Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

Tucker, Anita Carson; Heisler, W. Scott; Janisse, Laura D.

doi:10.7812/tpp/13-141

Cited by 43 publications

(62 citation statements)

References 75 publications

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“…Although these process failures include both errors and “problems,” task interruptions due to something or someone not being available when needed, problems are far more common yet have drawn far less attention [7, 8]. In fact, problems occur about once per hour per nurse on hospital units, and 95% of problems are managed through workarounds (alternate ways to achieve a goal) rather than system corrections [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

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Real-Time Reporting of Small Operational Failures in Nursing Care

Stevens

Ferrer

2016

Nursing Research and Practice

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Addressing microsystem problems from the frontline holds promise for quality enhancement. Frontline providers are urged to apply quality improvement; yet no systematic approach to problem detection has been tested. This study investigated a self-report approach to detecting operational failures encountered during patient care. Methods. Data were collected from 5 medical-surgical units over 4 weeks. Unit staff documented operational failures on a small distinctive Pocket Card. Frequency distributions for the operational failures in each category were calculated for each hospital overall and disaggregated by shift. Rate of operational failures on each unit was also calculated. Results. A total of 160 nurses participated in this study reporting a total of 2,391 operational failures over 429 shifts. Mean number of problems per shift varied from 4.0 to 8.5 problems with equipment/supply problems being the most commonly reported category. Conclusions. Operational failures are common on medical-surgical clinical units. It is feasible for unit staff to record these failures in real time. Many types of failures were recognized by frontline staff. This study provides preliminary evidence that the Pocket Card is a feasible approach to detecting operational failures in real time. Continued research on methodologies to investigate the impact of operational failures is warranted.

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Section: Introductionmentioning

confidence: 99%

“…How problems are managed, therefore, is considered to be an important determinant of a hospital's organizational culture for quality of care [9, 10]. Moreover, failure to use the frontline workers' knowledge of quality problems discards an important source of organizational intelligence for quality improvement [11].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Reporting of Small Operational Failures in Nursing Care

Stevens

Ferrer

2016

Nursing Research and Practice

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“…This is because a predetermined supply stock may not ensure that frontline service providers have the supplies necessary to serve patients. In other words, operational failures arise when the work of the supply departments is not aligned with the needs of current customers (Tucker et al 2014). Operational failures can therefore be a symptom of a lack of internal integration in internal supply chains (Dröge et al 2004, Fredendall et al 2009, Pagell 2004.…”

Section: Objectivesmentioning

confidence: 99%

“…Operational failures typically occur at the interface between supply departments that supply-to-stock and service providers who provide make-to-order service (Tucker et al 2014). For example, in hospitals, nursing units often experience breakdowns in the supply of materials from central supply, pharmacy, sterile processing, biomedical equipment, and information technology.…”

Section: Operational Failures and Workaroundsmentioning

confidence: 99%

Game—The Dressing Change Game

Tucker

Lefton

2015

INFORMS Transactions on Education

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Many employees face operational failures-missing or insufficient supplies, equipment, information, and personnel-that interfere with their workflow and can negatively impact organizational performance. However, employees often devise methods to work around these obstacles that may come with negative side effects. The Dressing Change Game is a 40-minute in-class exercise that enables students to directly experience workarounds as a natural response to operational failures and allows them to see the trade-off between shortterm and longer-term organizational performance that occurs as a result of workarounds. The overarching learning objective is for students to gain an appreciation that optimizing individual-or unit-level performance likely undermines organizational-level performance.

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“…Despite this fact, broader aspects of the perioperative system not directly involved in the act of surgery are understudied. 9,23,27,29 Therefore, examining critical points of interdependence between the OR and other facets of the perioperative system should yield valuable insights that the perioperative team can leverage to improve surgical performance. 23,[25][26][27][28] The few studies focusing on broader perioperative system functioning support these findings and suggest that OR performance is heavily dependent upon staff members from all facets of perioperative system successfully coordinating critical pieces of information and equipment.…”

mentioning

confidence: 99%

Frictions as Barriers to Perioperative Alignment

Shewchuk

Carlson

Klosterman

et al. 2014

Quality Management in Health Care

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The quality of the relationship between the sterile processing department (SPD) and the operating room (OR) is an important determinant of OR safety and performance. In this article, the concept of "friction" refers to the SPD behaviors and attributes that can negatively affect OR performance. Panels of SPD professionals initially were asked to identify and operationally define different ways in which behaviors of a hospital's SPD could compromise OR performance. A national convenience sample of OR nurses (N=291) rated 14 frictions in terms of their agreement or disagreement that each had a negative effect on OR performance in their hospital. Overall, more than 50% of the entire sample agreed that 2 frictions, "SPD does not communicate effectively with the OR" (55%) and "SPD inventories are insufficient for surgical volume" (52%), had negative effect on OR performance. However, a latent class analysis revealed 3 distinct classes of nurses who varied with respect to their level of agreement that SPD-OR frictions negatively affected OR performance. The observed heterogeneity in how different groups of nurses viewed different frictions suggests that effective efforts aimed at reducing performance-limiting frictions should be customized so that resources can be used where they are most needed.

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Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

Cited by 43 publications

References 75 publications

Real-Time Reporting of Small Operational Failures in Nursing Care

Real-Time Reporting of Small Operational Failures in Nursing Care

Game—The Dressing Change Game

Frictions as Barriers to Perioperative Alignment

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