Unveiling the Impact of Operational Failures on Patients: A SEIPS-based Analysis From the Perspective of Hospital Nurses.

Objectives: Operational failures (OFs) in hospital environments pose significant challenges for nurses, affecting patient care, workflow efficiency, and clinical processes. Common OFs include supply chain disruptions, communication breakdowns, and equipment failures. Although OFs are pervasive and frequent, current research primarily focuses on process improvement and employee well-being, neglecting the patient-centric perspective in this discourse. The objective of this study is to explore the impact of OFs on patient well-being through semi-structured interviews conducted with hospital nursing staff.

Methods: A qualitative and exploratory approach, in accordance with the SRQR guidelines, was employed to ensure methodological rigor and transparency by providing a comprehensive understanding of the phenomenon. This multicenter study was conducted in 23 wards across 5 general hospitals in Belgium. It included in-depth, semi-structured face-to-face interviews with 26 nurses, and 2 group discussions: one with nurse managers (n=6), and another with patients (n=14). Thematic analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to examine how OFs emerge within work systems and affect patients.

Results: The results indicate that minor OFs, including short delays in care or small communication lapses, can disrupt the continuity of care, leading to heightened patient stress and dissatisfaction. Conversely, major OFs, such as critical equipment breakdowns or medication errors, pose substantial and widespread risks, negatively impacting both patient experience and safety. Patients' reactions to such failures depend on the preventability of the error and the severity of its consequences, ranging from understanding to outright anger.

Conclusions: The numerous day-to-day problems that nurses encounter due to poorly performing work systems can significantly compromise patient well-being and safety, ultimately affecting patient satisfaction and trust in health care.