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The role of continuous quality improvement and psychological safety in predicting work-arounds

Halbesleben, Jonathon R. B.; Rathert, Cheryl

doi: 10.1097/01.HMR.0000304505.04932.62
HCMR Award Winner

Background: Work-arounds are work procedures that are undertaken to address a block in work flow. Although there has been extensive interest in the health care literature concerning work-arounds, there is a dearth of literature exploring the factors that predict work-arounds.

Purpose: The purpose of this article is to examine the role of continuous quality improvement and psychological safety as predictors of work-arounds in health care organizations. Specifically, we hypothesized that continuous quality improvement and psychological safety predicted work-arounds such that psychological safety mediated the relationship between continuous quality improvement and work-arounds.

Methodology: This study was part of a larger cross-sectional field study exploring workforce issues among cancer registrars working in acute care hospitals who report tumor data to a state cancer registry in the Midwest. Eighty-three employees of cancer registries responded to telephone survey items assessing continuous quality improvement (personal influence and management style), psychological safety, and work-arounds.

Findings: Using mediated multiple regression (with findings confirmed with a Sobel test), we found partial support for the hypothesized mediated relationship between personal influence, management style, psychological safety, and work-arounds. The exception to this pattern concerned personal influence. Because personal influence is a dimension of continuous quality improvement, it would be negatively associated with work-arounds; we found the opposite to be true in this study.

Practice Implications: To avoid problems with work-arounds, our findings suggest that organizations need to commit to continuous improvement at a strategic level. In addition, culture and management behaviors need to shift away from reinforcement of individual first-order problem solving (manifest as work-arounds) toward second-order problem-solving approaches.

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

Cheryl Rathert, PhD, is Assistant Professor, Department of Health Management & Informatics, School of Medicine, University of Missouri, Columbia. E-mail:

A previous version of this article was presented at the annual meeting of the Academy of Management on August 2006 in Philadelphia, Pennsylvania. This study was approved by the University of Missouri Institutional Review Board and was supported by a contract with the Missouri Department of Health and Senior Services.

© 2008 Lippincott Williams & Wilkins, Inc.