Avoiding Workarounds through Systems Design - Anita Tucker Answers Your Questions

On October 30, 2013, Anita Tucker, ISRN Steering Council member and Associate Professor of Business Administration at the Harvard Business School presented a web seminar titled “Avoiding Workarounds through Systems Design.” Below are questions that could not be answered during the scheduled session.

If you missed the web seminar, an archive of the seminar can be viewed by clicking on this link.

Does a "service line" model of management (matrix model) improve or detract from achieving good internal integration. What model of management seems to lend to the best internal integration.

This is a great question, but unfortunately I don’t have any data linking specific management models, such as service lines, to internal integration outcomes, such as the frequency of operational failures.  I think that service line management – if it includes all of the support systems necessary to provide care – could provide the alignment toward organizational goals that could lead to internal integration.

I would love to hear from folks who work in service line hospitals about their experiences with this type of organizational structure.

'Workarounds' is a benign term - suggestions regarding how to add the bad connotative sense to it?

Whenever I present my research, I usually get an opposite kind of comment: that is people feel that I make workarounds sound bad, when in fact, they could be helpful for the patient because they enable the patient to get the care he or she needs.

I am not sure if this has a bad connotative sense, but I have come to think of workarounds as a compensatory action – that is the employee is forced to compensate for a faulty system design. 

Can we get access to the pharmacy study?

Here is the citation:

Sobek, D. K., C. Jimmerson. 2003. Applying the Toyota Production System to a Hospital Pharmacy. Proceedings of the Industrial Engineering Research Conference

In the old days, we used standing orders, but they didn't necessarily cross over into supplies or even pharmacy.  Does this research support revisiting that approach?

I think so.  My understanding of standing orders is that they are a predetermined set of actions to be taken for a particular medical condition treated on the nursing unit.  I do think that the concept could be expanded to include the equipment that is required to treat that condition.  I think that the one expansion would be including the ancillary support units in the dissemination of the expanded standing orders as well as the predicted flow of patients on the units, so that can tailor their work such that it meets the incoming patients’ needs.

To what degree are there interactions between improving pairwise coordination and optimizing end-to-end flow?

This is an interesting question!  I don’t have a definitive answer for this, but I believe that being able to improve pairwise coordination is a necessary condition for achieving end-to-end optimal flow.

Thank you for this presentation.  Obviously there are implications for other settings of patient care such as primary care and home health.  Are there studies applicable to those settings?

I am sure there are studies on primary care and home health, but at this time, I don’t have any citations to share.  Perhaps someone in the network could share their research with us!

I am familiar with your work that you defined workarounds as first-order problem solving. Did you come up with this term?

Yes, we came up with the term first-order problem solving in a 2003 paper. 

Tucker, A. L., A. C. Edmondson. 2003. Why hospitals don't learn from failures: Organizational and psychological dynamics that inhibit system change. California Management Review 45(2), 1-18.

It was based on Argyris and Schon’s terms of single loop and double loop learning.

Argyris, C., D. Schon. 1978. Organizational Learning: a theory of action perspective. Addison-Wesley Publishing Company, Reading, MA.

How did you define workarounds in your studies?

In one of my recent working papers, I use Halbesleben and his colleague’s definition of workarounds

Halbesleben et al. (2010) define a workaround as “a situation in which an employee devises an alternate work procedure to address a block in the flow of his or her work” (p.1).

Halbesleben, J. R. B., G. T. Savage, D. S. Wakefield, B. J. Wakefield. 2010. Rework and workarounds in nurse medication administration process: Implications for work processes and patient safety. Health Care Manage. Rev. 35(2), 124-133.

To learn more about the papers that were referenced in this blog post, please visit the eReading Room's library of annotated bibliographies in the Member Center. If you are not a member of the ISRN, click on Join Us! in the left margin.