This paper examines why large-scale digital optimisation in healthcare has often failed to deliver its promised benefits. Rather than focusing on technology or algorithms, it analyses healthcare as a flow system shaped by human work patterns, cognitive limits, and organisational routines. Drawing on systems theory, ergonomics, and empirical experience from the Swedish Rheumatology Quality Register (SRQ), the paper introduces the concept of human-centered logistics: the design of clinical systems that prioritise predictable flow, minimal decision burden, and resilience independent of individual staff members. It argues that many digital systems fail because they interrupt clinical flow, fragment work, and shift hidden labour onto clinicians. The paper proposes a practical framework for designing self-stabilising clinical workflows in which registries, digital tools, and routines form a coherent, low-friction system. Positioned within the Clinical Governance & Systems (CGS) series, this work provides the conceptual foundation for subsequent papers on patient-engaged registries and learning health systems.
Anita Domargård (Sun,) studied this question.