A recent New York Times op-ed offers that the prevalence of workarounds is an indication of the overall dysfunction of the American healthcare system, going as far as to indicate these workarounds are often a “trade-off in values” where providers must choose between onerous rules and patient safety. While workarounds are not ideal, we must ask ourselves: do workarounds provide us with opportunities for improvement or unintended consequences?
I am not new to this industry, actually I am on the upper end (33 years) of practicing nursing in a variety of roles and settings, all nurses can provide you with examples of times when they or their colleagues created workarounds. I would bet ¾ of the individuals who created workarounds never even thought of the potential side effects! Their goal to was to meet the needs of the patient in a timely and efficient manner.
Any quality or safety professional will tell you the use of workarounds continues to expand to meet the needs of a complex changing clinical environment and are often a sign of a system or process flaw. Healthcare organizations often redesign and implement new work processes away from the point of care in hopes of improving patient safety, meeting a new standard or regulation, or attempting to protect margins. As a result, there are often intentionally designed “blocks” or barriers that limit how specific work is done.
To get work done, healthcare developed a workaround culture, which values expertise in overcoming obstacles for the current patient. Often nurses and caregivers wear these workarounds as a badge of honor – an illustration of their commitment to provide the best, most timely, safest care possible to each patient, in spite of any impediments they encounter.
The danger is that some of these workarounds become embedded and accepted as the norm in the patient care processes, which then makes them very hard to detect and has significant long-term consequences. As David Rockefeller once said, “If necessity is the mother of invention, discontent is the father of progress.” If this is the case, how do we harvest insight from these workarounds to drive progress and alignment throughout healthcare to address some of the dysfunction Dr. Brown mentions in the New York Times article?
All workarounds contain useful information. Healthcare has to study workarounds as part of problem-solving processes with frontline workers, who are in the best position to identify sustainable, efficient and effective process improvements. Incorporating staff and proactively identifying potential workarounds will help identify flaws and provide important evidence about system vulnerability and organizational risk. Analysis of the content, findings, and circumstances that prompted a workaround provides useful information that leads to the improvement of safety, efficiency, and effectiveness of care delivery processes.
Inge Garrison is the Chief Nursing Officer (CNO) and VP of Strategic Advisory Services at Verge Health. To learn more about Strategic Advisory Services through Verge Health, visit here.