One of the ways we try to maintain safety in our everyday work is to do a workaround. Workarounds in healthcare are common, sometimes planned, sometimes not, but in the vast majority of occasions well meaning. Often a workaround is a method for overcoming a problem or limitation in a way of working.
A workaround is where individuals deviate from the prescribed work, often for genuine reasons. These are a few of the different types of workarounds:
- erroneous or unintentional – the healthcare workers did not know the policy existed or that it had been updated or did not fully understand the policy and was not aware of the right steps to make
- routine — the healthcare workers routinely work around an unworkable policy
- situational or exceptional – the healthcare workers workaround the normal procedure to accommodate the situation
- optimising — the workaround is better than the prescribed way to workarounds may be done to make the work more efficient, quicker, or even to maintain safety
We don’t have a clear understanding of the scale and nature of the workarounds because we don’t study them and often staff don’t feel able to disclose what they are doing. The workarounds become normal, the ‘way we do things round here’.
If the workaround is regarded as usual practice, then they are usually only detected when something goes wrong. Because of this, workarounds are intricately linked to when things go wrong and are considered the same as breaking the rules. Particularly in nursing and midwifery, they can lead to punishment, sanction and professional retribution.
But here’s the thing.
If most of the time work goes ok.
If we believe in the 90% rule then the workarounds must also contribute to things going right.
Understanding why people don’t follow policies is a key component of safety. The reasons may lead to valuable lessons for the organisation who may need to re-write some of the standards or rules or may have to consider how these rules could be made easier to implement.
PATIENT SAFETY NOW 