Nurs Res. 2023;72(1):20-29. doi: 10.1097/NNR.0000000000000626. Epub 2022 Sep 10.
Operational failures, defined as the inability of the work system to reliably provide information, services, and supplies needed when, where, and to who, are a pervasive problem in U.S. hospitals that disrupt nurses' ability to provide safe and effective care.
We examined the relationship between operational failures, patient satisfaction, nurse-reported quality and safety, and nurse job outcomes (e.g., burnout and job satisfaction) and whether differences in hospital work environments explained the relationship.
We conducted a cross-sectional analysis using population-based survey data from 11,709 registered nurses in 415 hospitals who participated in the RN4CAST-US nurse survey (2015-2016) and the 2016 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The RN4CAST-US nurse survey focused on hospital quality and safety, job outcomes, and hospital work environments. The HCAHPS survey collected publicly reported patient data on their satisfaction with their care. Operational failures were evaluated using an eight-item composite measure that assessed missing supplies, orders, medication, missing/wrong patient diet, electronic documentation problems, insufficient staff, and time spent on workarounds and nonnursing tasks. Multilevel regression models were used to test the hypothesized relationships.
Operational failures were associated with low patient satisfaction scores, poor quality and safety outcomes, and poor nurse job outcomes, and those associations were partly accounted for by hospital work environments.
Operational failures prevent high-quality care and positive patient and nurse outcomes. Operational failures and the hospital work environment should be targeted simultaneously to maximize quality improvement efforts. Hospital leadership should work with frontline staff to identify and target the sources of operational failures in nursing units. Improvements to hospital work environments may reduce the occurrence of operational failures.
操作故障是指工作系统无法可靠地提供所需的信息、服务和物资，无论是在何时、何地以及提供给谁，这在美国医院中是一个普遍存在的问题，会干扰护士提供安全有效的护理的能力。
我们研究了操作故障与患者满意度、护士报告的质量和安全以及护士工作结果（如倦怠和工作满意度）之间的关系，以及医院工作环境的差异是否解释了这种关系。
我们使用了基于人群的调查数据进行了横断面分析，这些数据来自参与 RN4CAST-US 护士调查（2015-2016 年）和 2016 年医院消费者评估医疗保健提供者和系统（HCAHPS）调查的 415 家医院的 11709 名注册护士。RN4CAST-US 护士调查侧重于医院质量和安全、工作结果以及医院工作环境。HCAHPS 调查收集了关于患者对其护理满意度的公开报告数据。操作故障使用八项复合指标进行评估，评估指标包括供应品缺失、医嘱缺失/错误、药物缺失/错误、错误/缺失患者饮食、电子文档问题、人手不足以及用于替代方案和非护理任务的时间。使用多水平回归模型检验假设关系。
操作故障与低患者满意度评分、质量和安全结果不佳以及护士工作结果不佳相关，这些关联部分归因于医院工作环境。
操作故障会妨碍高质量的护理以及积极的患者和护士结果。应同时针对操作故障和医院工作环境，以最大限度地提高质量改进努力。医院领导应与一线工作人员合作，确定并针对护理单元中的操作故障源进行目标定位。改善医院工作环境可能会减少操作故障的发生。
