Working Paper | HBS Working Paper Series | 2013

Work Design Drivers of Organizational Learning about Operational Failures: A Laboratory Experiment on Medication Administration

by Anita L. Tucker

Abstract

Operational failures persist in hospitals, in part because employees work around them rather than attempt to prevent recurrence. Drawing on a process improvement tool—the Andon cord—we examine three work design components that may foster improvement-oriented behaviors: 1) blockages to prevent workarounds; 2) a support person to assist with problem-solving; and 3) education portraying operational failures as "waste" to be removed from the system. Using laboratory experiments, we test each component's impact on whether hospital nurses speak up about medication administration problems and contribute improvement ideas. We find that each component provides its own contribution to organizational performance. Blockages encourage people to suggest improvement ideas, while education sparks improvement suggestions even when there are no blockages. Blockages can backfire, however, if they are difficult to work around in a policy-compliant manner and problem-solving support is unavailable. Under these conditions, blockages led to a risky workaround associated with a 10X overdose of insulin. Risky workarounds can be mitigated with a readily-available support person, whose presence also elicits higher levels of speaking up about operational failures.

Keywords: health care; process improvement; organizational learning; behavioral operations; prosocial behavior; experiments; Organizational Change and Adaptation; Behavior; Performance Improvement; Health Care and Treatment; Business Processes; Health Industry;

Citation:

Tucker, Anita L. "Work Design Drivers of Organizational Learning about Operational Failures: A Laboratory Experiment on Medication Administration." Harvard Business School Working Paper, No. 13-044, November 2012. (Revised September 2013.)