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Impacts of operational failures on primary care physicians’ work: a critical interpretive synthesis of the literature


Sinnott C, Georgiadis A, Park J and Dixon-Woods M. Impacts of operational failures on primary care physicians’ work: a critical interpretive synthesis of the literature. The Annals of Family Medicine. 2020;18(2);159-168

Why it matters

High-quality healthcare depends on the smooth running of systems to ensure that everything healthcare staff need to deliver patient care is in the right place at the right time.

Operational failures are system-level errors in the supply of information, equipment or materials to healthcare staff. Examples of operational failures include materials not being re-stocked, equipment being stored in the wrong place, or the wrong medications being sent to a ward. Studies of operational failures in hospitals have found the time spent working around even minor problems can mount up – impacting on patient safety and experience, efficiency, and staff satisfaction.

It is important that operational challenges are recognised and addressed in all settings. Primary care is where most patients have contact with the healthcare system, but it is an area already under pressure, with high levels of staff stress, increasing workload, and workforce challenges. So operational failures in primary care settings could be especially high impact and there is a real need to understand them.

Our approach

Our study set out to determine what existing research tells us about how operational failures in primary care affect the work of general practitioners (GPs).

We searched seven databases for papers published in English up to October 2017 that addressed organisational problems, supply errors, disruptions, and interruptions in primary care. We combined and analysed the information in the papers we found.

An important element of our search was that we didn’t just want to catalogue operational failures, we also wanted to know what the research was saying about how operational failures affected the work of GPs.

What we found

Though no paper explicitly referred to operational failures, we found 95 papers that met our general definition. Most were from the United States and the UK.

The studies identified a gap between what GPs felt they should be doing and what they were doing. This gap was strongly linked to operational failures – including those relating to technology, information, and coordination – over which doctors often had little control.

The most frequently reported failures related to technology, followed by failures in practice processes, such as problems with information moving through the practice.

The impacts of these problems included taking up time, disrupting tasks, delaying clinical decisions, and interfering with the doctor-patient relationship.

It was clear that operational failures influence GPs’ work. In order to deliver care, doctors have to work around these problems, which often means doing extra work – or “compensatory labour” – and that extra work is often frustrating, time-consuming and administrative.

Compensatory labour is not usually factored into a doctor’s schedule. It’s not recognised or paid for, and this important work is added to already packed schedules. GPs saw this work as taking them away from their work with patients.

Having an incomplete picture of the work done by GPs and the problems they face means missing opportunities to improve the quality and safety of the primary care work environment.

These findings have important implications for practice and policy. It is important to pay attention to the basic operational systems in primary care, including how these systems interact with other health and social care systems, so primary care is a better experience for those who use it and work in it.

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