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Title: Managing workarounds in a healthcare context : a framework to improve quality and patient safety
Author: Nadhrah, Nada Ali
ISNI:       0000 0004 5994 3222
Awarding Body: University of Reading
Current Institution: University of Reading
Date of Award: 2016
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The use of workarounds has been mentioned in various healthcare discipline by different approaches. However, there has been limited research thoroughly investigating the workaround phenomena and none provided a comprehensive approach that considered all stakeholders involved. The aim of this thesis is to develop a framework that can be used to enhance the understanding and knowledge of workarounds that occur in hospitals and consequently improve hospital management's ability to manage those workarounds. That is obtained by considering workarounds main elements; nature as a process, factors behind their existences, and their impact so that the level of patient safety and service quality can be improved. In order to understand the workarounds, the above can be investigated as three aspects: the process aspect of workarounds, the factors influencing professionals to use workarounds, and the impact of workarounds. First, workarounds are analysed in terms of the existing and alternative process, roles of users and the number of people involved, and time consumed to complete the process compared to the original formal work process. Data was obtained by an exploratory study conducted by semi-structured interviews at early stage of this research and six workaround cases were collected and mapped using Business Process Modelling Notation (BPMN). The exploratory study conducted, an extensive literature review, lead to the identifications of the factors influencing the use workarounds. Based on the findings a conceptual model, Workaround Motivational Model (WAMM), was formed based on the Theory of Interpersonal Behaviour (TIB) in order to investigate professional' behaviour intentions to use workarounds. A questionnaire has been developed to examine the following factors: attitude, social factors, perceived consequences (personal value), perceived consequences (patient value), perceived behavioural controls, ease of use, usefulness, facilitating conditions, and habits. Exploratory factor analysis was applied to detect the main factors followed by a linear regression analysis to identify the most significant ones. The main factors identified that have a significant influence on professionals' intention to use workaround were: social influence, habit, perceived ease of use, and perceived consequences (patient value). Finally, in order to evaluate the impact of workarounds, a Workaround Assessment Sheet (WA-AS) was developed based on the earlier findings and applied to the workaround cases. The theoretical contribution of this thesis was identifying four different types of workarounds based on their process structure. There are four types: simple workaround, process workaround, compound workaround, and consequential workaround. In addition, the workaround Motivational Model (WAMM) is a statistical model that theories professionals' intention to use workaround in healthcare context. The practical and methodological contribution was a Workaround Conceptual Knowledge Framework (WACKF) that can be applied by quality specialised and decision makers to understand workarounds used in their organisations and consequently be able to manage them. The framework has got three main components. First component is the use of process techniques to analyse workarounds and identify activities, role and number of people involved, and time consumed to complete the process and compare it to the formal work process. Second, the use of the WAMM questionnaire to identify the factors that influence professionals to use workarounds. Third, the use of the Workaround Assessment Sheet (WA-AS) to evaluate the upside and downside from workaround use in the organisation. The framework provides guidelines, underpinned by theory, that enables management level to have a holistic view of workaround in their organisation and then decide whether to adopt this workaround or strongly eliminate it. In Delphi study experts in quality and hospital management were used to assess and confirm that the components of the framework are appropriate and logically lead to better understanding of workarounds. Results of the framework validation by the decision makers also indicated that the WACKF contributes in understanding the workarounds and consequently improve the patient safety and service quality.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available