Work design drivers of organizational learning about operational failures

Operational failures persist in hospitals, in part because employees work around them rather than attempt to prevent recurrence. Drawing on a process improvement tool--the Andon cord--we examine three work design components that may foster improvement-oriented behaviors: 1) blockages to prevent workarounds; 2) a support person to assist with problem-solving; and 3) education portraying operational failures as "waste" to be removed from the system. Using laboratory experiments, we test each component's impact on whether hospital nurses speak up about medication administration problems and contribute improvement ideas. We find that each component provides its own contribution to organizational performance. Blockages encourage people to suggest improvement ideas, while education sparks improvement suggestions even when there are no blockages. Blockages can backfire, however, if they are difficult to work around in a policy-compliant manner and problem-solving support is unavailable. Under these conditions, blockages led to a risky workaround associated with a 10X overdose of insulin. Risky workarounds can be mitigated with a readily-available support person, whose presence also elicits higher levels of speaking up about operational failures.