• Patient safety;
  • process improvement;
  • hospital systems

Objective. To contrast the safety-related concerns raised by front-line staff about hospital work systems (operational failures) with national patient safety initiatives.

Data Sources. Primary data included 1,732 staff-identified operational failures at 20 U.S. hospitals from 2004 to 2006.

Study Design. Senior managers observed front-line staff and facilitated open discussion meetings with employees about their patient safety concerns.

Data Collection. Hospitals submitted data on the operational failures identified through managers' interactions with front-line workers. Data were analyzed for type of failure and frequency of occurrence. Recommendations from staff were compared with recommendations from national initiatives.

Principal Findings. The two most frequent categories of operational failures, equipment/supplies and facility issues, posed safety risks and diminished staff efficiency, but have not been priorities in national initiatives.

Conclusions. Our study suggests an underutilized strategy for improving patient safety and staff efficiency: leveraging front-line staff experiences with work systems to identify and address operational failures. In contrast to the perceived tradeoff between safety and efficiency, fixing operational failures can yield benefits for both. Thus, prioritizing improvement of work systems in general, rather than focusing more narrowly on specific clinical conditions, can increase safety and efficiency of hospitals.