Adjusting the cost-quality equation

Linden, Lois; English, Kathy

doi:10.1097/00001786-199404000-00007

Cited by 23 publications

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“…One study of nursing work found that, on average, nurses spend 42 minutes of each 8‐hour shift resolving operational failures such as missing medications and broken or missing equipment (Tucker 2004). Other studies estimate that nurses spend from 10 percent (Linden and English 1994) to 25 percent (Miller, Deets, and Miller 1997) of their time looking for other staff members. Operational failures can also cause interruptions, as shown in a study that examined interruptions encountered by one hospital nurse during a 10‐hour period.…”

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Operational Failures and Interruptions in Hospital Nursing

Tucker

Spear

2006

Health Services Research

311

298

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Objective. To describe the work environment of hospital nurses with particular focus on the performance of work systems supplying information, materials, and equipment for patient care. Data Sources. Primary observation, semistructured interviews, and surveys of hospital nurses. Study Design. We sampled a cross-sectional group of six U.S. hospitals to examine the frequency of work system failures and their impact on nurse productivity. Data Collection. We collected minute-by-minute data on the activities of 11 nurses. In addition, we conducted interviews with six of these nurses using questions related to obstacles to care. Finally, we created and administered two surveys in 48 nursing units, one for nurses and one for managers, asking about the frequency of specific work system failures. Principal Findings. Nurses we observed experienced an average of 8.4 work system failures per 8-hour shift. The five most frequent types of failures, accounting for 6.4 of these obstacles, involved medications, orders, supplies, staffing, and equipment. Survey questions asking nurses how frequently they experienced these five categories of obstacles yielded similar frequencies. For an average 8-hour shift, the average task time was only 3.1 minutes, and in spite of this, nurses were interrupted mid-task an average of eight times per shift. Conclusions. Our findings suggest that nurse effectiveness can be increased by creating improvement processes triggered by the occurrence of work system failures, with the goal of reducing future occurrences. Second, given that nursing work is fragmented and unpredictable, designing processes that are robust to interruption can help prevent errors.

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confidence: 99%