Operational failures that hurt hospital performance

Operational failures waste at least 10 percent of caregivers' time and can compromise the quality, timeliness and efficiency of care delivery, according to a September working paper from the Harvard Business School.

The authors observed nurses on medical/surgical units at two hospitals and support staff and identified 120 operational failures, including instances where an employee lacked the supplies, equipment, information or people needed to complete work tasks.

A nurse experienced an average of one failure every 37 minutes, which ate up 12 percent of his or her day and delayed care by 5.5 minutes, the authors found.

Moreover, nurses' workaround to the operational failures--searching for needed items and securing them for their own use--created operational failures for other nurses.

They also concluded only 14 percent of these breakdowns in internal supply chains stemmed from people's mistakes or lack of training. Most arose from work-design flaws lacking lean principles, such as insufficient workspace (29 percent), poor process design (23 percent) and a lack of integration in the internal supply chains (23 percent), according to the research summary.

To increase hospital productivity and therefore care quality, timeliness and efficiency, hospitals must directly connect supply departments to patients' needs.

The authors found that when items on the nursing unit did not match what patients needed, the nurses would "go on an expedition" to find the necessary materials or equipment. Nursing departments will avoid operational failures by giving suppliers a yes or no work request on behalf of a specific patient.

In addition to ensuring employees have the basic infrastructure necessary to do their work and a supply department that is responsive to patients' needs, attributes of high-performing hospitals and health systems also include the use of information technology and evidence-based medicine for making clinical decisions, patient monitoring and drug prescribing, and compensation practices that promote quality metrics on chronic disease, prevention and patient experience, FierceHealthcare previously reported.

For more:
- here's the summary
- read the paper (.pdf)