Seeing the Signs of Workarounds: A Mixed-Methods Approach to the Detection of Nurses’ Process Deviations

Abstract

Workarounds are intentional deviations from prescribed processes. They are most commonly studied in healthcare settings, where nurses are known for frequently deviating from the intended way of using health information systems. However, workarounds in healthcare have only been studied using qualitative methods, such as observations and interviews. We conduct a case study in a Dutch hospital and use a mixed-methods approach that draws not only on interviews and observations, but also on process mining, to detect and analyse eight workarounds that occur in a clinical care process. We contribute to theory by demonstrating that it is possible to use data to determine the occurrence of a rich variety of workarounds found using qualitative methods. Practically, this implies that workarounds that are identified qualitatively can be further analysed and monitored using quantitative methods. Once identified, workarounds also provide an attractive starting point for organisational learning and improvement.