Address correspondence to Anita L. Tucker, D.B.A., M.S., The Wharton School, University of Pennsylvania, 551 Huntsman Hall, 3730 Walnut Street, Philadelphia, PA 19104-6340. Anita L. Tucker is also with the Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA. Steven J. Spear, D.B.A., M.S., M.S., is a senior fellow with the Institute for Healthcare Improvement, Cambridge, MA.
Operational Failures and Interruptions in Hospital Nursing
Article first published online: 13 JAN 2006
Health Services Research
Volume 41, Issue 3p1, pages 643–662, June 2006
How to Cite
Tucker, A. L. and Spear, S. J. (2006), Operational Failures and Interruptions in Hospital Nursing. Health Services Research, 41: 643–662. doi: 10.1111/j.1475-6773.2006.00502.x
- Issue published online: 13 JAN 2006
- Article first published online: 13 JAN 2006
- Nursing work environment;
- work systems;
- medical errors
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.