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This explored the role of continuous quality improvement (CQI; involving management style & personal influence) and psychological safety (PS) as predictors of work-arounds in health care; 83 employees were surveyed.

Work-arounds were defined as “work procedures that are undertaken to address a block in work flow”. The authors note that work-arounds “have become so common in patient care settings that …health care professionals [have been characterised as] masters of work-arounds” (p.135).

Work-arounds may be positive and be related to improved reliability and innovation, but if not connected effectively to organisational learning and improvement then may introduce unexpected variability.

Results

After controlling for tenure, both improvement-oriented management style (which captures the extent to which interactions necessary for CQI occur between managers and employees) and personal influence (capturing employee perceptions of whether the organisation values learning from employees) were significant predictors of PS.

Additionally, both factors were significant predictors of work-arounds: where management style was associated with less work-arounds, and personal influence with more work-arounds.

Personal influence was hypothesised to have an impact on work-arounds when people, believing they can influence the environment, may take advantage of that perception by altering work. The findings in this study partially support this idea, but found that the direct relationship b.t. personal influence and work-arounds is mediated via PS.

The authors explain the relevance of findings. First, they suggest that organisations should strongly consider a strategic application of CQI to emphasise deeper focus on true problem solving, e.g. second-order problem solving, rather than first-order which emphasises quick, local adaptations (*not an earth-shattering idea, but at least further data to support the idea*).

Further, in an environment focused on CQI, work-arounds represent ideal learning opportunities to improve work reliability.

They note that organisations that want to capitalise on CQI “need to set up conditions whereby employees feel comfortable sharing their workarounds in the context of improving work processes” (p141); PS is strongly linked here.

To foster a CQI environment, organisations need to move away from first-order problem solving – citing data from Amy Edmondson where 70% of nurses believed their managers expected them to solve problems locally.

Managers need to be physically present at least some of the time during shifts, as they’re more likely to become aware of frontline problem solving and local constraints.

The authors explain how managers that work closely with frontline employees can foster trusting relationships – particularly when they value the contributions of workers. In this case, supported and trusted managers are more likely to foster employees that feel “psychologically safe and therefore more creative in their problem-solving efforts” (p142). The paper covered more details around generating trust.

Further, the authors refer to a more recent study of theirs which suggested building workaround discussions into regular rounds/activities to capture the extent and learning.

Authors: Halbesleben, J. R., & Rathert, C. (2008). Health care management review, 33(2), 134-144.

Study link: https://doi.org/10.1097/01.hmr.0000304505.04932.62

Link to the LinkedIn article: https://www.linkedin.com/pulse/role-continuous-quality-improvement-psychological-ben-hutchinson