Operational failures in General Practice: A scoping review

Talk Code: 
Carol Sinnott
Dr John Park, Dr Alex Georgiadis, Dr Rebecca Simmons, Prof Mary Dixon-Woods
Author institutions: 
The Healthcare Improvement Studies (THIS) Institute and Department of Primary Care and Public Health, University of Cambridge


General practice is under pressure. Proposed solutions overwhelmingly focus on increasing the number of GPs, while deficiencies in the systems that support GP work are often overlooked. In the secondary care literature, problems in work-systems that supply healthcare professionals with information, equipment or materials needed to do their job have been called operational failures (OF). Examples include missing thermometers, delayed test results or broken monitors. When faced with OFs, staff must seek the missing item or use workarounds to continue their work-task. Resolving an OF may take seconds but cumulative time losses are significant. A sound description of the nature of OFs as they apply to general practice may identify targets for intervention. We systematically reviewed existing literature on OFs in general practice.


We developed our search strategy with a medical librarian and ran it in PubMed, Embase, PsychINFO, CINAHL, Health Business Elite, British Nursing Index and Healthcare Management Information Consortium for papers published in English from inception until October 2017. Inclusion criteria were studies in primary care, using empirical data (observational, experimental and qualitative), and focused on OFs that disrupt GP work. Exclusion criteria were studies in secondary or specialist care; examining non-physician work; policy, theoretical or conceptual papers.One author reviewed titles and abstracts for all retrieved citations, with two other authors each screening a 15% subset of citations. Two authors screened full texts of potentially relevant citations. Based on search results, we adopted a scoping review approach to analysis as it permitted a “mapping” of the literature on OFs in general practice.


After removal of duplicates, the search retrieved 8534 citations. No paper specifically addressed OFs in general practice. However, 603 papers focussed on issues within the definition of OFs i.e. problems in the supply of information, equipment or materials that frustrated GP work. These problems arose from the interface between the practice and the larger healthcare system, or from within practice systems. Information problems included missing medical records or delays in communication from other healthcare professionals. Equipment problems often related to electronic health records, which were variably seen as a solution to or a source of problems. Material problems related to the supply of pre-printed forms, needles and syringes and also encompassed the poor fit of clinical materials such as guidelines to many patients in general practice.


We have identified a range of system-level problems that can be described as OFs in GP work systems. Addressing problems in GP work-systems may reduce risk of burn out, improve GP retention and lead to potential benefits for the quality and safety of patient care. This review will direct our future improvement research in primary care by identifying potential targets for intervention.

Submitted by: 
Carol Sinnott
Funding acknowledgement: 
Carol Sinnott is funded through an NIHR Clinical Lecturership in General Practice. John Park is funded through an Academic Clinical Fellowship in General Practice. The Healthcare Improvement Studies Institute is made possible by the Health Foundation.