What everyday NHS workarounds are really telling us
Across the NHS, coping mechanisms are part of everyday operational life.
Spreadsheets maintained outside core systems.
Shadow trackers used to reconcile reports that don’t quite align.
Manual checks layered on top of existing processes, just to be safe.
These are not signs of poor practice. In most cases, they are created by capable, committed teams doing what they can to keep services running and patients safe under sustained pressure. Often, they are the reason things continue to function at all.
The issue is not that coping mechanisms exist.
It is what happens when they become permanent.
Periods of sustained delivery pressure, such as the run-in to the end of the financial year, tend to bring these coping mechanisms into sharper focus. When timelines are compressed and tolerance for disruption is low, teams rely on whatever gives them confidence and control in the moment.
What coping mechanisms are signalling
Coping mechanisms tend to emerge when the system underneath cannot reliably support the work being asked of it.
This might be due to workforce gaps, high turnover, mistrusted data, EPR workflows that do not reflect operational reality, or reporting that lags behind what teams are seeing day to day. Performance expectations continue to rise, but the infrastructure to support them does not always keep pace.
In these conditions, people adapt. They create parallel processes to regain confidence, visibility and control. In the short term, this is entirely rational.
The cost hidden inside the signal
Over time, however, these signals reveal deeper, often unacknowledged costs.
Risk can become invisible, sitting in undocumented processes or with individuals rather than within the organisation. When people leave or capacity shifts, that risk can surface suddenly.
Data quality can deteriorate further, as manual fixes and reconciliations are not consistently fed back into source systems. Different teams begin working from different versions of the truth, undermining confidence in reporting and decision-making.
There is also a human cost. Coping mechanisms add workload that is often unseen and unrecognised. Manual reconciliation, duplicate checking and constant vigilance contribute to fatigue and burnout, particularly for operational and administrative teams already under pressure.
Perhaps most importantly, improvements achieved through coping rarely last. When progress depends on heroic effort rather than reliable systems, performance gains are fragile and often need to be repeated.
Interpreting the signal, not suppressing it
It is tempting to try to eliminate coping mechanisms altogether, encouraging teams to “just use the system” or to be more disciplined.
This approach rarely works.
Coping mechanisms exist because they are doing a job the system cannot currently do. Removing them without addressing the underlying issue does not reduce risk; it simply shifts it elsewhere. Teams either recreate the workaround in a different form or operate with less confidence and visibility.
Neither outcome supports safe, sustainable operations.
From signal to control
Addressing coping mechanisms requires a shift in focus. Rather than treating them as problems to be removed, they need to be understood and interpreted.
They point to where data is not trusted, where processes do not align with reality, where ownership is unclear, or where volume has outgrown capacity. Taking time to diagnose these root causes is essential.
This is where advisory support often plays a role, helping organisations step back, understand what is really happening on the ground, and prioritise changes that restore stability and confidence in day-to-day operations.
Alongside this, there is a role for technology, used carefully and deliberately. Technology cannot replace good operational design, but it can reduce reliance on fragile manual effort. Automating high-volume validation, surfacing exceptions rather than requiring teams to check everything, and providing a shared, trusted view of patient pathways all help reduce the need for parallel systems.
When advisory insight and technology are used together, they support a move away from constant coping towards greater operational control.
A more sustainable position
Coping mechanisms are understandable, and in many cases they are a testament to the commitment of NHS teams.
But they should not be the long-term operating model.
The aim is not to remove effort from NHS operations, but to ensure effort is spent where it adds the most value: improving patient care, safety and performance, rather than compensating for fragile systems.
When organisations move from coping to control, improvement becomes more sustainable, confidence in data returns, and teams are better supported to do the work they are there to do.
