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

Mhorag Goff, Damian Hodgson, Simon Bailey, Michael Bresnen, Rebecca Elvey, Katherine Checkland
2021 New technology, work and employment  
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,
more » ... unds 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. K E Y W O R D S health care, information technology, organisational change, policy pilots, projects, workarounds AUTHOR BIOGRAPHIES Mhorag Goff is a Research Associate in the Institute for Health Policy and Organisation at the University of Manchester. Her interests are in STS and sociological approaches to organisations, information systems and in ethnographic methods. Most recently, she has worked on studies of policy-led changes to the primary care workforce, the impact pf social distancing on socially excluded older adults, and on experiences of precarity among fixed-term researchers, having previously been involved with development of a researcher network. Damian Hodgson is Professor of Organisation Studies at the Management School at the University of Sheffield and Fellow of the Academy of Social Sciences. His research focuses on issues of power, knowledge, identity and control in complex organisations, with particular interest in project-based organisations and the organisation of health and care. He has published widely and has led several NIHR-funded research projects focusing on primary care reorganisation, access to care and continuity of care, workforce transformation, and the integration of health and care. He was previously Professor and Co-Director of the Institute of Health Policy and Organisation at the University of Manchester. Simon Bailey is a Research Fellow in the Centre for Health Services Studies, University of Kent. His interests are in the sociological study of technology, work and organisation, with a recent focus upon precarious and project-based work. Michael Bresnen is Professor of Organisation Studies and Head of Department of People and Performance in the Faculty of Business and Law at Manchester Metropolitan University. He has previously worked at the universities of Manchester, Leicester, Warwick, Cardiff and Loughborough. He has researched and published widely on healthcare managers, on the organisation and management of projects (with particular reference to the construction industry) and on learning and innovation in project-based settings. His most recent funded research has been on healthcare management and leadership in the NHS (for the NIHR), project-based learning in construction, manufacturing and services (for the EPSRC) and biomedical innovation processes in the UK and United States (for the ESRC and EPSRC). He was a co-founder and co-director of both the Health Services Research Centre (Alliance Manchester Business School) and the Innovation, Knowledge and Organisational Networks Research Centre (Warwick Business School). Rebecca Elvey is Research Fellow in the Centre for Primary Care and Health Services Research at The University of Manchester. She is an applied health services researcher, with an interest in exploring multiple perspectives on health services, including those who commission, provide and use them. Katherine Checkland is Professor of Health Policy and Primary Care at the University of Manchester and an NHS GP. Her work focused upon the management and organisation of the NHS, with a particular focus upon planning and commissioning services and the impact of policy change on service organisation and delivery. She is Associate
doi:10.1111/ntwe.12190 fatcat:tglhcs5cqnfrjmbwesgagg3ysq