3 research outputs found
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Organizational Factors that Contribute to Operational Failures in Hospitals
The performance gap between hospital spending and outcomes is indicative of inefficient care delivery. Operational failures—breakdowns in internal supply chains that prevent work from being completed—contribute to inefficiency by consuming 10% of nurses’ time (Hendrich et al. 2008, Tucker 2004). This paper seeks to identify organizational factors associated with operational failures, with a goal of providing insight into effective strategies for removal. We observed nurses on medical/ surgical units at two hospitals, shadowed support staff who provided materials, and interviewed employees about their internal supply chain’s performance. These activities created a database of 120 operational failures and the organizational factors that contributed to them. We found that employees believed their department’s performance was satisfactory, but poorly trained employees in other departments caused the failures. However, only 14% of the operational failures arose from errors or training. They stemmed instead from multiple organizationally-driven factors: insufficient workspace (29%), poor process design (23%), and a lack of integration in the internal supply chains (23%). Our findings thus suggest that employees are unlikely to discern the role that their department’s routines play in operational failures, which hinders solution efforts. Furthermore, in contrast to the “Pareto Principle” which advocates addressing “large” problems that contribute a disproportionate share of the cumulative negative impact of problems, the failures and causes were dispersed over a wide range of factors. Thus, removing failures will require deliberate cross-functional efforts to redesign workspaces and processes so they are better integrated with patients’ needs
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Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals
Frontline care providers in hospitals spend at least 10% of their time working around operational failures, which are situations where information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at two hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of over 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include (1) hospital-level—rather than department-level—performance measures; (2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; (3) knowledge that is necessary for efficient handoffs of materials is translated across departmental boundaries; and (4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries