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  • 2013
  • Working Paper
  • HBS Working Paper Series

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

By: Anita L. Tucker
  • Format:Print
  • | Language:English
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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.)
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More from the Author

    • Summer 2014
    • Permanente Journal

    Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

    By: Anita L. Tucker, W. Scott Heisler and Laura D. Janisse
    • 2014
    • Faculty Research

    The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay

    By: Hummy Song, Anita L. Tucker and Karen L. Murrell
    • 2013
    • Faculty Research

    Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time

    By: Jillian Berry Jaeker, Anita L. Tucker and Michael H. Lee
More from the Author
  • Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals By: Anita L. Tucker, W. Scott Heisler and Laura D. Janisse
  • The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay By: Hummy Song, Anita L. Tucker and Karen L. Murrell
  • Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time By: Jillian Berry Jaeker, Anita L. Tucker and Michael H. Lee
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