Workarounds

Abstract

Patient safety and the quality of clinical interventions rely on the application of best practices in clinical processes to achieve clinical and service specifications for patients. However, outcomes vary due to variations in work activity performance in terms of efficiency and quality, and variations in what is done. This chapter explores the concept of deviations from formal work processes as workarounds in health interventions. It examines workaround evolution and development, the motivation for them, and types. It identifies their positive and negative impact on patient safety and quality. The chapter is based on primary research and workaround case studies of 14 staff in three hospitals. The approach supports the work to develop a generic conceptual normative analysis model of workarounds and adopts BPMN and organisational semiotics to qualitatively and quantitatively define and compare the original work process and workaround. This chapter extends definitions of workaround types and the relationship between actors in the formal work process and informal workaround process. The authors propose a conceptual model to identify the relative safety risk of workarounds and hence their likely patient impact. The discussion focuses on the initial findings of this model on patient safety and how different workaround types impact patient safety. The chapter highlights examples of the clinical work deviations and shows that they can have both positive and negative benefits for patient safety. It emphasises how, using an informatics approach, workarounds need to be considered in detail to understand the motivation and potential impact on health activities.