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

Goff, Mhorag, Hodgson, Damian, Bailey, Simon, Bresnen, Michael ORCID: https://orcid.org/0000-0002-3295-8235, Elvey, Rebecca and Checkland, Katherine (2021) Ambiguous workarounds in policy piloting in the NHS: tensions, trade‐offs and legacies of organisational change projects. New Technology, Work and Employment, 36 (1). pp. 17-43. ISSN 0268-1072

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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.