Learning from workarounds in barcode medication administration: a Safety-II perspective

Workarounds (WAs) in healthcare digital technologies are common, and several coping measures have been proposed. However, prior studies did not emphasize how to learn from WAs, which should be the basis for any improvement. This study addresses this gap by introducing guidelines to learn from WAs. The guidelines are underpinned by the Safety-II perspective, which recognizes that WAs are context-dependent and have mixed outcomes. A case study of barcode medication administration in a large hospital provides the empirical foundation for the guidelines. Data collection encompassed documentary analysis, shadowing of caregivers, interviews, focus groups, a survey for assessing risks of WAs, and a psychological safety survey. Results revealed 22 WAs, 43 contributing factors, nine potential desired outcomes and nine potential undesired outcomes. Tackling the contributing factors is crucial to reduce the frequency and risks associated with WAs. Five learning guidelines emerged, addressing: (i) prioritization of WAs based on their risk; (ii) emphasis on risk reduction rather than elimination; (iii) data-driven focus groups; (iv) limitations of WAs as a source of learning; and (v) use of language consistent with Safety-II; this guideline is accompanied by a new WA definition. These guidelines might inform the design of learning systems supportive of resilient healthcare.