The article suggests that the root cause of workarounds majorly is the issue of poorly performing work systems. For instance, nurses are sometimes faced with issues such as broken equipment, wrong dosing of patient medication, breakdown in information communication and other bottlenecks that serve as hindrance to the smooth flow of work in the clinical setting. These bottlenecks hinder patient care due to the operational failures. In the face of this, health care professionals, especially nurses still manage to provide quality care to patients. The only way they are able to achieve this feat is by working around these bottlenecks. These workarounds, however, are not standard methods of accomplishing these duties.
The article states that workarounds are an integral part of the health care culture. The reason being that it offers benefits. They build organizational resilience in the face of failing systems. It also provides a rare opportunity to be innovative in solving problems because improvisations come out of the necessity to get the job done.
These workarounds are also said to be beneficial to health care professionals especially nurses because they bring a sense of accomplishment to the individuals that are able to bypass these system failures. There are consequences to the use of workarounds to accomplish tasks. The main issue is in preventing an occurrence of the issue, which caused the use of a workaround in the first place. Most times, health care professionals do not bother to address the issues that brought about the bottlenecks in the first place. They do not engage in additional steps to prevent recurrence. This leads to the necessity to use this workaround later when the same problem arises.
The lack of communication that arises from none reporting of system failures keeps managers and relevant personnel unaware of the problem. Therefore, the problems are not investigated, neither are steps taken to correct the problem. Thus, the same problem is likely to recur in future.
Workarounds also potentially put other units in jeopardy. for example if the problem in a ward is the shortage of certain equipment or materials, and the nurse goes to another unit to obtain those materials or equipment from another colleague, it would eventually lead to shortage of such materials or equipment in the other unit thereby putting both units in jeopardy. Operational failures should not be used as an excuse to engage in workarounds, rather, it should be an opportunity to learn from the system and offer improvements to make the system more efficient. Managers should encourage staff to report system failures even if they have to engage in a workaround in order to satisfy the transient need. This would ensure a more efficient system.
Communication between staff and manager should also be strengthened so that actions taken to correct system failures should be communicated to the nursing staff as a form of feedback mechanism. In doing this, the nursing staff would be aware of steps that are being taken, or that have been taken to correct the lapses encountered. Nurses should be discouraged from engaging in workarounds for the reasons adduced by this article. Workarounds have both positive and negative sides. Whereas it is provides job satisfaction by helping to overcome system failures. It should only be used as a one-time solution to problems so that it does not become a dangerous habit that would be difficult to control. Ethical issues are also raised by the use of workarounds. For example, correcting a wrong drug dosage without informing the physician means that such nursing staff would be liable if any adverse effect comes as a result of the changed dosing. Communication should be improved between manager and nursing staff so that issues that being about workarounds are addressed and long-lasting solutions proffered to problems.
Reference
Anita, Tucker (2009). Workarounds and Resiliency on the Front Lines of Health Care. Agency for Healthcare Research and Quality: Web Mortality and Morbidity Rounds. Retrieved on 12th May, 2012 from
