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Impacts of Operational Failures on Primary Care Physicians' Work: A Critical Interpretive Synthesis of the Literature.

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Georgiadis, Alexandros 
Park, John 


PURPOSE: Operational failures are system-level errors in the supply of information, equipment, and materials to health care personnel. We aimed to review and synthesize the research literature to determine how operational failures in primary care affect the work of primary care physicians. METHODS: We conducted a critical interpretive synthesis. We searched 7 databases for papers published in English from database inception until October 2017 for primary research of any design that addressed problems interfering with primary care physicians' work. All potentially eligible titles/abstracts were screened by 1 reviewer; 30% were subject to second screening. We conducted an iterative critique, analysis, and synthesis of included studies. RESULTS: Our search retrieved 8,544 unique citations. Though no paper explicitly referred to "operational failures," we identified 95 papers that conformed to our general definition. The included studies show a gap between what physicians perceived they should be doing and what they were doing, which was strongly linked to operational failures-including those relating to technology, information, and coordination-over which physicians often had limited control. Operational failures actively configured physicians' work by requiring significant compensatory labor to deliver the goals of care. This labor was typically unaccounted for in scheduling or reward systems and had adverse consequences for physician and patient experience. CONCLUSIONS: Primary care physicians' efforts to compensate for suboptimal work systems are often concealed, risking an incomplete picture of the work they do and problems they routinely face. Future research must identify which operational failures are highest impact and tractable to improvement.



operations research, organization and administration, organizational efficiency, primary care, review, Efficiency, Organizational, Humans, Medical Errors, Physicians, Primary Care, Primary Health Care, Quality Improvement

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Ann Fam Med

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Annals of Family Medicine


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Wellcome Trust (097899/Z/11/Z)
Health Foundation (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
This work has been supported by an NIHR (UK) Clinical Lectureship, an Academy for Medical Sciences (UK) Starter Grant (SGL018\1023) and Mary Dixon-Woods’ Wellcome Trust Senior Investigator Award (WT09789). MDW is supported by the Health Foundation's grant to the University of Cambridge for The Healthcare Improvement Studies Institute.