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continuous quality improvement, psychological safety, work-arounds



  1. Halbesleben, Jonathon R. B.
  2. Rathert, Cheryl


Background: Work-arounds are work procedures that are undertaken to address a block in work flow. Although there has been extensive interest in the health care literature concerning work-arounds, there is a dearth of literature exploring the factors that predict work-arounds.


Purpose: The purpose of this article is to examine the role of continuous quality improvement and psychological safety as predictors of work-arounds in health care organizations. Specifically, we hypothesized that continuous quality improvement and psychological safety predicted work-arounds such that psychological safety mediated the relationship between continuous quality improvement and work-arounds.


Methodology: This study was part of a larger cross-sectional field study exploring workforce issues among cancer registrars working in acute care hospitals who report tumor data to a state cancer registry in the Midwest. Eighty-three employees of cancer registries responded to telephone survey items assessing continuous quality improvement (personal influence and management style), psychological safety, and work-arounds.


Findings: Using mediated multiple regression (with findings confirmed with a Sobel test), we found partial support for the hypothesized mediated relationship between personal influence, management style, psychological safety, and work-arounds. The exception to this pattern concerned personal influence. Because personal influence is a dimension of continuous quality improvement, it would be negatively associated with work-arounds; we found the opposite to be true in this study.


Practice Implications: To avoid problems with work-arounds, our findings suggest that organizations need to commit to continuous improvement at a strategic level. In addition, culture and management behaviors need to shift away from reinforcement of individual first-order problem solving (manifest as work-arounds) toward second-order problem-solving approaches.