Every day, data moves through mental health systems in ways that are so mundane that they are easily overlooked. A message arrives. A report is opened. A score is entered. Then another. And another. Nothing breaks. The system is still there. The reports can still be generated. But something begins to tilt, to shift. This post traces what happens when the work required to hold a measurement system together slowly moves out of the workflow and into the hands of the people using it. Not all at once, but one small step at a time. Drip. Drip. Drip.
Every day, there is a clinician sitting at their desk, getting ready to see their next client. The client has taken a psychological assessment from a third-party assessment platform.
So.
The clinician opens the chart.
The report from the third-party assessment is not there.
They check their messages.
A notification that the results are ready is in their inbox from the assessment platform.
They open it.
Download the PDF.
Enter the scores by hand. Check what they entered. Check again.
But like the drip, drip, drip of a leaky faucet, something seems off.
This happens again.
And again.
And again.
Clinicians cannot give therapy and conduct assessments too.
So it keeps getting chased down.
By someone.
Administrative support staff.
Drip. Drip. Drip.
Not one clinician. Not one client. Not one assessment. The assessments keep stacking. It does not end.
So. A name is checked. Then checked again. A list is opened. Closed. Opened again.
Drip. Drip. Drip.
A dashboard appears.
Clinicians. Clients. Assessments.
Because the EHR does not track what it does not manage.
Drip. Drip. Drip.
The data keeps appearing. Reports can still be generated.
But the system underneath rumbles a bit.
The work required to keep it going moves out of the workflow and into the hands of the people using it.
This is where systems begin to fail after rollout.
This is where systems start to give way, not all at once, but at the point where they ask for just a little more each time, the kind of added burden that accumulates when the workflow does not quite hold together (Boswell et al., 2015). The system is technically there, the notification arrives, the report exists, but availability does not close the gap between where the data lives and where decisions are made (Fortney et al., 2017).
A client takes an assessment.
A message arrives.
A file is opened.
Numbers are entered.
It does not arrive all at once.
It keeps coming.
One more. Then another.
The same message gets opened again.
A name is scanned twice. Then once more.
Not one clinician. Many.
Not one client. Many.
Not one assessment. Many.
By the time it is ready, the moment to use it has passed (Lambert, 2010).
Over time, the work teeters. The process begins to shift. What started as part of the system becomes something maintained through effort, small adjustments carried by both clinicians and staff that slowly change how the system actually functions in practice (Lewis et al., 2020).
It builds.
In the pause before opening the next message.
In the second check.
In the third.
In the extra click that was not there before.
It tightens. Just a little. Each time.
Drip. Drip. Drip.
