Prevent, Redesign, Adopt or Ignore: Improving Healthcare Using Knowledge of Workarounds

The complex and variable nature of healthcare work makes alignment of health information systems to healthcare processes a challenge, causing the emergence of workarounds. We developed three artifacts to use knowledge of workarounds to address this misalignment and enable the improvement of work systems. (1) The Workaround Snapshot, in which the necessary social and technical information about a workaround is captured, such as motivation, impact on the work system, and possible actions that can be taken. (2) The Workaround Action Impact Matrix, which illustrates the possible decisions that can be made. (3) The Workaround Snapshot Approach, a socio-technical approach that uses the previous artifacts to enable continuous improvement. Following the principles of design science, the artifacts are demonstrated and evaluated through a case study at a Dutch hospital, where we identified and examined twelve workarounds. The approach has proven to enable the organization to make well-informed decisions on actions to be taken, which at times result in direct improvement of the work system. We contribute to existing research in moving past the identification and categorization of workarounds, towards utilizing explicit knowledge of workarounds to improve the work system.