THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
RAND Europe, Cambridge, UK.
Br J Gen Pract. 2022 Jan 27;72(715):e148-e160. doi: 10.3399/BJGP.2021.0357. Print 2022 Feb.
Although problems that impair task completion - known as operational failures - are an important focus of concern in primary care, they have remained little studied.
To quantify the time GPs spend on different activities during clinical sessions; to identify the number of operational failures they encounter; and to characterise the nature of operational failures and their impact for GPs.
Mixed-method triangulation study with 61 GPs in 28 NHS general practices in England from December 2018 to December 2019.
Time-motion methods, ethnographic observations, and interviews were used.
Time-motion data on 7679 GP tasks during 238 hours of practice in 61 clinical sessions suggested that operational failures were responsible for around 5.0% (95% confidence interval [CI] = 4.5% to 5.4%) of all tasks undertaken by GPs and accounted for 3.9% (95% CI = 3.2% to 4.5%) of clinical time. However, qualitative data showed that time-motion methods, which depend on pre-programmed categories, substantially underestimated operational failures. Qualitative data also enabled further characterisation of operational failures, extending beyond those measured directly in the time-motion data (for example, interruptions, deficits in equipment/supplies, and technology) to include problems linked to GPs' coordination role and weaknesses in work systems and processes. The impacts of operational failures were highly consequential for GPs' experiences of work.
GPs experience frequent operational failures, disrupting patient care, impairing experiences of work, and imposing burden in an already pressurised system. This better understanding of the nature and impact of operational failures allows for identification of targets for improvement and indicates the need for coordinated action to support GPs.
尽管影响任务完成的问题——即操作失败——是初级保健中一个重要的关注焦点，但它们仍然很少被研究。
量化全科医生在临床就诊期间从事不同活动所花费的时间；确定他们遇到的操作失败数量；并描述操作失败的性质及其对全科医生的影响。
2018 年 12 月至 2019 年 12 月，在英格兰 28 家 NHS 全科诊所的 61 名全科医生中进行了混合方法三角测量研究。
使用时间运动方法、民族志观察和访谈。
61 个临床疗程中，对 7679 项全科医生任务的时间运动数据表明，操作失败约占全科医生完成的所有任务的 5.0%（95%置信区间[CI]为 4.5%至 5.4%），占临床时间的 3.9%（95%CI 为 3.2%至 4.5%）。然而，定性数据表明，依赖预编程类别的时间运动方法大大低估了操作失败。定性数据还进一步描述了操作失败，不仅包括时间运动数据中直接测量的失败（例如，中断、设备/供应品不足和技术），还包括与全科医生协调角色以及工作系统和流程中的弱点相关的问题。操作失败的影响对全科医生的工作体验产生了重大影响。
全科医生经常遇到操作失败，扰乱了患者护理，损害了工作体验，并给已经面临压力的系统带来了负担。对操作失败的性质和影响的更好理解有助于确定改进的目标，并表明需要协调行动来支持全科医生。
