The ‘Spaghetti notes’ phenomenon

Most people I know like pasta. I don’t. I find it bland and boring (sorry Italy).

I find spaghetti particularly annoying. No matter how much I eat, the portion in my dish never seems to reduce. It gets all tangled on my fork, it dangles everywhere, and it makes a big mess.

Which is a nice segue to this post:

The more ‘functional’ (i.e. specialised/ compartmentalised) a service has been designed then…

…the more likely that a client must speak with lots of different people (‘a new person every time’)

and the more likely that the client’s needs are then broken up into ‘transactions’ and passed on (a.k.a ‘referred’) to lots of other people to work on…

…the more people ‘touch’ (i.e. work on) a client record…

…the more file notes are left on the client record…

…the harder it is for someone working on a client record to work out what is going on…

…the more likely that, during a client interaction, the person attempting to help can’t possibly read ‘all the notes’ and so only reads what is obvious to them in the time (that they feel1) they have available to them…

…the more likely that something important is missed from within the notes…

…the more likely that inappropriate/ incomplete actions are taken and, worse, serious errors are made…

…the more likely that a client needs more work done2 on their record (to deal with the resultant failure demands, to ‘undo’ the actions taken, and the knock-on effects)…

…the more likely that a ‘leaving good notes’ policy is rolled out (including ‘best practice note templates’ and ‘quality control’ by inspection of note taking)…

…the more time taken by everyone working on a client record to make detailed notes (and to ‘police’ this)…

…the more involved each note becomes…

…the even harder it is to work out what is going on (because there’s yet more notes and each one has become painful to read – even containing internal hieroglyphics to supposedly make an ‘easier to consume’ short-hand)…

…until we arrive at the ‘spaghetti notes phenomenon’ where it’s virtually impossible to know, let alone understand, what’s gone on when viewing a client record, and it would take days of effort from a dedicated and experienced worker to review all the notes and patch them together into a coherent whole…

…and if they do this, they will stand back and think “oh my @%&!, what a pile of waste it took to achieve a shite client experience.”

 

The final ‘nail in the coffin’: Someone helping a client can often look at the spaghetti before them in the client record and (rationally) arrive at the conclusion that it would be much easier to ignore all the notes and talk to the client as if they are starting all over again.

 

Reflection:

Focusing on making good notes is an example of single-loop learning (‘making a wrong thing righter’).

The real problem isn’t with the notes, it’s with the design of the system that means that so many people are working on the same client record, because it’s this that creates the spaghetti.

 

Clarification: I’m absolutely NOT against good notes – if I’d worked on a client file a month ago, I’d like to read my own note that effectively and efficiently reminds me where I left off. I’d also like any colleague to be able to read it and gain a similar understanding.

What I AM against is a system design that causes a ‘note making’ reinforcing feedback loop3.

 

Footnotes

1. A person helping a client could take a great deal of time to work through the notes – to make sure that they gain the necessary understanding – but does their working environment cause them to think that this time isn’t available to them?

Do they feel like they’ve got to get through x number of tasks today and so time is of the essence?

2. And, of course, this ‘more work’ needs yet more notes adding to the client record.

In my experience, a ‘here’s what we did to undo an error’ file note is a convoluted thing to read (let alone write), and almost impossible to follow because ‘you had to be there’ to actually get it…which means that such file notes are often glossed over because it’s easier to do so…which leads us back around into the same torturous circle.

3. For those readers that may not understand what this means, a reinforcing loop is one in which the result of an action produces yet more of the same action, thus producing growth (or decline depending on which direction the action in question is leading).