Bridging organisational levels of patient safety: the role of workarounds
Tracks
Room 1
| Wednesday, December 2, 2026 |
| 11:50 AM - 12:10 PM |
| Plenary Room - Grand Central |
Overview
Danielli Cossul
Speaker
Danielli Cossul
Federal University of Rio Grande do Sul
Bridging organisational levels of patient safety: the role of workarounds
Abstract
Aim: Patient safety (PS) emerges from interactions among subsystems distributed across multiple organisational levels. At the micro level, it is influenced by workarounds (WAs) deployed by frontline workers to cope with work constraints, generating both benefits and risks. At the meso level, PS emerges from formal management practices that often ignore WAs or treat them as procedural deviations that should be suppressed. This paper discusses how to reduce this disconnect between levels through the adoption of the Resilience Engineering perspective, which acknowledges the complexity underlying WAs.
Method: a case study on barcode medication administration (BCMA) was conducted. At the micro level, the study identified 22 WAs and 43 contributing factors (CF), based on 14 interviews and 80 hours of shadowing. At the meso level, practices adopted by the clinical risk management and quality and safety departments were investigated. Data collection included document analysis, 16 interviews, two focus groups, and 100 hours of observations. The dataset underwent thematic analysis using the four potentials of resilient systems.
Results: twenty-six practices were identified with the potential to anticipate the need for WAs and their risks (11), learn from everyday work in which WAs emerge (6), monitor system performance and the conditions associated with the emergence of WAs (5), and respond to the factors that trigger the need for WAs, thereby reducing their occurrence (4).
Discussion: WAs play a mediating role between the micro and meso levels by informing system redesign. However, resilience and safety depend on management practices capable of integrating perspectives from both levels (e. g., psychological safety is crucial to discuss performance variability). Additionally, the practices identified may be enhanced through the mediation of WAs; team training initiatives could incorporate formal adaptations, while procedural audits could broaden their focus to include the analysis of CF associated with the emergence of WAs.
Method: a case study on barcode medication administration (BCMA) was conducted. At the micro level, the study identified 22 WAs and 43 contributing factors (CF), based on 14 interviews and 80 hours of shadowing. At the meso level, practices adopted by the clinical risk management and quality and safety departments were investigated. Data collection included document analysis, 16 interviews, two focus groups, and 100 hours of observations. The dataset underwent thematic analysis using the four potentials of resilient systems.
Results: twenty-six practices were identified with the potential to anticipate the need for WAs and their risks (11), learn from everyday work in which WAs emerge (6), monitor system performance and the conditions associated with the emergence of WAs (5), and respond to the factors that trigger the need for WAs, thereby reducing their occurrence (4).
Discussion: WAs play a mediating role between the micro and meso levels by informing system redesign. However, resilience and safety depend on management practices capable of integrating perspectives from both levels (e. g., psychological safety is crucial to discuss performance variability). Additionally, the practices identified may be enhanced through the mediation of WAs; team training initiatives could incorporate formal adaptations, while procedural audits could broaden their focus to include the analysis of CF associated with the emergence of WAs.
Biography
Danielli Cossul holds a Bachelor’s degree in Psychology and a Master’s degree in Industrial Engineering. She is currently a full-time PhD student in the Postgraduate Program in Industrial Engineering at the Federal University of Rio Grande do Sul (UFRGS), where she is a member of the Centre for Studies in Operations Management in Complex Systems. She is also a member of the Technical Committee on Ergonomics and Resilience Engineering of the Brazilian Association of Ergonomics and Human Factors (ABERGO).
