribunal staff experience it too. The human effort is not the issue, the design of the work is.

Many public sector systems are built on layers of safety, compliance and accountability, often with very good reason. In a clinical environment, those guardrails really do matter because they prevent harm – so I’m sure there are several considerations in either of these cases that are invisible to me but must form part of the decisions around system design. That said, the challenge is that they can also create handoff friction, queueing, duplicated work and avoidable waiting. A few hours of delay at discharge, a day lost in paperwork approval, a week lost in cross-team sign-off: each incident is small but aggregated across a system, it becomes capacity, cost and sometimes safety.

This raises an important point about how organisations try to solve these problems. Sometimes the instinct is to add more people and funding, as in the asylum example. In other contexts the instinct is to cut headcount or restructure in search of efficiencies. Both approaches start from the assumption that the core issue is resourcing, but in many cases the limiting factor is not the number of people in the system, it’s the way the system moves work between them.

When the underlying workflow is fragmented, slow or full of institutional friction, adding staff increases volume capacity but not flow, and cutting staff reduces volume capacity but still does not improve flow and will therefore fail in creating efficiencies. The more useful starting point is a systems question rather than a staffing question: what would this look like if it flowed end-to-end without unnecessary waiting, rework or duplication? Staffing decisions may still follow, but they become informed by reality rather than assumption or hope.

This is where the experience in the hospital connects to what we see across councils, agencies and public bodies. The gap is rarely about motivation, it is about flow. Highly skilled people are working hard inside systems that were not designed for how work actually moves now. When local optimisation (pharmacy accuracy, A&E triage, ward bed management, etc.) outweighs system optimisation (safe and timely discharge), everyone feels the impact - staff as much as patients.

The encouraging part is that not everything requires policy change or structural upheaval - some improvements live at the team level. Clarifying handoffs, reducing redundant authorisations, agreeing sequencing rules, making ownership explicit, giving teams more influence over how work flows through them: these adjustments are small in comparison to national reforms, but the impact can be large. If the system cannot change quickly, teams can still claim the parts they control and make them better.

That is the space Teamshaper works in. We are not attempting to redesign entire institutions or rewrite policy. We help teams examine how work actually moves, identify where it gets stuck, understand what people need from one another and adjust workflows so the system supports the human effort rather than constraining it. The NHS experience reinforced that the talent and compassion are already there in abundance. If more of the system matched the quality of the people, the gains in capacity, efficiency and experience would be significant.