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Work-arounds in health care settings: Literature review and research agenda

Halbesleben, Jonathon R. B.; Wakefield, Douglas S.; Wakefield, Bonnie J.

doi: 10.1097/

Background: As health care professionals seek to balance technological and regulatory demands with the need to provide patient-centered care, all in an efficient and cost-effective manner, they may see a greater need to improvise or work around intended work practices. Health care professionals acknowledge widespread use of work-arounds, and the literature documents their prevalence and influence on performance. Despite their importance, few studies have focused exclusively on work-arounds. This suggests a key area of need in the research, particularly because work-arounds are frequently cited in the context of serious patient safety consequences.

Purpose: The purpose of this article is to review the existing literature concerning work-arounds to elucidate the definition and nature of work-arounds, how work-arounds can be differentiated from similar constructs (e.g., errors, mistakes, and deviance), and the potential causes of work-arounds and to explore potential consequences of work-arounds in health care settings.

Approach: We conducted a systematic review of the literature concerning work-arounds to develop themes concerning the nature of work-arounds and ideas for future research on the topic.

Implications for Practice: In this article, we develop links between work-arounds and potential outcomes, particularly safety outcomes. Moreover, we discuss the manner in which open discussion can allow work-arounds to facilitate work process improvement and the role that climate and culture play in reducing work-arounds.

Jonathon R. B. Halbesleben, PhD, is Assistant Professor, Department of Management and Marketing, University of Wisconsin-Eau Claire. E-mail:

Douglas S. Wakefield, PhD, is Director, Center for Health Care Quality, Department of Health Management and Informatics, University of Missouri-Columbia.

Bonnie J. Wakefield, PhD, RN, is Director, Health Services Research and Development, Harry S. Truman Memorial Veterans' Hospital; and Research Associate Professor, Sinclair School of Nursing, University of Missouri-Columbia.

© 2008 Lippincott Williams & Wilkins, Inc.