PCPs often conceal inadequate work systems
Primary care physicians often conceal operational failures, the authors of a critical interpretive synthesis concluded.
Hiding these failures — which the authors defined as “system-level errors in the supply of necessary materials, equipment or information to employees” — risks “an incomplete picture of the work [PCPs] do and problems they routinely face,” Carol Sinnott, MB, BAO, BCh, MMedSci, MRCPI, a clinical lecturer at The Healthcare Improvement Studies Institute in the United Kingdom, and colleagues wrote.
“This is problematic because failings that affect the ability to provide safe, high-quality care are likely to be highly consequential in primary care, where the majority of health care contacts occur and where escalating workload, unprecedented levels of stress and a crisis in recruitment and retention are major threats to sustainability,” they continued.
According to Sinnott and colleagues, previous studies that examined operational failures in health care were largely limited to hospital settings. To fill the research gap, Sinnott and colleagues reviewed 95 articles from seven databases that addressed disruptions, interruptions, organizational problems and supply errors in primary care. Most of the articles were from the United States and the United Kingdom (77 articles), but articles also came from Canada, Ireland, Israel, Australia, Cyprus, Malaysia, New Zealand, Norway, Singapore, Spain and the United Arab Emirates.
They found that most of the operational failures were rooted in information technology — for example, having problems with electronic health records, computer decision support systems, e-prescribing and e-referral systems. The second most commonly reported operational failures were practice processes. In this category, the most common deficiencies were inefficient channeling of information through the practice or inefficient material supplies. Other studies described operational failures stemming from secondary care, including suboptimal communication of patient information, medication discrepancies and flawed systems for patient testing.
Sinnott and colleagues also identified eight consequences of the operational failures: additional steps, workarounds, consumed time, disruptions, delayed decision-making, interference with physician-patient relationships, cognitive burden (eg, information overload) and dissatisfaction.
“A unifying feature of many operational failures was that they were unaccounted for in primary care work systems,” researchers wrote. “These operational failures, combined with the role of primary care in synthesizing information and coordinating care, actively configure the work that physicians have to do to care for their patients, requiring significant compensatory labor to deliver on the goals of care ... and lead to unwanted consequences such as physician stress and burnout.”
In the study, researchers called for adding more physicians to practices and stakeholders making “significant investments” to rectify the identified deficiencies.
In an interview with Healio Primary Care, Sinnott mentioned other ways that PCPs can reverse the identified deficiencies.
“Primary care physicians can highlight the operational failures they encounter to authorities such as practice managers, hospital liaison officers and local medical committees,” she said. “This will serve to make the operational failures they encounter visible and better highlight the improvement opportunities that may exist.” – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.