The impact of operational failures on hospital nurses and their patients

Operational failures in healthcare can hinder employees, potentially decreasing both productivity and quality of care. At the same time, regulatory agencies, industry experts, and consumers increasingly demand that health care organizations learn from prior failures to prevent recurrence. Building on the notion that learning from operational failures requires an accurate understanding of their nature, this paper reports on an in-depth study of operational failures encountered by hospital nurses. Data analysis suggests that in this context (1) most operational failures stem from breakdowns in the supply of materials and information across organizational boundaries and (2) employees quickly compensate for most failures. We propose that these two conditions—lack of control of processes that create failures and the ease with which employees restore functioning—make it difficult for organizations to recognize these incidents as learning opportunities, and if they do, to capitalize on the opportunity. This has an important implication for efforts to generate organizational learning and improvement from employees’ experiences with failures. Highly interdependent front-line workers do not control organizational processes responsible for the majority of failures they encounter and have a difficult task convincing powerful associates that these obstacles warrant solution efforts, making it likely operational failures will persist. © 2004 Elsevier B.V. All rights reserved.