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Operational failures and how they influence the work of GPs: a qualitative study in primary care

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Dixon-Woods, mary 
Georgiadis, alex 


Background 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.

Aim To identify operational failures in the primary care work environment and to examine how they influence GPs’ work.

Design and setting Qualitative interview study in the East of England.

Method Semi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.

Results 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.

Conclusion 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.



general practice, organisational efficiency, primary health care, psychological burnout, task performance and analysis, workflow, Attitude of Health Personnel, England, General Practitioners, Humans, Primary Health Care, Qualitative Research

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British Journal of General Practice

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Royal College of General Practitioners
Academy of Medical Sciences (Starter R18)
Wellcome Trust (097899/Z/11/Z)
Health Foundation (unknown)
This work has been supported by a National Institute for Health Research (NIHR) (UK) Clinical Lectureship, an Academy for Medical Sciences (UK) Starter Grant (SGL018\1023), Mary Dixon-Woods’ Wellcome Trust Senior Investigator Award (WT09789), and the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Mary Dixon-Woods is supported by the Health Foundation’s grant and is also an NIHR Senior Investigator (NF-SI-0617-10026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, the Health Foundation, the Academy for Medical Sciences, or the Wellcome Trust.