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

Health Care Manage Rev. 2008 Jan-Mar;33(1):2-12. 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Efficiency, Organizational
  • Health Facility Administration*
  • Health Services Research*
  • Humans
  • Management Audit / methods*
  • Medical Errors
  • Safety
  • Total Quality Management*
  • United States
  • Work Simplification