How can we decrease burnout and safety workaround behaviors in health care organizations? The role of psychosocial safety climate
| DOI | https://doi.org/10.1108/PR-07-2017-0224 |
| Published date | 04 March 2019 |
| Pages | 528-550 |
| Date | 04 March 2019 |
| Author | Sari Mansour,Diane-Gabrielle Tremblay |
| Subject Matter | HR & organizational behaviour,Global HRM |
How can we decrease burnout and
safety workaround behaviors in
health care organizations? The
role of psychosocial safety climate
Sari Mansour and Diane-Gabrielle Tremblay
Université Téluq,
Université du Québec, Quebec, Canada
Abstract
Purpose –Conducted with a staff of 562 persons working in the health sector in Quebec, mainly nurses, the
purpose of this paper is to test the indirect effects of psychosocial safety climate (PSC) on workarounds
through physical fatigue, cognitive weariness and emotional exhaustion as mediators.
Design/methodology/approach –The structural equation method, namely CFA, was used to test the
structure of constructs, the reliability and validity of the measurement scales as well as model fit. To test the
mediation effects, Hayes’s PROCESS (2013) macro and 95 percent confidence intervals were used and 5,000
bootstrapping re-samples were run. The statistical treatments were carried out with the AMOS software V.24
and SPSS v.22.
Findings –The results based on bootstrap analysis and Sobel’s test demonstrate that physical fatigue,
cognitive weariness and emotional exhaustion mediate the relationship between PSCand safety workarounds.
Practical implications –The study has important practical implications in detecting blocks and obstacles
in the work processes and decreasing the use of workaround behaviors, or in converting their negative
consequences into positive contributions.
Originality/value –To the authors’knowledge, this is the first study to examine the relationship between
PSC, burnout and workaround behaviors. These results could contribute to a better understanding of this
construct of workarounds and how to deal with it. Moreover, the test of the concepts of PSC in this study
provides support for the theory of “conservation of resources”by proposing an extension of this theory.
Keywords Quantitative, Psychosocial safety climate
Paper type Research paper
1. Introduction
Although the notion of “workarounds”comes from the field of information technology, it is
now used in the healthcare sector given the complexity and particularities of the care activity
(Eisenhauer et al., 2007; Halbesleben et al., 2008). Morath and Turnbull (2005) consider that
health workers are “masters”of workarounds. The care sector is a “high-hazard industry”
in which employees’actions could lead to injury or evento the death of the patient (McNulty
et al., 2009). Work in healt hcare organizatio ns is characterized simultaneously by routine,
highly structuredand ultra-safe practices,but also by irregular, erratic and harmfuldemands.
Patricians have to learn on the job at the same time as they have to display professional
autonomy (Debono et al., 2013).
These characteristics of healthcare organizations translate into employees’work,
behaviors and responses to the demands of clinical practice (Debono et al., 2013). Indeed, it
seems that healthcare organizations, especially hospitals, have developed a large number of
standardized routines, policies and technologies that seek to standardize patrician’s practice,
make patients safer and save hospitals’financial resources (Halbesleben et al., 2008).
However, facing the complexity of care within a system that increasingly requires
standardization, “employees develop inconsistent and idiosyncratic work patterns that they
believe increase their performance and patient safety”(Wheeler et al., 2012, p. 547). These
practices are called “workarounds.”In other terms, an employee develops an alternative
Personnel Review
Vol. 48 No. 2, 2019
pp. 528-550
© Emerald PublishingLimited
0048-3486
DOI 10.1108/PR-07-2017-0224
Received 28 July 2017
Revised 6 December 2017
21 April 2018
22 June 2018
Accepted 4 July 2018
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0048-3486.htm
528
PR
48,2
work procedure to address a block in his or her workflow (Halbesleben, 2010) without
analyzing why this blockage is happening (Finkelman and Kenner, 2012).
Workers in health care organizations thus develop workaround behaviors in response to
four factors they perceive: prevent or weaken the care they provide for their patients; are not
in the best interest of their patients; make the realization of their job difficult or longer; or
potentially threaten professional relationships (Debono et al., 2013).
Berlinger observed that nurses or other health professionals who choose to work around
work processes may not do so intentionally, but rather can even consider it to be part of
patient safety (Berlinger, 2016). Thus, workaround behaviors can be understood either as an
advantage or as unsafe practices; they can also have impacts on patient care quality and
safety (Lalley, 2013). On the one hand, workarounds can make a worker feel efficient and
able to manage complicated rules that appear to slow the process and the attainment of
work goals. This behavior may never actually lead to injury. However, workers may
consider it risky to discuss the fact that they work around rules or sometimes violate
instructions given by the employer (Berlinger, 2016). Another positive consequence of
workarounds is that they make it possible for employees to develop creative solutions and
more efficient work processes (Lalley and Malloch, 2010). They can also draw attention to
practices or blocks or obstacles in workflows that need to be corrected (Vestal, 2008).
According to Morath and Turnbull (2005), however, research on workarounds indicates
that these behaviors can create an environment which is risky, one that can lead to less
reliability of the preventive systems put in place by the organization in order to protect
workers, patients and hospitals. Tucker et al. (2014) show that workers in some sectors may
spend as much as 10 percent of their work time working around operational failures.
As workarounds are created under the pressure to respect rules or meet other work
demands, they can also have negative consequence such as medical errors, which can
subsequently lead to injuries (Halbesleben, 2010), or even patient death.
The issue of workarounds is especially relevant to organizations in the context of increased
emphasis on creating high reliability health care organizations (Halbesleben et al., 2008).
Unfortunately, despite the possibility of tragic results stemming from workarounds in the course
of medical practice, academic researchers’interest in the topic has not gone much beyond simply
documentation of its existence (Halbesleben and Rathert, 2008). According to Halbesleben and
Rathert (2008), there are very few studies that examine the antecedents of workarounds.
For example, recently, research has shown that several factors have, over time,
contributed to the development of workaround behaviors. These include heavy workloads
(Westphal et al., 2014; Lopez et al., 2010); a negative organizational climate characterized by
poor leadership; few opportunities for professional development; a lack of involvement of
nurses in decision-making; a lack of perceived human resources management and support
(Wheeler et al., 2012; Koppel et al., 2008; Fogarty and McKeon, 2006; Tucker and
Edmondson, 2002); and incompatibilities between organizational policies and safety or
technology (Koppel et al., 2008; Schoville, 2009).
However, Debono et al. (2013) indicate in their scoping review of workarounds that “there
are still relatively few peer reviewed studies examining nurses’workaround behaviors as a
primary focus”(Debono et al., 2013, p. 12). These authors also found that in general,
researchers indicate the potential effects of workaround behaviors rather than provide
empirical evidence of their actual impact (Debono et al., 2013). To fill these gaps, our
research responds to the call for additional research on workarounds by Rathert et al. (2012)
and Debono et al. (2013), as well as a need for replication in additional bigger samples
(Halbesleben, 2010).
Our study contributes to the extant literature and to practice in significant ways.
First, Rathert et al. (2012) have studied the effects of many work environment factors
(teamwork, job autonomy and time pressure) on one of the factors of burnout (exhaustion)
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The role of
psychosocial
safety climate
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