> None of this is really surprising to me; any inadequate system seems to have a tendency to create its own shadow workflow that hides problems by working aroun

> None of this is really surprising to me; any inadequate system seems to have a tendency to create its own shadow workflow that hides problems by working around them. This reminds me strongly of Seeing Like A State. The formal system only appears to work because it's supported by an informal system devised by actual users. The system is created according to a "map" or abstraction of the real hospital. But the map is always lacking in detail, may be skewed in various ways, and results in an unrealistic system.