Workarounds and Their Impact on Patient Safety

Workarounds are informal practices that healthcare workers develop to circumvent perceived obstacles in their workflow. While often created with good intentions, workarounds can undermine safety systems and introduce new risks. CPHQ candidates should understand why workarounds develop, how they affect patient safety, and what organizations can do to address them.

Why Workarounds Develop

Healthcare workers create workarounds for several reasons. Poorly designed processes may be inefficient or impractical in real clinical situations. Technology that is difficult to use or that slows workflow may be bypassed. Time pressure and competing demands force clinicians to find shortcuts. Resource constraints (inadequate supplies, equipment, or staffing) create barriers to following standard procedures. Sometimes, workarounds arise because policies were developed without adequate input from frontline staff and do not reflect the realities of clinical practice. The gap between "work as imagined" (how leadership believes work is done) and "work as done" (how work actually happens) is where most workarounds live.

Examples in Healthcare

Common healthcare workarounds include bypassing barcode scanning during medication administration (scanning the medication to a label rather than the patient's wristband), overriding clinical decision support alerts without reading them, using an override code on automated dispensing cabinets to access medications before pharmacist verification, keeping commonly used supplies in unauthorized locations, sharing login credentials for electronic systems, and using verbal or telephone orders to avoid the CPOE system. Each of these workarounds bypasses a safety control that was designed to prevent errors.

Impact on Patient Safety

Workarounds are problematic because they bypass safety barriers, creating gaps in the organization's layers of defense (the Swiss cheese model). They also normalize deviance, gradually shifting the standard of practice away from established safety protocols. When workarounds become routine, staff may no longer recognize them as deviations from standard practice. Additionally, workarounds are typically invisible to management and quality systems, meaning the organization may believe its safety barriers are functioning when they are actually being routinely bypassed.

Addressing Workarounds

Organizations should take a systems-based approach to workarounds rather than simply punishing the individuals who use them. The first step is to identify workarounds through direct observation, staff surveys, and open dialogue with frontline workers. The next step is to understand the root cause: what obstacle is the workaround designed to circumvent? If the underlying process is truly flawed, the appropriate response is to fix the process rather than enforce a broken one. If the workaround bypasses a necessary safety control, the organization must address the barriers to compliance while maintaining the safety function.

Creating Better Systems

Preventing workarounds requires designing systems that are efficient, intuitive, and compatible with clinical workflow. This means involving frontline staff in process design, conducting usability testing before implementing new technologies or workflows, reducing unnecessary complexity in processes and technology, providing adequate resources (time, supplies, staffing) to follow established protocols, and creating feedback mechanisms that allow staff to report workflow barriers without fear of punishment. Quality professionals play a key role in bridging the gap between organizational expectations and frontline reality, ensuring that safety systems work in practice and not just on paper.