Work coordination, workflow, and workarounds in a medical context

Abstract

In this paper we report an ethnographic study of workarounds-informal temporary practices for handling exceptions to normal workflow-in a hospital environment. Workarounds are a common technique for dealing with the inherent uncertainty of dynamic work environments. Workarounds can help coordinate work, especially under conditions of high time pressure, but they may result in information or work protocols that are unstable, unavailable, or unreliable. We investigated workarounds and their effects through observation and interviews in a major teaching medical center. Our results suggest 4 key features of workarounds that technologies might help address: (a) workarounds differ as a function of people's role; (b) workarounds draw on tacit knowledge of others' abilities and willingness to help; (c) workarounds can have a cascading effect, causing other workarounds down the line; (d) workarounds often rely on principles of fairness and who owes whom a favor. We provide recommendations for designing systems to better support workarounds in dynamic environments.