Abstract
BackgroundOperational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs’ experiences of work, they remain under-explored in primary care.AimTo identify operational failures in the primary care work environment and to examine how they influence GPs’ work.Design and settingQualitative interview study in the East of England.MethodSemi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.ResultsGPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook ‘compensatory labour’ to fulfil their duties of coordinating and safeguarding patients’ care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.ConclusionOperational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.
Highlights
Though primary care is essential to equitable, high-quality, and cost-effective health services,[1] its sustainability is increasingly challenged by both the number of GPs leaving the profession and problems in recruitment.[2,3] Two-thirds of GPs report unmanageable workloads,[4] and almost half report emotional exhaustion associated with their work.[5]
GPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices
Operational failures — defined as disruptions, errors, or inadequacies in the information, supplies, or equipment needed for patient care11 — occur frequently in secondary care settings
Summary
Though primary care is essential to equitable, high-quality, and cost-effective health services,[1] its sustainability is increasingly challenged by both the number of GPs leaving the profession and problems in recruitment.[2,3] Two-thirds of GPs report unmanageable workloads,[4] and almost half report emotional exhaustion associated with their work.[5]. Operational failures — defined as disruptions, errors, or inadequacies in the information, supplies, or equipment needed for patient care11 — occur frequently in secondary care settings These failures frustrate employees, decrease individual and organisational performance, and increase risks to patients.[11,12,13] Often, they may appear initially as small problems (for example, thermometer probe covers going missing or incorrect medications delivered to wards), but cumulatively can be highly impactful because they push healthcare professionals to use workarounds or timeconsuming adjustments to get tasks done.[12] Hospital-based research shows that 9% of a healthcare professional’s working day can be spent dealing with operational failures,[11] but once recognised they are tractable to improvement through systems redesign with attendant benefits in organisational efficiency and job satisfaction.[14]. Despite their likely relevance for GPs’ experiences of work, they remain underexplored in primary care
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More From: The British journal of general practice : the journal of the Royal College of General Practitioners
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