The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index; none of the 26 sources its claims cite is checked for support yet.
Front‐Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems
Open accessAbstract
Objective. To contrast the safety‐related concerns raised by front‐line staff about hospital work systems (operational failures) with national patient safety initiatives. Data Sources. Primary data included 1,732 staff‐identified operational failures at 20 U.S. hospitals from 2004 to 2006. Study Design. Senior managers observed front‐line staff and facilitated open discussion meetings with employees about their patient safety concerns. Data Collection. Hospitals submitted data on the operational failures identified through managers' interactions with front‐line workers. Data were analyzed for type of failure and frequency of occurrence. Recommendations from staff were compared with recommendations from national initiatives. 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 front‐line staff experiences with work systems to identify and address 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.
Overview
Integrity signals
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Cites
Statistics
Verification
Claims the paper makes
60 Own result · 22 Own interpretation · 21 Not checked yet · 18 Own method · 4 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings suggest that front-line workers experience routine breakdowns in work systems that impede safety and efficiency.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Abstract
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Hospitals conducted intervention activities in a median of five work areas.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This problem was pervasive: 85 percent of hospitals reported missing equipment or supplies.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Equipment/Supply Failures
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One-third of communication/documentation failures were the result of poor coordination among health care providers.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Communication/Documentation Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Another third of the equipment/supplies failures centered on equipment that did not meet the needs of the patients.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Equipment/Supply Failures
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the surgical unit of Hospital 122, a chronic deficiency of oxygen tanks meant patients were transferred between units without them.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Equipment/Supply Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although these five categories occurred less frequently, they were prevalent and reported by 80-85 percent of the hospitals.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Poor layout of the unit often made it difficult for providers to observe patients.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Facilities Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, in Hospital 32's catheter lab, the overhead lighting was inadequate for procedures on patients' left shoulders, forcing physicians to forgo the use of protective shielding because the arm it was attached to interfered with the only movable light fixture.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Facilities Failures
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Physicians reported inconsistent notification from nurses about changes in patient conditions, such as abnormal test results and drops in blood pressure.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Communication/Documentation Failures
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 28
- Probably not a substantial claim. 23
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The two most frequently identified categories of operational failures were equipment/supply and facility design failures (18 percent each), which were reported in all 20 hospitals.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Similar to other studies that have considered the front-line perspective of patient safety (Pronovost et al. 2004;Frankel et al. 2005;Rathert, Fleig-Palmer, and Palmer 2006), our methodology yielded concerns that were grounded in the context of direct patient care.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Abstract
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 20 hospitals collected 1,732 failures (median 5 62 failures per hospital) across 173 work areas.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This preidentification of failures enabled the unit manager to distill commonly held concerns, which staff could then highlight during intervention activities with senior managers.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > METHODS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Work system observations allowed senior managers to witness challenges to providing safe patient care.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > METHODS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, OR staff reported that they were frequently uninformed about scheduling changes, which resulted in confusion and delay.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Communication/Documentation Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, with regard to operational failures, the bottom quartile identified 42 or fewer failures while the top quartile recorded between 163 and 229 failures.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Staff from all departments lamented a lack of advance notice about patient conditions--such as a need for supplemental oxygen or isolation--which created safety risks because they were unprepared when the patient arrived.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Communication/Documentation Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Personnel also frequently complained of insufficient storage space, which often resulted in storage of dirty equipment in nondesignated places, such as hallways, creating a fire and infection control risk.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Facilities Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining five categories included operational failures related to policies (5 percent), response time (4 percent), security (4 percent), infection control (3 percent), and task management (2 percent).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The next three most frequently occurring failure types were communication/documentation (16 percent), staffing/staff development (16 percent), and medication (12 percent).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Poor lighting and a lack of automatic doors hindered physicians and staff.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Facilities Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One hospital visited only three work areas, while four hospitals visited more than 10.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Similar to studies of computerized physician order entry systems (Koppel et al. 2005), we found that the ADD machines had discrepancies that could lead to medication errors such as a mismatch between the dose in the drawer and the dose on the screen, active patients being deleted from the computer, or patients coming up on the screen who had already been discharged or who were never on that unit.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Medication
What the sources say
- Not checked yetcites Koppel et al. 2005 source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One hospital's ICU staff complained that weekly inventory of its ADD machine took 45 minutes.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Medication
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, senior managers observed that a lack of support staff (housekeepers, secretaries) caused inefficiencies and interruptions for physicians and nurses who had to perform support staff functions (e.g., answering phones, cleaning rooms) themselves.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Staffing/Staff Development Failures
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were also delays in procedures (e.g., line insertion), results from tests, and even surgeon arrival, which caused delays in treatment for patients and sometimes rework as patients waited so long they needed to be re-assessed.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Policy, Response Time, Infection Control, Security, and Pace of Work
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Staff also felt vulnerable because of a perceived lack of security in the hospital, especially on the night shifts and in remote areas of the hospitals.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Policy, Response Time, Infection Control, Security, and Pace of Work
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, LFLE suggested that while most hospitals had policies to satisfy publicized national goals, such as the use of two patient identifiers when providing care, front-line staff reported low compliance with such policies.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, LFLE communication failures not addressed by national initiatives included more basic issues such as difficulty contacting medical personnel, lack of notice about patient-procedure schedule changes, redundant documentation, and poorly designed forms that were difficult to use.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Many have been identified elsewhere (e.g., equipment inspection during JCAHO accreditation surveys), but they have not been highlighted as priorities by national patient safety initiatives.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The national patient safety initiatives reviewed are representative of national patient safety priorities.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The two most frequent categories of operational failures, equipment/supplies and facility issues, posed safety risks and diminished staff efficiency”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, both safety and efficiency--which together create value for patients--can benefit from improving work system performance.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Abstract
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Following recommendations for qualitative research (Miles and Huberman 1994), we used an iterative coding process that resulted in 10 failure categories.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Data Collection and Analysis
What the sources say
- Not checked yetcites Miles and Huberman 1994
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the hospitals nor any individuals received compensation for participation, and all activities were approved by the Institutional Review Boards at the participating institutions.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Setting
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Four hospitals were excluded from the analysis because one closed and the other three completed observations in only one work area, leaving a final sample of 20 hospitals.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Setting
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed reliability of our codes by having two investigators independently code 100 operational failures.They achieved a nearly perfect k value of 0.88.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Data Collection and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no difference between the 24 participating hospitals and 68 control hospitals nor the 92 hospitals in the larger study and all U.S. hospitals on teaching status, tax status, and ownership.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Setting
plainn = 68- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although our intervention raised a large number of safety concerns, there are undoubtedly other issues not captured by our data collection instruments that might negatively affect safety and efficiency.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > METHODS
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This pretest process was repeated with a second subset of the data until saturation was reached and no new codes needed to be developed.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Data Collection and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Prior research suggests that contact with more people increases effectiveness of information gathering (Thomas et al. 2005).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > METHODS
What the sources say
- Not checked yetcites Thomas et al. 2005
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As a result, patients were more likely to become unstable, resulting in admission to the ICU and longer hospital stays.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Equipment/Supply Failures
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Previous research on hospital work environments shows that equipment failures can frustrate patient care providers and decrease quality of care (de Leval et al. 2000;Beaudoin and Edgar 2003;Cleary 2003;Tucker 2004;Rathert, Fleig-Palmer, and Palmer 2006).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites de Leval et al. 2000
- Not checked yetcites Beaudoin and Edgar 2003
- Not checked yetcites Cleary 2003
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“For example, requiring health care providers to perform housekeeping and secretarial functions because of inadequate staff support interferes with the safe delivery of medical care and wastes expensive resources (Tucker and Spear 2006).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Tucker and Spear 2006
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Poor facility design can compromise patient confidentiality and create safety risks through limited patient visibility (Carayon et al. 2006).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Carayon et al. 2006
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Patient care delays place patients at risk for poor outcomes and prolonged pain and suffering (Derlet and Richards 2000).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Derlet and Richards 2000
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, before hospitals can successfully implement improvements that rely on specific supplies--such as an infection-preventing surgical supply--they need to first ensure that they can consistently provide required supply items in general.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, our data suggest that these assumptions are faulty.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“operational failures are important because they are latent failures, or system weaknesses that on their own may be insufficient to cause accidents, but in combination often lead to catastrophic events (Reason 1990;Vincent, Taylor-Adams, and Stanhope 1998).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Reason 1990
- Not checked yetcites Vincent, Taylor-Adams, and Stanhope 1998
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“As several of our examples illustrate, missing equipment typically results in people working around the issue by locating substitutes, which wastes staff time and delays patient care (Tucker 2004).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Tucker 2004
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, the types of failures that were uncovered might vary with implementation style.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, issues identified likely represent a subset of what might have been recommended with a broader mandate.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Nonetheless, some of the issues raised may have been outside of the domain of safety.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“While front-line staff were encouraged to speak openly, it is possible that interpersonal risks associated with speaking up, including fear of shame or retribution, may have presented a barrier to complete disclosure (Tucker and Edmondson 2003).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
What the sources say
- Not checked yetcites Tucker and Edmondson 2003
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the hospitals were randomly selected, willingness to sustain effort required for intervention activities could not be standardized.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Providing staff with more reliable work systems represents a complementary strategy to increasing staffing levels--with its commensurate improvement in staff satisfaction, reduced turnover, and patient care outcomes (Aiken et al. 2002).”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > DISCUSSION
What the sources say
- Not checked yetcites Aiken et al. 2002 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, the data were recorded by each hospital's liaison, rather than by an outside researcher, perhaps resulting in reporting bias.”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > Limitations and Future Research
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
The frequency with which operational failures were reported by staff reflects the actual frequency or importance of those failures in hospital work systems.
“The two most frequently identified categories of operational failures were equipment/supply and facility design failures (18 percent each), which were reported in all 20 hospitals.”
The paper relies on this without support.
The operational failures captured by the intervention's data collection instruments are representative of the work system problems that affect safety and efficiency in the participating hospitals.
“Although our intervention raised a large number of safety concerns, there are undoubtedly other issues not captured by our data collection instruments that might negatively affect safety and efficiency.”
The paper relies on this without support.
The national patient safety initiatives reviewed are representative of national patient safety priorities.
“equipment and facilities issues were not explicitly mentioned by the Joint Commission's 2008National Patient Safety Goals (2007)”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“For instance, frontline hospital staff involved in a patient safety intervention identified patient safety as a priority; but they cited a lack of proper equipment/supplies and facility issues as major operational barriers that their institutions did not prioritize when implementing a new policy [32].”
From Implementation science issues in understanding, collecting, and using cost estimates: A multi-stakeholder perspective (2021) · cites this paper as [32]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Medication | 214 (12) | | 19 (95) | | Communication | | 62 (23) | |”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > CONCLUSIONS
Reported 23 · recomputed 28.971963
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Communication/documentation | 275 (16) | | 20 (100) | | Poor information transfer between | | 89 (33) | |”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > CONCLUSIONS
Reported 33 · recomputed 32.363636
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Medication | 214 (12) | | 19 (95) | | Communication | | 62 (23) | | | Equipment | | 55 (20) | | | Staffing/staff development | | 27 (10) | |”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > CONCLUSIONS
Reported 10 · recomputed 12.616822
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Medication | 214 (12) | | 19 (95) | | Communication | | 62 (23) | | | Equipment | | 55 (20) | |”
§ Front-Line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems > CONCLUSIONS
Reported 20 · recomputed 25.700935
Citations
Cites
Qualitative Data Analysis: An Expanded Sourcebook
(1994) · Journal of Environmental Psychology · doi:10.1016/s0272-4944(05)80231-2 · Cited by 48,420
Crossing the Quality Chasm: A New Health System for the 21st Century
Committee on Quality of Health Care in America (2002) · Journal for Healthcare Quality · doi:10.1111/j.1945-1474.2002.tb00463.x · Cited by 8,508
Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Aiken, L. H. (2002) · JAMA · doi:10.1001/jama.288.16.1987 · Cited by 5,226
Reason, J. (1990) · doi:10.1017/cbo9781139062367 · Cited by 5,108
Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors
Koppel, R. (2005) · JAMA · doi:10.1001/jama.293.10.1197 · Cited by 2,126
Work system design for patient safety: the SEIPS model
Carayon, P., Schoofs Hundt, A., Karsh, B.-T., Gurses, A. P., Alvarado, C. J., Smith, M., & Flatley Brennan, P. (2006) · Quality in Health Care · doi:10.1136/qshc.2005.015842 · Cited by 1,795 · cited 2×
“Poor facility design can compromise patient confidentiality and create safety risks through limited patient visibility (Carayon et al. 2006).”
BackgroundMaking health care safer: a critical analysis of patient safety practices.
Shojania, K. G., Duncan, B. W., McDonald, K. M., Wachter, R. M., & Markowitz, A. J. (2001) · PubMed Central · Cited by 1,612
Five Years After To Err Is Human
Leape, L. L., & Berwick, D. M. (2005) · JAMA · doi:10.1001/jama.293.19.2384 · Cited by 1,264
Overcrowding in the nation’s emergency departments: Complex causes and disturbing effects
Derlet, R. W., & Richards, J. R. (2000) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(00)70105-3 · Cited by 1,052
Tucker, A. L., & Edmondson, A. C. (2003) · California Management Review · doi:10.2307/41166165 · Cited by 949
Self-citation
Research works printed but not linked: 4
- Beaudoin L. E., 2003, Hassles, Nursing Economics, 21, 106
- National Quality Forum, 2006, Safe Practices for Better Healthcare 2006 Update: A Consensus Report
- Pronovost P. J., 2004, Senior Executive, Joint Commission Journal of Quality Improvement, 30, 59
- Rathert C., 2006, Minimizing Medical Errors, Journal of Applied Management and Entrepreneurship, 11, 5
Cited by
Sorted by citations
Speaking up for patient safety by hospital-based health care professionals: a literature review
Okuyama, A., Wagner, C., & Bijnen, B. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-61 · Cited by 534
Lawton, R., McEachan, R. R. C., Giles, S. J., Sirriyeh, R., Watt, I. S., & Wright, J. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000443 · Cited by 311
Doing No Harm: Enabling, Enacting, and Elaborating a Culture of Safety in Health Care.
Vogus, T. J., Weick, K. E., & Sutcliffe, K. M. (2010) · Academy of Management Perspectives · doi:10.5465/amp.2010.55206385 · Cited by 233
Reducing Hospital Errors: Interventions that Build Safety Culture
Singer, S. J., & Vogus, T. J. (2013) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031912-114439 · Cited by 219
Self-citationThe Role Of Nurses In Improving Hospital Quality And Efficiency: Real-World Results
Needleman, J., & Hassmiller, S. B. (2009) · Health Affairs · doi:10.1377/hlthaff.28.4.w625 · Cited by 157
Metadata
- Authors
- Tucker, A. L., Singer, S. J., Hayes, J. E., & Falwell, A.
- Affiliations
- Harvard University (US)
- Stanford University (US)
- Corresponding author
- Tucker, Anita L.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2008-09-20
- Volume
- 43
- Issue
- 5p2
- Pages
- 1807-1829
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC2654160
- OpenAlex
- W2042274627
- Semantic Scholar
- 5daa6b66e5f3efe3dfebafab336c7b844587ab6b
- Cited by
- 129
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 11 · 2021: 12 · 2020: 3 · 2019: 7 · 2018: 9 · 2017: 11 · 2016: 11 · 2015: 5 · 2014: 10 · 2013: 5 · 2012: 9
- FWCI
- 8.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Keywords
- patient safety, operational failures, employee efficiency, hospital management
- MeSH terms
- Attitude of Health Personnel, Patient Care, Health Priorities, Health Services Research, Hospital Administration, Hospital Administrators, Hospital Design and Construction, Humans, Materials Management, Hospital, Operations Research, Personnel, Hospital, Quality Assurance, Health Care, Sampling Studies, United States, Program Evaluation, Efficiency, Organizational, Safety Management, Interdisciplinary Communication
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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