Article | Health Services Research

Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems

by Anita L. Tucker, Sara J. Singer, Jennifer E. Hayes and Alyson Falwell


Objective To link safety-related concerns raised by frontline staff about hospital work systems (operational failures) to the safety and efficiency of hospitals, and to contrast these concerns with national patient safety initiatives.

Data Sources Primary data include semi-structured interviews with frontline staff and 1732 staff identified operational failures at 20 U.S. hospitals from 2004-2006.

Study Design Senior-level managers observed frontline staff work with particular attention to patient safety issues and facilitated open-discussion meetings with employees about their safety related concerns.

Data Collection Hospitals submitted data on the operational failures they identified through their interactions with frontline workers. Data were analyzed for type of failure and frequency of occurrence. Interviews were conducted with frontline staff.

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 frontline staff experiences with work systems to identify and remove 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.

Keywords: Perspective; Opportunities; Safety; Performance Efficiency; System; Failure; Conferences; Employees; Management Analysis, Tools, and Techniques; Experience and Expertise; Health Care and Treatment; Health Industry; United States;


Tucker, Anita L., Sara J. Singer, Jennifer E. Hayes, and Alyson Falwell. "Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems." Health Services Research 43, nos. 5, pt.2 (October 2008).