When do workarounds help or hurt patient outcomes? The moderating role of operational failures

Abstract

Hospital providers often use workarounds to circumvent processes so that patients can receive care. Workarounds in response to operational failures enable care to continue and therefore may be indicative of workers' commitment. On the other hand, workarounds in the absence of operational failures may signal an ineffective approach associated with lower quality of care and worse patient outcomes. Working closely with healthcare providers, we developed a survey to measure workaround behaviors and operational failures on medical/surgical units. The lead author surveyed over 4,000 nurses from 63 hospitals throughout the United States. We matched this data with audit data on the incidence of pressure injuries among over 21,000 patients on 262 nursing units in 56 survey hospitals. Hospital‐acquired pressure injuries are a significant risk to patient health and hospital costs. We do not find support for our hypothesis that workarounds are associated with a higher rate of hospital‐acquired pressure injuries. However, when we take into account the moderating role of operational failures on the relationship between workarounds and pressure injuries, we find significant results. When nursing units have lower levels of operational failures, workarounds are associated with higher rates of hospital‐acquired pressure injuries. Our results provide evidence that workarounds may be associated with negative patient outcomes, if they stem from a process‐avoiding approach. The best results can be achieved by reducing both operational failures and workarounds via instilling a process‐focused approach.

Sustainable process improvements: Evidence from intervention‐based research

“…We address this limitation by working with caregivers to redesign a process while also aiming to maintain recurring cycles of organizational learning in practice (Anand, Ward, & Tatikonda, 2010; Nonaka & Von Krogh, 2009). We put in place a system for learning how to learn (Argyris & Schön, 1978) that goes beyond reactionary process changes (Tucker, Zheng, Gardner, & Bohn, 2020) and involves employees doing the work in redesigning how to do the work (Spear & Bowen, 1999).…”

The impact of planning and communication on unplanned costs in surgical episodes of care: Implications for reducing waste in hospital operating rooms

“…The cause for this often stems from the lack of planning rather than a change in the condition of the patient. We share the findings in extant research and assert that addressing the workarounds by taking concrete steps, such as updating the PPC, can present long-term benefits for healthcare organizations (Fredendall et al, 2009;Tucker et al, 2019;Tucker & Spear, 2006). However, the current culture within the healthcare system considers the level of supply waste within the OR as acceptable.…”

“…Additionally, as shown in prior research, operational failures, such as those resulting from an inadequacy of PPC, are handled through workarounds (Morrison, 2015;Tucker, 2004;Tucker, Zheng, Gardner, & Bohn, 2019) that have an inadvertent effect of inhibiting learning opportunities. A deviation from the PPC implies that something unforeseen has occurred and has added complexity to the process.…”

“…A deviation from the PPC implies that something unforeseen has occurred and has added complexity to the process. This fire-fighting approach to solving an operational failure might address the immediate concern at hand, but it reduces quality, increases costs, and presents possibilities of potential security lapses (Bohn, 2000;Tucker et al, 2019). If the surgeon spends time prior to the episode of care thinking through the process, they would have a better chance of preempting the need and identifying where the PPC is inadequate.…”

Editorial: Delivering effective healthcare at lower cost: Introduction to the special issue

“…Two papers (Catena, Dopson, & Holweg, 2020;Lee, Venkataraman, Heim, Roth, & Chilingerian, 2020) examine how operational policies set by a national health system affect the delivery of healthcare. Two papers examine operations at the level of the entire hospital (Johnson, Burgess, & Sethi, 2020;Tucker, Zheng, Gardner, & Bohn, 2020). Two papers describe hospital-emergency-department operations (Berry Jaeker & Tucker, 2020;Davis, Zobel, Khansa, & Glick, 2020).…”