Impacts of Operational Failures on Primary Care Physicians’ Work: A Critical Interpretive Synthesis of the Literature
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* Verneda S. Troyer
* Jennifer M. Ledonne

The *Annals of Family Medicine* encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1

## HOW IT WORKS

In each issue, the *Annals* selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on “TRACK Discussion / Submit a comment.”) Discussion questions and information are online at: [http://www.AnnFamMed.org/site/AJC/](http://www.AnnFamMed.org/site/AJC/).

## CURRENT SELECTION

### Article for Discussion

 Sinnott C, Georgiadis A, Park J, Dixon-Woods M. Impacts of operational failures on primary care physicians’ work: a critical interpretive synthesis of the literature. Ann Fam Med. 2020; 18( 2): 159– 168.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTgvMi8xNTkiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzE4LzIvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)

### Discussion Tips

This study aims to review how operational failures in primary care affect the work of primary care physicians. As you read the article, what operational failures do you identify in your daily work? How could identifying these failures allow for change in your office?

### Discussion Questions

*   What question is asked by this study and why does it matter?

*   How does this study advance beyond previous research and clinical practice on this topic?

*   What is the critical interpretive synthesis method? How does it differ from other methods (ie, systematic reviews and meta-analyses)?

*   Compared to alternative methods, how strong is the study design for answering the question?

*   To what degree can the findings be accounted for by: 
    
    *   Definition of operational failures utilized by the studies?
    
    *   Inclusion & exclusion criteria?
    
    *   Screening of studies & determining quality?
    
    *   Data extraction from the studies?
    
    *   Chance?

*   Would different authors have reached the same conclusions?

*   What are the main study findings?

*   How comparable are the results (operational failures/compensatory labor) to your practice? What is your judgment about the transportability of the findings?

*   How might this review change your practice operations? Hospital system? Policy? Research?

*   Who do the study findings apply to, and how might they be engaged in interpreting or using the findings? What other specialties share in similar operational failures?

*   What are the next steps in interpreting or applying the findings?

*   What could be done to make compensatory labor more visible and trackable? Is there an objective way this could be done?

*   What researchable questions remain? Should future studies break down operational failures into more specific subsets so they may be better addressed?

*   How might future research be able to determine causes or solutions to operational failures? Could solutions to operational failures cause other operational failures?

*   © 2020 Annals of Family Medicine, Inc.

## References

1.  Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIzOiIvYW5uYWxzZm0vMTgvMi9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)