this post was submitted on 30 Sep 2025
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That sounds wonderful. Typically if a place has that little tech debt it means that they've overhired and there isn't enough work, but if you said they were on a limited budget, then maybe not. It does sound like the kind of place where I can imagine that happening though. A tech-focused workplace would probably find or create other work. For a hospital, the IT department is a random cost centre, and probably fairly cheap compared to doctors, medical equipment, insurance, etc. And, a hospital probably understands much better than most workplaces about why security is important (keeping patient records private), why a "move fast and break things" attitude is sometimes a terrible fit, why documentation and checklists matter, etc.
Did you ask them if there was any tech debt? Because, I wouldn't be surprised if they thought there were things they could improve. Like, the documentation probably looked complete to you, but maybe they knew that there were a few areas they could have done better. Like, with the "cleaning" analogy, I've been places I thought were spotless, but the people who cleaned it always thought there was more they could do.
Sadly the realities are different: I visit around one healthcare facility every other week in all of Europe, far more infrequently in Africa, Asia and Oceania.
Hospitals consistently have the worst IT departments I ever see - outdated technology, budget constraints (I literally saw a full IT loss due to "we don't pay for our firewall licences for over 3 years") and a fucking lack of care. One of the most well known clinical information systems has a hardcoded admin account with a single letter as PW in it Another popular system will try to install an ancient version of TeamViewer. In other words: It's a mess - btw often the budgets are huge and more than what nurses cost.
That's why this unicorn stuck with me. They were "relaxed" - because they all had a workload that was "manageable", there was someone to take over if shit hits the fan,etc. And they didn't feel like they would need to do this and this - I know and fear this myself, it's the bane of my existence as a project guy. They? They had a nice, lean but powerful project workflow and change management.
In the end it all came down to very very good management - a manager who knows their team that well is worth their weight iin gold.
Probably good support for that manager from the levels higher up too. Because, like you said, that sounds like a unicorn. That sort of thing just doesn't happen.