Abstract
PurposeThe purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.Design/methodology/approachThe paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.FindingsIdentified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.Originality/valueBalancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.
Highlights
Resource limitation is an issue in healthcare services worldwide
Further requirements were that the studies needed to involve health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality
Evidence on trade-offs, organizational factors and clinical quality was retrieved from studies conducted in hospitals and primary healthcare services
Summary
Resource limitation is an issue in healthcare services worldwide. Healthcare demands are unlimited, the costs are increasing and the resources are restricted (Keliddar et al, 2017). In the perspective of the efficiency-thoroughness trade-off principle (ETTO principle) (Hollnagel, 2009), this means that healthcare workers need to do trade-offs between what is efficient (keeping the resource use low) and what is thorough (achieving the intended outcome and avoiding error). Such trade-offs are, according to Hollnagel (2009), a normal and necessary part of health personnel’s everyday effort to keep the healthcare service running, as it is not possible to emphasize both efficiency and thoroughness at the same time. An unbalance between the two, where one is weighted over the other, may lead to errors and adverse events (Hollnagel, 2009)
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