A story about manual workflows, endless coordination, and building solutions that never got deployed
I’ve written before about managing clinical scheduling at the VA. But there’s another operational challenge that stands out, something most healthcare administrators know intimately but rarely discuss: the administrative burden of managing action items.
The Process That Never Sleeps
At the VA hospital, I managed dozens of simultaneous action items flowing between our regional office (VISN) and hospital leadership. Here’s how it worked:
The regional office would send a data request to our leadership. Simple enough on paper. In practice, it meant I was orchestrating a multi-step dance involving:
- Department chiefs who needed to gather the data
- Specialists within departments who had the actual information
- Leadership review to ensure responses met formatting standards
- The approval chain: Chief of Staff, Associate Director, Director
- Final delivery back to the regional office
Each step was an email. Each email had attachments. Each attachment had links to other documents. Every single transition was manual.
The Hidden Complexity
What made this challenging wasn’t any single action item. It was managing dozens simultaneously, each at a different stage of completion, each with its own deadline, each involving different stakeholders with competing priorities.
I tracked everything in spreadsheets. Milestone dates. Deadline countdowns. Who had the ball. Where bottlenecks were forming. Which items were at risk.
The mornings started with reviewing the status of every open item. Who responded overnight? Who’s running late? What needs a gentle nudge? What needs escalation?
Then came the emails. Checking in with department chiefs. Reminding specialists about pending requests. Confirming leadership had reviewed submissions. Following up on approvals that were stuck somewhere in the routing chain.
The Real Cost
This wasn’t just busywork. These action items mattered. They informed policy decisions. They affected resource allocation. They shaped how care was delivered to veterans.
But the manual coordination consumed hours every day across the organization. My time tracking and following up. Department chiefs’ time gathering information. Specialists’ time preparing responses. Leadership’s time reviewing and approving.
Time that could have been spent on strategic work. Time that could have been spent with teams and patients. Time that could have been spent on the mission instead of managing the process.
The stress wasn’t from the work itself. It was from the knowledge that one missed deadline, one lost email, one forgotten follow-up could cascade into real problems. When you’re managing dozens of these simultaneously across multiple departments, the coordination overhead affects everyone.
The Pattern I Started Seeing
After months of this, I noticed something. The actual content of the responses – the data, the analysis, the insights – that required human judgment and expertise. That’s where department chiefs and specialists added irreplaceable value.
But the coordination? The tracking? The reminders? The routing? The formatting checks? The status updates? That was pure process. Repetitive. Predictable. Rules-based.
I found myself thinking: There has to be a better way.
Designing the Solution
I didn’t just complain about the chaos. I built a solution.
Working within VA technology constraints, I designed a comprehensive automation system using Microsoft tools already approved for use. SharePoint for centralized tracking. Power BI for real-time dashboards. Microsoft Approvals for leadership routing. Teams for departmental collaboration.
The proposal addressed everything: automated email parsing to extract requirements, intelligent routing to departments, deadline tracking with automatic reminders, and streamlined leadership approvals that eliminated the endless back-and-forth emails.
I even designed the contingency plans. What happens during system outages? How do we run dual workflows during pilot testing? What’s the phased implementation approach?
The presentations were thorough. The business case was solid. The technology was already approved and available.
And I wasn’t proposing someone else build it. I planned to create it myself, working with the VA’s Office of Information Technology for guidance and support. I had the intimate knowledge of the workflows and the technical background to make it happen.
What I Learned
I submitted those proposals to my supervisor in VA leadership. I was never asked to present them or move forward with implementation. They haven’t been implemented to this day.
I don’t know if they ever reached the hospital director. They could have stopped at any point in the chain of command. That’s how large organizations work.
This isn’t about anyone making a wrong decision. In healthcare administration, dozens of good ideas compete for limited resources and attention every day. Proposals move up through chains of command where priorities get weighed against budgets, timelines, competing initiatives, and operational realities I wasn’t aware of.
What I learned wasn’t about organizational failure. It was about organizational reality.
The best solution in the world has to navigate approval chains, resource allocation, change management considerations, and timing. Sometimes great ideas don’t move forward not because they’re wrong, but because something else is more urgent or because the conditions aren’t right yet.
And sometimes you never know why.
Why This Matters
If you’ve worked in healthcare administration, you’ve lived some version of this story. Maybe it’s action items. Maybe it’s quality improvement projects. Maybe it’s accreditation prep. Maybe it’s regulatory reporting.
The names change, but the pattern is the same: critical work bottlenecked by manual coordination. Talented professionals spending hours managing workflows instead of applying their expertise. Administrative burden that everyone accepts as the reality of healthcare operations.
And sometimes, proposals that have merit but never get the green light to move forward. That’s part of working in large organizations with complex approval structures and competing priorities.
Looking Forward
That experience taught me several things that shape how I approach healthcare automation today.
First, the boundary between what requires human judgment and what could be automated is clear. The data interpretation, quality review, strategic decisions, and final approvals? That’s where humans add irreplaceable value. The tracking, routing, deadline monitoring, and status updates? That’s where automation eliminates chaos.
Second, solutions have to work within real constraints. Using already-approved tools. Respecting existing workflows during transition. Building contingencies for when systems fail. Healthcare can’t afford experimental technology or risky implementations.
Third, having the right solution isn’t enough. You also need the ability to move it through organizational structures, secure resources, navigate competing priorities, and implement change in live healthcare environments. Sometimes that means being in a position where you can make those decisions yourself.
Those years managing action items, designing automation proposals, and learning about organizational realities? That’s the foundation of everything I’m building now. Not just the technical knowledge, but understanding what it actually takes to make automation work in healthcare.
Luke McNeur spent seven years in healthcare operations at the VA before founding Neurvana AI, which helps independent home care agencies eliminate scheduling chaos through intelligent automation. He holds a BS in Health Care Administration and combines frontline operations experience with 15+ years of enterprise technology leadership.