Increasing efficiency is crucial in healthcare systems. To do so, a classical approach is to redesign organizations using Discrete Event Simulation (DES). However, DES models workers only as resources producing labour with a certain efficiency. To overcome this limitation, DES can be embedded in a Soft Systems Methodology (SSM) framework. In this article, we show how an ethnographic study is undertaken early in such a framework. Precious insights are gained and these findings call for more frequent use of observation in addition to interviews when redesigning organizations.