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

Pilot projects are increasingly used as a mechanism to enact organizational change, particularly government policy. Information technology’s centrality to organizations 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 problematize 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 organization.