Operational Failures and Interruptions in Hospital Nursing

Tucker, Anita L.; Spear, Steven J.

doi:10.1111/j.1475-6773.2006.00502.x

Cited by 311 publications

(324 citation statements)

References 55 publications

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“…These have been referred to as glitches (Uhlig et al 2002), operational failures (Tucker 2004, Tucker andSpear 2006), performance obstacles (Gurses and Carayon 2007), hassles (Beaudoin and Edgar 2003), blockages (Rathert et al 2012), and situational constraints O'Connor 1980, Villanova andRoman 1993). In this paper, we refer to them as operational failures.…”

Section: Prior Research On Operational Failures and Lean Manufacturinmentioning

confidence: 99%

Lean in healthcare – history and recent developments

Sloan¹,

Fitzgerald²,

Hayes³

et al. 2014

Journal of Health Organization and Management

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Abstract: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 crossfunctional efforts to redesign workspaces and processes so they are better integrated with patients' needs.

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Section: Prior Research On Operational Failures and Lean Manufacturinmentioning

confidence: 99%

Lean in healthcare – history and recent developments

Sloan¹,

Fitzgerald²,

Hayes³

et al. 2014

Journal of Health Organization and Management

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show abstract

“…31 Furthermore, researchers have demonstrated that systems issues can add substantially to nursing workload. 32 Methods such as those described in our study take into account both patient-related and systems-related tasks, and therefore could result in more detailed workload assessments. With more detailed information about contributors to workload, better predictions about optimal staffing could be made, which would ultimately lead to fewer adverse patient events.…”

Section: Discussionmentioning

confidence: 99%

Defining and measuring the effort needed for inpatient medicine work

Lamba

Schapira

Singh

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Current metrics for assessing physician workload are inadequate. Understanding the effort associated with work tasks could make workload assessments more robust.OBJECTIVE:To assess the physical, mental, and psychological effort needed for the tasks performed by internal medicine doctors while admitting a patient to the hospital.DESIGN:Cross‐sectional survey.SETTING:A single Midwest academic institution.SUBJECTS:Internal medicine housestaff, hospitalists, and nonhospitalist internal medicine faculty.MEASUREMENTS:Subjects rated 99 tasks across 3 domains: physical, mental, and psychological effort using a scale of 1–7 (1 = least effort, 7 = most effort). A composite effort score was calculated for each task and for each of 6 task categories: direct patient care, indirect patient care, searching for/finding things, educational/academic activities, personal/downtime activities, and other.RESULTS:Overall, the most difficult task was going to codes, which was also the most difficult psychological task. The most difficult physical task was placing a central line, and the most difficult mental task was transferring an unstable patient to the intensive care unit. The easiest task was using the Internet. That was also the easiest physical, mental, and psychological task. Direct patient care was more difficult than indirect patient care overall (3.58 vs 3.21; P < 0.001).CONCLUSION:We began the process of describing the workload of inpatient doctors by measuring the difficulty of the tasks they perform while admitting patients. To assess the relationship between workload and other outcomes (such as physician burnout and patient safety), it is essential that we be able to accurately measure workload. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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“…These systems problems and the work-arounds nurses used to resolve them equate to a workload of one-third of a patient per nurse and serve to interrupt patient care and create potential safety issues. 3 Results from Dr Tucker's research suggest that efforts to improve systems and processes affecting nursing work need to be thoughtfully managed. Using the measure of perceived improvement, she reported that generating more improvement ideas and identifying the very best idea did not lead to improved performance.…”

Section: The Science Of Health Care Deliverymentioning

confidence: 99%

Highlights From the Third Annual Mayo Clinic Conference on Systems Engineering and Operations Research in Health Care

Kamath

Osborn

Roger

et al. 2011

Mayo Clinic Proceedings

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was held. The continuing mission of the conference is to gather a multidisciplinary group of systems engineers, clinicians, administrators, and academic professors to discuss the translation of systems engineering methods to more effective health care delivery. Education, research, and practice were enhanced via a mix of formal presentations, tutorials, and informal gatherings of participants with diverse backgrounds. Although the conference promotes a diversity of perspectives and methods, participants are united in their desire to find ways in which systems engineering can transform health care, especially in the context of health care reform and other significant changes affecting the delivery of health care. Proc. 2011;86(8):781-786 T he Mayo Clinic Conference on Systems Engineering and Operations Research, held in August 2010, brought together a multidisciplinary group of participants, including health care and operations research (OR) professionals, administrative leaders, academic professors, and students to share and discuss the effective translation of systems engineering (SE) and OR concepts, methods, and tools to enhanced delivery of health care. The overall focus of the conference was to showcase and demonstrate the tremendous value of SE/OR in the delivery of high-quality, costeffective, and patient-focused health care. With substantial changes expected due to health care reform and related legislation, the conference was well received and timely. The topics, workshops, and conference sessions were developed with an emphasis on how research and education can be translated to improved clinical practice. Examples include SE/OR models and implementation experience in cancer screening, medical decision making, delivery of nursing care, patient education and experience, and organizational quality initiatives. The conference also offered participants insight into building an SE/OR infrastructure for health care and enhancing the awareness and education related to these disciplines. Mayo ClinEngineering could be simply defined as the purposeful application of science and mathematics to create valuable and useful solutions. In relation to health care, science and engineering are applied with a deliberate focus on humans-patients, families, and staff-as well as by sharing discoveries and outcomes to continually improve health and patient care. The conference agenda (Figure 1) consisted of sessions that balanced the technical aspects of SE/OR research with the human aspects of health care. Effectively managing this blend was a key to the conference's success and is addressed in the following highlights from the conference.

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Operational Failures and Interruptions in Hospital Nursing

Cited by 311 publications

References 55 publications

Lean in healthcare – history and recent developments

Lean in healthcare – history and recent developments

Defining and measuring the effort needed for inpatient medicine work

Highlights From the Third Annual Mayo Clinic Conference on Systems Engineering and Operations Research in Health Care

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