Advice from three senior managers at Ascension.

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All too often, patients face obstacles that prevent them from efficiently managing their health care. These typically include excessive wait times, redundant and confusing paperwork, and other processes that can be daunting and draining. These mostly administrative burdens act as a “time tax” and can significantly disadvantage our most vulnerable patients by reducing their engagement in tending their own health, often leading to deferred or delayed care. American legal scholar and author Cass Sunstein has coined the term sludge to refer to these types of situations in which the design of a specific process consistently impedes individuals from completing their intended action. We believe that there is significant opportunity to improve health care by focusing more attention on removing sludge. This process has become known as a sludge audit — a systematic approach to identifying the presence and cost of sludge and figuring out how to eliminate it.