Abstract/Summary

Purpose – Development of a multi-dimensional framework for detecting and understand workarounds within a healthcare environment. Workarounds are defined as informal work processes sometimes deemed illegitimate, which are used when formal work processes are unable to be carried out. Workaround can be either positive or detrimental; this study investigated both for the purpose of legitimising the positives workarounds. Development – A multi-disciplinary approach (Informatics, Psychology, Linguistics, Anthropology, Philosophy and Sociology) was used towards the developed of the framework. The Framework consisted of multiple components such as a typology matrix rooted in the theory of Workarounds (Alter, 2014); Work Systems Framework (Alter, 2013); Hall and Trager‘s (1953) matrix for Analysis of Culture, The Seven Circumstances (Robertson, 1946), and lastly individual; group work process and cognitional norms were used as a unit of analysis for an embedded and holistic understanding of the Distributed Cognitions within an organisation. Research Context – Healthcare domain within a GP Practice (NHS Wales) and Moorefield‘s Eye Hospital (NHS England) Design/Methodology/Approach – Design Science was used for its ability to allow for sequential abstraction or incorporation of pivotal changes to be made towards the development of the framework (artefact). Design Science also allowed for the research to progress from a knowledge base to building and testing of the artefact within the appropriate designated environment (primary and secondary NHS healthcare setting). A qualitative semi-structured interview and participant observation was used as a method of collecting data. Demographic for Primary Care - 1 practice manager; 1 receptionist; 2 nurses and 1 IT Assistant/Nurse. Demographic for Secondary Care - 1 professor; 4 consultants; 3 nurses; 3 technicians and 3 IT staff members Findings – The research found that, workarounds were rife within most organisations in relation to work processes, information systems and technology and were undetectable without the application of a qualitative means of measure. The findings from the healthcare environment showed that the qualitative analytical data had the ability to aid the current KPI‘s, which were found to be heavily invested in the usage of quantitative numerical data, therefore giving meaning and motive to the existing performance metric. Contribution - A unique multi-dimensional framework was developed for an embedded situational level of understanding, prior to administering change within any domain and organisation. The multi-dimensional framework was also developed to align with any existing KPIs and good practice of an organisation. Key Words – Workarounds, Multi-Dimensional Framework, Matrix, Typology, Healthcare, Norms Analysis, Distributed Cognitions.