Working around health information systems: To accept or not to accept?

Many healthcare processes are complex and variable, which makes it difficult to align them with rigid information systems. To cope with the resulting misalignment, caregivers invent alternatives, also known as workarounds. Workarounds with negative consequences, such as those that affect the safety of patients, need to be prevented. However, those with positive consequences may be adopted by the organisation. In this study, we set out to discover which workarounds are generally acceptable and which ones should be rejected. We have discovered ten different workarounds in a Dutch hospital and analysed these in terms of three characteristics associated with healthcare processes. We found that workarounds existing in knowledge-intensive processes and/or where a patient is involved are generally considered unacceptable. In contrast, workarounds in processes with a high degree of collaboration are likely to be accepted, provided that little knowledge is required and that no patient is involved. We contribute to the current literature on addressing workarounds in healthcare settings by providing insights into the factors influencing the organisational decision to accept or reject workarounds. In addition, we provide healthcare organisations with the tools to evaluate which workarounds are attractive to be established as proper work practices.