Long wait times, convoluted forms, and confusing processes often make accessing healthcare unnecessarily difficult for patients. These frustrating barriers are also burden healthcare staff with added bureaucracy. However, by systematically identifying and removing sludge, clinicians can streamline care delivery and improve experiences for both patients and providers.
The concept of “sludge” was coined by economist Richard Thaler to describe obstacles that hinder people from accessing helpful services or information. While "nudges" make desired choices easier, sludge makes them harder. In healthcare, common sources of sludge include repetitive paperwork, complex referral systems, and phone tree menus.
Sludge wastes precious time and creates anxiety. Studies show we often neglect the opportunity cost of time spent navigating healthcare bureaucracy—time that could be better spent on work, family, or leisure. Evidence also suggests we tend to add steps rather than remove them when solving problems. This makes “de-sludging” a critical priority.
The recent Primary Care Recovery Plan in England acknowledges the problem of sludge. By expanding self-referral options, improving communication channels, and enabling pharmacists to treat minor conditions, the plan aims to remove bureaucratic burdens for patients and providers.
Clinicians everywhere should apply this de-sludging mindset. Start by auditing pathways to identify wasted steps. How many clicks or forms are required for routine processes? How might you simplify referrals or information sharing? Pilot and evaluate changes, considering unintended consequences like over-burdening certain services.
Though not a cure-all, de-sludging can incrementally improve daily experiences in healthcare when thoughtfully implemented. It lightens the cognitive load for stressed patients. It frees up providers to focus on delivering compassionate care. And it sends the message that everyone’s time matters.
By routinely asking "how could we simplify this?" clinicians can gradually streamline systems. With care and creativity, we can begin clearing away the sludge and revealing the human connections at healthcare's heart.
