What device users actually notice first when quality starts to fall apart

I’ve been responsible for quality on Class II products long enough to see the same surface symptoms show up across different companies and tech stacks. In our 200-person shop the first few signs of "quality rot" weren’t flagged in an audit report — they came from users, clinicians, and service teams who had to do the workarounds. This post is a short catalog of the things people notice first when a QMS is slipping, the underlying process failures those symptoms usually point at, and a few pragma