Operational failures and how they influence the work of general practitioners: A qualitative study in primary care

Problem

General practice faces a workforce recruitment and retention crisis. While the pressures experienced by General Practitioners (GPs), including unmanageable workloads, the complexity of patients’ needs and policy expectations to move more care from hospitals to the community have been well documented, there has been less focus on whether the wider health system facilitates the work of GPs by supporting an efficient primary care work environment.This study aims to understand what and how system-level operational failures in the primary care work environment interfere with and influence GPs’ work, with a view to identifying failures that may be tractable to improvement.

Approach

We conducted a qualitative interview study, using “operational failures”- defined as disruptions, inadequacies or errors in the information, supplies, or equipment needed for patient care - as a sensitising concept. Twenty-one GPs were recruited via the East of England Clinical Research Network, using criteria of length of time since qualification, location, and practice size. The technique of chart-stimulated recall was utilised during interviews. Analysis was based on the constant comparative method.

Findings

Operational failures experienced by GPs arose mainly from inadequate channels of communication external to their own practices, but also related to problems in practice technology and suboptimal distribution of work within practices. GPs were obliged to undertake compensatory labour to fulfil their duties of overseeing, coordinating and safeguarding patients’ care. Though individual operational failures often took only minutes to resolve, the additional strain they imposed in the context of already stretched daily schedules, threatened job satisfaction, patient safety and the quality of care. Though GPs often believed that working around these problems was the simplest solution, compensatory labour may be counterproductive in the longer term by keeping problems obscured as learning opportunities.

Consequences

Operational failures within general practices and the wider healthcare system interfere with and configure GPs’ work and signal system-level weaknesses that cause pressure within the primary care work environment. Using failure occurrence as a trigger for improvement efforts at a local and collective level will be critical to making the primary care work environment more attractive and efficient.