The Impact of Workaround Difficulty on Frontline Employees’ Response to Operational Failures: A Laboratory Experiment on Medication Administration

• Published in: Management science Vol. 62; no. 4; pp. 1124 - 1144
• Main Author: Tucker, Anita L.
• Format: Journal Article
• Language: English
• Published: Linthicum INFORMS 01.04.2016; Institute for Operations Research and the Management Sciences
• Subjects: Access; Drug administration; Drugs; Experiments; Failure analysis; healthcare: hospitals; Hospitals; Laboratories; Management; Nurses; Operations management; organizational studies: behavior; Owners; Pharmacy; Policy making; Real time; Recurrence; reliability: quality control; Work environment
• ISSN: 0025-1909; 1526-5501
• DOI: 10.1287/mnsc.2015.2170

Operational failures persist, in part because employees work around them without engaging in actions to prevent recurrence. To break this cycle, we investigate the impact of work design factors on responses to operational failures. We use hospital nurses as subjects in a laboratory experiment, where, unknown to them, two medication administration supplies are missing. We observe their real-time responses to the two failures and whether they contribute an improvement idea. We randomly assign half of the participants to an experiment location far away from a satellite pharmacy where the missing supplies can be obtained (“difficult condition”), and the other half are located near the satellite pharmacy (“easy condition”). Both conditions contain risky, against-policy supplies that can be used to complete the work tasks, giving participants a choice between policy-compliant workarounds and risky, against-policy workarounds. In the first study, we find that participants in the difficult condition are more likely to contribute improvement ideas but are less likely to use policy-compliant workarounds. A second experiment with a 2 × 2 design shows that participants in the difficult condition who have high access to the process owner are more likely to use policy-compliant workarounds than when they have low access. Our results suggest that hospitals can increase communication about operational failures by deliberately making it difficult to work around them while simultaneously providing a high level of access to process owners. Otherwise, nurses encountering operational failures are likely to resort to against-policy workarounds, a behavior observed in practice. This paper was accepted by Serguei Netessine, operations management .