When Everybody’s Blocked: Understanding Shared Perceptions of Workarounds and Workaround Behaviors

Abstract

Workarounds – the steps taken to navigate a block in a process – are a persistent issue in healthcare management. To date, they have been studied as an individual-level phenomenon caused by individual-level antecedents (e.g., burnout) and organization- level factors (e.g., supply shortages). Using multilevel theory and studies of behavioral contagion, we add to the literature on workarounds by conceptualizing them as a department-level phenomenon. We argue that the homogeneous social context within hospitals allows individuals within departments to form shared perceptions of process blocks and work around these process blocks in similar ways. In our sample of 373 hospital employees nested within 32 departments, we find that safety climate (i.e., higher levels of managerial safety practices) leads to fewer workarounds at the department level. Contrary to expectations, we find that higher levels of the priority of safety dimension of safety climate lead to a reduction in workarounds at the department level when managerial safety practices are low, but not high. We discuss the theoretical implications of our work, including how demographic dissimilarities within departments (e.g., amount of experience and education) potentially influence the prevalence of workarounds.