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Abstract：
Operational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs\' experiences of work, they remain under-explored in primary care.
To identify operational failures in the primary care work environment and to examine how they influence GPs\' work.
Qualitative interview study in the East of England.
Semi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.
GPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook \'compensatory labour\' to fulfil their duties of coordinating and safeguarding patients\' care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.
Operational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.
To identify operational failures in the primary care work environment and to examine how they influence GPs\' work.
Qualitative interview study in the East of England.
Semi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.
GPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook \'compensatory labour\' to fulfil their duties of coordinating and safeguarding patients\' care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.
Operational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.
摘要：
操作故障,定义为信息中的不足或错误，用品,或患者护理所需的设备，已知在医院环境中是非常重要的。尽管它们可能与全科医生的工作经验相关，它们在初级保健中仍未得到充分探索。
识别初级保健工作环境中的操作故障，并检查它们如何影响全科医生的工作。
英格兰东部的定性访谈研究。
对全科医生进行了半结构化访谈(n=21)。数据分析基于常数比较法。
GP报告了大量的操作故障，其中许多与外部医疗保健提供者的信息传输有关，实践技术,以及在实践中组织工作。面对操作失败，全科医生承担“补偿性劳动”以履行其协调和保护患者护理的职责。在已经紧张的日常时间表的背景下，处理运营故障会带来巨大的额外压力，但是这项工作基本上是看不见的。在某种程度上,这是因为全科医生采取行动来解决此时此地的问题，而不是将它们提交给源代码，并且他们典型地没有在系统级别报告操作故障。他们还确定了在实践层面进行流程改进的挑战，包括关于授权的法医学不确定性。
全科医生在初级保健方面的操作失败及其工作经验。补偿性劳动是一项繁重的工作，其后果是使这些失败在很大程度上不可见的意外后果。认识到操作失败的重要性应激发努力，使初级保健工作环境更具吸引力。
识别初级保健工作环境中的操作故障，并检查它们如何影响全科医生的工作。
英格兰东部的定性访谈研究。
对全科医生进行了半结构化访谈(n=21)。数据分析基于常数比较法。
GP报告了大量的操作故障，其中许多与外部医疗保健提供者的信息传输有关，实践技术,以及在实践中组织工作。面对操作失败，全科医生承担“补偿性劳动”以履行其协调和保护患者护理的职责。在已经紧张的日常时间表的背景下，处理运营故障会带来巨大的额外压力，但是这项工作基本上是看不见的。在某种程度上,这是因为全科医生采取行动来解决此时此地的问题，而不是将它们提交给源代码，并且他们典型地没有在系统级别报告操作故障。他们还确定了在实践层面进行流程改进的挑战，包括关于授权的法医学不确定性。
全科医生在初级保健方面的操作失败及其工作经验。补偿性劳动是一项繁重的工作，其后果是使这些失败在很大程度上不可见的意外后果。认识到操作失败的重要性应激发努力，使初级保健工作环境更具吸引力。
