Ambiguous workarounds in policy piloting in the NHS: Tensions, trade‐offs and legacies of organisational change projects

Abstract

Pilot projects are increasingly used as a mechanism to enact organisational change, particularly government policy. Information technology's centrality to organisations often makes it key to the introduction of new processes. However, it can give rise to workarounds as employees circumvent impediments it presents by rejecting its prescribed use. Workarounds tend to be conceptualised dichotomously, as either ‘good’ problem solving, or ‘bad’ subversion of the technology. In pilot projects, workarounds are more ambiguous because those that support projects' successful completion in the short‐term may undermine day to day operations longer term. We draw on interview data from a policy pilot in general practice in the National Health Service in England aimed at extending access to care. We problematise the dichotomous conceptualisation of workarounds, finding they can be simultaneously supportive and undermining of policy pilots. Workarounds thereby become political, as employees are required to trade‐off consequences for themselves and the wider organisation.

Parasitic universes: Organisational and technological meddling in the social

“…Yet, contemporary examples such as healthcare or education in the United Kingdom, Australia, and elsewhere, suggest that senior management will more likely find ways to mobilise the systems so that value can be extracted from professional work, ultimately straining but not breaking the psychological contract (Spina et al, 2020). Conflicts between organisational and social imperatives end up being contained or worked around within a professional ethos (Bailey et al, 2019; Goff et al, 2021), or are met with entrepreneurial zeal (Bailey et al, 2017; Hodgson et al., 2022).…”

“…If they ‘spend less’ and thus generate a time‐counted profit, they are rewarded. If professional ‘workarounds’ are to be achieved (Dupret, 2017; Goff et al, 2021), labour must locate capacity for profitmaking as the relations between the social and the technical shift.…”

The Problem of Success and Failure in Public-private Innovation Partnerships

“…We have noted the effects of this within our case. Connected to the issue of time is the instrumental rationality that projects impose on their protagonists; that is, the need for measurable outcomes mobilises a search not for what might or could work, or work most effectively, but what can be made to work within the time available (Bailey et al, 2017; Bailey et al, 2019; Goff et al, 2021). This links to the self-referential nature of success noted above and may be somewhat more modest than the claims made during the tendering stage to meet the expectations for a successful application.…”

The nature and role of informal resilience practices in the performance of lean production systems

“…(2020) found that informal practices negatively impacted operational performance, while Nasarwanji et al. (2016) and Goff et al. (2021) concluded that informal practices added unnecessary complexity.…”

“…The next hypothesis addresses the role of informal resilience in the operational performance of LPSs. Tucker et al (2020) found that informal practices negatively impacted operational performance, while Nasarwanji et al (2016) and Goff et al (2021) concluded that informal practices added unnecessary complexity. Moreover, informal practices may hinder the credibility of formal management structures, which may be interpreted as wasteful bureaucracy (Dekker, 2014).…”