Across every industry, digital technologies have proved to be powerful tools for streamlining processes and automating workflows. In healthcare, the introduction of Electronic Health Records (EHRs) was hailed as a groundbreaking cure to the inefficiency of paper-based systems. But as many healthcare providers have now learned, digitizing a pointless or poorly designed process can make it even harder for employees to get their work done. The numbers are stark: a study in the Annals of Internal Medicine revealed that doctors in outpatient settings spend just 27% of their day in face-to-face patient care, while half of their time is consumed by EHRs and desk work.
This imbalance is a triple threat. It shortchanges patients, who are deprived of valuable time with their healthcare providers. It fuels burnout among nurses and doctors, who identify an excess of bureaucracy as the primary cause. And it’s expensive — the U.S. healthcare system spends a staggering $1 trillion per year, or a quarter of total expenditures, on administration.
While some are hopeful that generative AI will help cut through the paperwork, these predictions remain speculative. In the meantime, there’s a proven remedy for reducing the administrative burden. This solution doesn’t hinge on fancy algorithms but on a commitment to rooting out bureaucratic inefficiencies and simplifying work processes. Take the case of Hawaii Pacific Health (HPH), a non-profit system employing 7,000 staff across four hospitals in the Aloha state.
The story starts in 2017 with Dr. Melinda Ashton, a pediatrician serving as HPH’s Chief Quality Officer. In her role, Ashton had become increasingly concerned with the deluge of administrative tasks that were eroding the time medical staff could spend directly caring for patients. Across HPH there was a growing chorus of complaints about needless busywork and ponderous systems. Physicians and nurses were particularly frustrated by the hours they spent each day mechanically clicking through the maze of on-screen prompts that popped up whenever they needed to update a patient’s care records.
The spark for change came when a group of nurses decided to calculate the time they and their peers spent documenting the simple fact that they had completed their hourly rounds. The team estimated that this perfunctory task consumed 1,700 nursing hours per month.
This revelation — the perfect symbol of the unnecessary friction that was vexing clinicians — pushed Ashton over the edge. With a blend of boldness and pragmatism, she proposed a radical idea to her C-suite colleagues: rally all of HPH’s medical staff in a campaign to “Get Rid of Stupid Stuff.” The blunt name raised eyebrows among execs, and some suggested blander terms like “administrative simplification,” but Ashton stood her ground. It was crucial to acknowledge the problem honestly and be clear about the intent to solve it.
“Get Rid of Stupid Stuff” Suggestions
Get Rid of Stupid Stuff (GROSS) launched in October 2017. Clinicians were encouraged to identify anything in the EHR that was poorly designed, unnecessary, or just plain nonsensical. The submission form was simple and easily accessible on HPH’s internet.
To create buzz, Ashton toured each of HPS’s four hospitals. She shared vivid examples of administrative absurdity and invited her colleagues to join the campaign.
Most of the early nominations were for tasks that simply made no sense. A nurse in adolescent oncology pointed out that for over a decade she’d been dutifully documenting “cord care” for her patients. The absurdity? Adolescents don’t have umbilical cords. A neonatal nurse flagged another equally goofy task: Having to check three boxes every time she changed a baby’s diapers, indicating whether or not her tiny patient was incontinent of urine, stool, or both.
Other nominations targeted processes that were necessary but needed a serious efficiency upgrade. For instance, patients being discharged from the emergency department had to digitally sign an after-visit summary which was then printed out, scanned, and uploaded back into the system.
From Idea to Action
In the first year of the initiative, HPH staff submitted nearly 200 suggestions. These were reviewed by two nursing leaders in Ashton’s department, both of whom had extensive experience in IT and quality improvement. The GROSS core team developed a simple but effective triage mechanism.
Simple fixes, like removing the “cord” prompt for patients who weren’t newborns, were handled directly by the GROSS team. Ideas requiring further review and elaboration were handled by pre-existing quality and EHR working groups. These teams, representing different hospital areas, reviewed and prioritized the nominations. When a “stupid stuff” idea got the green light, the working group would invite the individual behind the original nomination to help with the redesign.
In some cases, finding a fix also meant liaising with clinical groups that had different perspectives on the merits of a specific practice. Emergency Department physicians, for example, preferred to fill out simple one-time prescriptions for antibiotics, while hospitalists, keen to prevent dosing delays, would typically opt for a recurring prescription, which took more time to enter. It was up to the working groups to identify these conflicts and design the best solution.
A small fraction of submissions — roughly one in every eight — ran into major regulatory or technological hurdles and were judged to be “not possible at this time.” When this happened, the GROSS team would write a response explaining why the fix wasn’t feasible. The goal was always to acknowledge every nomination and be transparent when the barriers to a redesign seemed insurmountable.
A Broader Impact
The second year of GROSS would yield another 300 nominations. Out of all the actionable ideas, about 10% involved patently stupid activities that could be terminated immediately; 15% flagged gaps in clinical communication and support for necessary workflows; and the remaining 75% identified redesign opportunities to improve efficiency and effectiveness. In addition to saving thousands of hours across HPH, the GROSS initiative also had an effect on the organization’s culture — principally by empowering frontline team members to challenge the systems and processes that make their work unnecessarily difficult and inefficient. As Ashton put it in an article for the New England Journal of Medicine: “… there is stupid stuff all around us, and although many of the nominations we receive aren’t for big changes, the small wins that come from acknowledging and improving our daily work do matter.”
Other hospital systems including the Cleveland Clinic and the Mount Sinai Health System, have taken take note of Dr. Ashton’s work implemented their own versions of “Getting Rid of Stupid Stuff.” Seeing the potential to scale this approach across health care system, the American Medical Association (AMA) launched a GROSS module as part STEPS Forward, its signature practice improvement program.
Frontline Initiative and Intelligence
Dr. Ashton’s individual leadership and initiative were key in Hawaii Pacific’s success. She didn’t mince words — she called out the “stupid stuff” for what it was. But the real magic of the effort was tapping into the power of the organization’s collective intelligence. Those at head office, no matter how well-intentioned, aren’t on the front lines and can’t, therefore, calibrate the true costs of bureaucratic folly. It’s the nurses, doctors, and others in the trenches, who see where the system falls short.
Yet, ideas alone aren’t enough. Dr. Ashton and team succeeded because they were disciplined and deliberate in the follow-through. GROSS wasn’t just an electronic suggestion box — it was a system that filtered, prioritized, and executed promising ideas, working across departments and disciplines. The initiative produced meaningful results — results that improve the lives of clinicians and patients in ways significant enough to justify the hard work of rooting out excess bureaucracy.
In the face of entrenched norms and processes, it’s easy to succumb to a sense of helplessness, to accept the status quo as an immovable reality; it’s also easy to believe that technology will solve every problem. Yet, the story of Hawaii Pacific Healthcare’s GROSS initiative offers a compelling counter-narrative. It’s a tale that reminds us that with simple, smart process improvements, we can, indeed, challenge and reshape the operational systems that bind us.
