title: The role of continuous quality improvement and psychological safety in predicting work-arounds.
abstract: BACKGROUND
  Work-arounds are work procedures that are undertaken to address a block in work flow. Although there has been extensive interest in the health care literature concerning work-arounds, there is a dearth of literature exploring the factors that predict work-arounds.
  
  
  OBJECTIVE
  The purpose of this article is to examine the role of continuous quality improvement and psychological safety as predictors of work-arounds in health care organizations. Specifically, we hypothesized that continuous quality improvement and psychological safety predicted work-arounds such that psychological safety mediated the relationship between continuous quality improvement and work-arounds.
  
  
  METHODS
  This study was part of a larger cross-sectional field study exploring workforce issues among cancer registrars working in acute care hospitals who report tumor data to a state cancer registry in the Midwest. Eighty-three employees of cancer registries responded to telephone survey items assessing continuous quality improvement (personal influence and management style), psychological safety, and work-arounds.
  
  
  RESULTS
  Using mediated multiple regression (with findings confirmed with a Sobel test), we found partial support for the hypothesized mediated relationship between personal influence, management style, psychological safety, and work-arounds. The exception to this pattern concerned personal influence. Because personal influence is a dimension of continuous quality improvement, it would be negatively associated with work-arounds; we found the opposite to be true in this study.
  
  
  CONCLUSIONS
  To avoid problems with work-arounds, our findings suggest that organizations need to commit to continuous improvement at a strategic level. In addition, culture and management behaviors need to shift away from reinforcement of individual first-order problem solving (manifest as work-arounds) toward second-order problem-solving approaches.
authors: Department of Management & Marketing, University of Wisconsin-Eau Claire, USA. halbesjr@uwec.edu
authors: Jonathon R B
authors: JR
authors: Halbesleben
authors: Cheryl
authors: C
authors: Rathert
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D015146:Midwestern United States; D011340:Problem Solving; D017751:Safety Management; D017749:Total Quality Management / Q000379:methods*; D014941:Work Simplification