Work-arounds in health care settings: Literature review and research agenda.
BACKGROUND
As health care professionals seek to balance technological and regulatory demands with the need to provide patient-centered care, all in an efficient and cost-effective manner, they may see a greater need to improvise or work around intended work practices. Health care professionals acknowledge widespread use of work-arounds, and the literature documents their prevalence and influence on performance. Despite their importance, few studies have focused exclusively on work-arounds. This suggests a key area of need in the research, particularly because work-arounds are frequently cited in the context of serious patient safety consequences.


OBJECTIVE
The purpose of this article is to review the existing literature concerning work-arounds to elucidate the definition and nature of work-arounds, how work-arounds can be differentiated from similar constructs (e.g., errors, mistakes, and deviance), and the potential causes of work-arounds and to explore potential consequences of work-arounds in health care settings.


METHODS
We conducted a systematic review of the literature concerning work-arounds to develop themes concerning the nature of work-arounds and ideas for future research on the topic.


CONCLUSIONS
In this article, we develop links between work-arounds and potential outcomes, particularly safety outcomes. Moreover, we discuss the manner in which open discussion can allow work-arounds to facilitate work process improvement and the role that climate and culture play in reducing work-arounds.
Halbesleben
Jonathon R B
JR
Department of Management and Marketing, University of Wisconsin-Eau Claire, USA. halbesjr@uwec.edu
Wakefield
Douglas S
DS
Wakefield
Bonnie J
BJ
D017598:Efficiency, Organizational; D058016:Health Facility Administration; D006302:Health Services Research; D006801:Humans; D008330:Management Audit / Q000379:methods*; D019300:Medical Errors; D012449:Safety; D017749:Total Quality Management; D014481:United States; D014941:Work Simplification