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Introduction
The topic of how to deal with process-related problems and produce sustained improvement continues to challenge organizational researchers. Some scholars assert that, when faced with a process failure, organizations should enact short-term measures to tide over the immediate crisis, but then continue to investigate the process critically and collaboratively to determine the root causes of the failure and implement improvements that prevent a recurrence of that problem (Hayes et al., 1988). Yet, Feigenbaum (1991) reports rarity in applying the second step, and it appears that the trend persists even today (Tucker, 2007; Lee, 2010; Edmondson, 2011). Organizations, therefore, continue to find that sustaining change within work systems a significant challenge.
The activities which result in short-term fixes to operational problems have been termed “first-order problem solving” (Tucker and Edmondson, 2003). For example, a nurse who detects a shortage of a medical supply in the supplies closet may implement any number of solutions – asking others, looking in other places or borrowing from another department – in order to solve the problem and minimize the interruption in patient care. If the nurse or nursing team stops there, the immediate crisis may be resolved; but the same scenario will likely recur because the root cause(s) to the problem have not been addressed. If, on the other hand, the nurse/nursing team investigates more deeply to identify why the stockout occurred, and implements countermeasures to prevent future stockouts, the result would be a longer-term solution to the problem that improves ongoing operational performance. Researchers term this second set of activities as “second-order problem solving.”
Improving healthcare work processes has received considerable attention in recent years because it is an important and vital sector of the economy, but one that continues to grapple with systemic issues (Thompson et al., 2003; Spear, 2006; Bohmer, 2010; Lee, 2010; Southard et al., 2012). Hospital operations are complex, requiring close coordination of activities across interdependent units to provide a customer service (Tucker et al., 2007). Furthermore, departments have conflicting priorities regarding what service to provide at what time, and face the challenge of providing the right quality of service to patients. Healthcare workers often experience difficulty in communicating and coordinating activities across departments as they lack common knowledge and...