THIS Institute, University of Cambridge, Cambridge.
ICON plc, the Translation and Innovation Hub Building, Imperial College London, London.
Br J Gen Pract. 2020 Oct 29;70(700):e825-e832. doi: 10.3399/bjgp20X713009. Print 2020 Nov.
Operational 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.
To identify operational failures in the primary care work environment and to examine how they influence GPs' work.
Qualitative interview study in the East of England.
Semi-structured interviews were conducted with GPs ( = 21). Data analysis was based on the constant comparison method.
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. 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.
Operational 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.
操作失败，定义为医疗护理所需的信息、供应品或设备中的不足或错误，已知在医院环境中后果严重。尽管它们可能与全科医生的工作经历有关，但在初级保健中仍未得到充分探索。
确定初级保健工作环境中的操作失败，并研究它们如何影响全科医生的工作。
在英格兰东部进行定性访谈研究。
对全科医生（=21 人）进行半结构化访谈。数据分析基于恒定比较法。
全科医生报告了大量的操作失败，其中许多与与外部医疗保健提供者、实践技术和实践内部工作组织有关的信息传递有关。面对操作失败，全科医生承担了“补偿性劳动”，以履行协调和保障患者护理的职责。在已经紧张的日常日程中，应对操作失败带来了巨大的额外压力，但这项工作在很大程度上仍然没有被注意到。部分原因是，全科医生采取行动解决当前的问题，而不是将问题追溯到源头，他们通常不会在系统层面上报操作失败。他们还指出，在实践层面上进行流程改进存在挑战，包括关于委托的医学法律不确定性。
初级保健中的操作失败对全科医生及其工作经历很重要。补偿性劳动负担繁重，其结果是使这些失败在很大程度上未被注意到。认识到操作失败的重要性应该会促使人们努力使初级保健工作环境更具吸引力。
