Why are post-op teams still opening Excel to hand off callbacks?

Say you’re building a product to help a hospital coordinate post-op follow-ups. A few days into the pilot, a coordinator tells you she can see who needs a call much faster. Then she asks if you can add an Excel export.

The request makes sense. Depending on how the list is built, a basic export might be fairly quick to ship. I’d still want to see what she does with the spreadsheet before deciding.

One thing I picked up studying strategic design and used a lot at Deloitte was asking people to show me what happens before and after the thing they want us to build. Sometimes you find a small improvement worth making. Sometimes you go back a step and find a piece of work you could make unnecessary altogether.

What happens when a patient doesn’t pick up?

It’s close to the end of her shift. The coordinator logs the call attempt in your product, opens the shared spreadsheet, puts a colleague’s name against the callback and adds a note to try after 10. Then she messages her colleague anyway.

If you ask what she wants the export for, she might say, “So I can share the list.” I’d ask about the message. She’s already put her colleague’s name in Excel. What does she still need to know before she goes home?

She can think the product is making her job easier, ask for a faster way to share the list and still feel uneasy leaving a callback overnight. Watching what she does after she opens Excel gives you a way to ask about that. Is she worried her colleague won’t see the row? Or does she need to know someone has actually agreed to take the call?

How far back can you go?

An export could save her from copying the list. That’s a useful incremental improvement, especially if she does it every day. You could also give her a way to assign the callback in your product and see when her colleague picks it up. That could take care of the spreadsheet and the message, provided both shifts already work there.

But I’d go one step further back. Why does a missed call become something the outgoing coordinator has to hand over manually in the first place?

Suppose the hospital already has a rule for who covers callbacks on the next shift. Could logging the missed call put the follow-up in that person’s queue, with the previous attempt and the note about calling after 10? The outgoing coordinator could still step in when a case needs a specific person. For the routine ones, she could log the attempt and get on with her shift.

That’s where I’d look for a step change. If it works across shifts, the team saves the work of coordinating each routine handoff, every time a patient doesn’t pick up. If the next shift starts in the EHR and you can’t get the callback into their queue there, though, you could build all of this and still leave the coordinator sending the same message at 6 pm.

What would you check in the pilot?

You sold the hospital easier coordination. Helping the first shift find who needs a call was a good first win. I’d follow a few callbacks into the next morning to see whether the product delivers on the rest of that promise.

I’d sit with the incoming coordinator and ask her to open whatever she normally opens first.

Can she see which calls are hers, what happened yesterday and when to try again? I’d also ask the outgoing coordinator what she had to do to make sure the call got there.

That’s what I’d want to know before deciding whether to build the export, change where the callback goes or do both.

Because this is the gap where you learn what would take away a customer’s pain and what would actually delight them. An Excel export is an incremental improvement. It makes one part of the handoff easier. But if you go a step further back, could you change how callbacks get picked up across shifts altogether? That’s where I’d look for an exponential outcome. One change to where a missed call goes could save both shifts from having to coordinate every routine callback by hand.