Understanding How Hospital Nurses Address Operational Failures That Impact Patients: An Exploratory Study of...

Operational failures in hospitals, such as communication breakdowns and equipment malfunctions, challenge nurses by disrupting patient care, workflow, and clinical processes. These failures are primarily addressed with short-term solutions, rather than comprehensive, long-term strategies. This study investigates the impact of operational failures on patients and examines whether nurses alter their problem-solving behavior in response to the perceived direct impact on patients. A qualitative, exploratory study was conducted in 23 wards across five Belgian hospitals. Data were collected through in-depth semi-structured interviews with 26 nurses and a group discussion with ward managers (n = 6). Findings reveal that barriers such as nurses' limited awareness regarding the broader impact of operational failures on patients, poor communication, and excessive workloads hinder problem-solving efforts. However, when operational failures result in patient harm, nurses are more likely to take corrective action to prevent recurrence. Enablers to enhance problem-solving behaviors include using narrative medicine to highlight patient safety risks, improvements to communication frameworks, the streamlining of reporting systems, and the allocation of adequate time and resources to address underlying issues. Furthermore, a proactive approach, grounded in Safety-II principles, emphasizes nurses' flexibility and adaptability, recognizing their indispensable role in learning from successful outcomes and making real-time adjustments to strengthen resilience within healthcare systems.