Can workarounds help us to deal with safety-related faults in health information systems?
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26 February 2016, by , in Blog, No comments

When health information systems exhibit faults the clinical impact ranges from inconvenient to dangerous, in some cases clinical safety can be compromised. But users are remarkably resourceful and when clinicians are reliant on systems to safely deliver care they are motivated to get the information they need. Complex applications often have more than one way of achieving an objective and when the technology lets us down a little ingenuity and controlled experimentation can reveal alternative solutions. When it comes to managing clinical risk, a degree of functional redundancy can offer useful mitigation.

Similarly workarounds are the manufacturers’ friend, they provide a stopgap during which the issue can be analysed and a strategic solution formulated. It is unfortunate that from time to time manufacturers use the presence of a workaround (which may be suboptimal) to deprioritise a concrete fix.

Workarounds are not without their problems and they should only be relied upon after considerable thought and careful analysis. A safety assessment needs to be undertaken on any proposed change in workflow or configuration to determine whether the workaround could introduce new hazards.

Sub-optimal workarounds have common traits. See if you recognise any of these offenders:

The labyrinth – a workaround which forces the user to complete a complex series of often illogical or incoherent actions to meet their objective. For example, navigating down many menu levels to access some long-forgotten screen. The path is hard to tread unless you follow it several times a day and the next time you return from a long weekend, you’ve forgotten the route.

The cliff edge – a workaround which gets the user from A to B perfectly well but take one wrong step and catastrophe strikes. These solutions operate dangerously close to other safety related functions and can inadvertently trigger otherwise unrelated hazards.

The distraction – a workaround which forces the user to break out of their normal workflow and go off at a tangent. For example, having to leave the prescribing functionality to go and investigate a patient’s allergies elsewhere in the system. The user is more likely to suffer a lapse or post-completion error as they forget to return to what they were originally doing.

The party whip – a workaround which is only successful if large numbers of people comply. Those people are often in disparate parts of an organisation, can be difficult to reach and whose compliance is impossible to monitor. The situation is made even more complex when those who are required to go out of their way to comply are a different population to those who ultimately see the benefit.

The problem shifter – a workaround which meets the user’s needs but causes a mammoth headache for someone else. For example, recreating clinics to manage a corrupt schedule only to find that crucial statistical reports are now gobbledegook.

The match and patch – a workaround which covers over the cracks but fails to deal with the underlying problem. The solution incompletely addresses the issue, represents a second best and can leave key hazards inadequately controlled.

Workarounds can be invaluable as a short term measure to reduce the clinical risk associated with safety-related faults. But their implementation requires change control, risk analysis, careful communication and frankly some old-fashioned common sense.

Dr Adrian Stavert-Dobson is the Managing Partner of Safehand, independent consultants in clinical risk management, and the author of Health Information System: Managing Clinical Risk.

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