Impacts of operational failures on primary care physicians’ work: A critical interpretive synthesis of the literature
Why it matters
Time is precious in general practice. With workloads increasing and burnout on the rise, general practitioners (GPs) are under significant stress – even when the systems around them function the way they are meant to. What happens when those systems fail?
‘Operational failures’ are well-documented in hospitals. Though they often cause only brief interruptions – like searching for missing equipment or re-ordering medicines when the wrong one is delivered to the ward – they add up to major time losses and other consequences for healthcare professionals and patients. But so far, operational failures have not received much attention in general practice, where the majority of healthcare contacts occur.
This kind of hospital-based research has been invaluable in highlighting challenges and identifying targets for improvement. But the same kind of study has been much more rare in primary care. With GPs facing mounting stress, and a growing crisis in GP recruitment and retention, it’s increasingly important to understand the kinds of operational failures that interfere with GPs’ work and to explore how to improve the systems and processes that support them.
As part of a larger project to identify and understand operational failures in general practice, we conducted a critical interpretive synthesis of the literature.
This approach combines elements of a systematic review with an interpretive and critical analysis. Rather than summarising the data, it aims to develop theories and concepts.
From more than 8,500 citations, we identified 95 papers that discussed operational failures to analyse and synthesise.
What we found
- Operational failures are pervasive in GPs’ daily work, disrupting their ability to do clinical work, adding to their workload and stress, and potentially interfering in their relationship with patients.
- These failures force GPs to do additional, mundane tasks that are not recognised or rewarded.
- Failures related to information technology (eg electronic health records) were the most frequently reported, followed by failures in practice processes.
- Relatively few papers look explicitly at operational failures in general practice or the impact they have, and even fewer look at failures in all aspects of a GPs’ work environment – meaning the literature likely doesn’t cover all failures and their knock-on effects.
- Future research should look more closely at GPs’ work environment to determine which operational failures have the most impact and which to prioritise for improvement.
- Unless failures in GPs’ work environments are addressed, efforts to bring in more GPs or redesign primary care may not be successful.