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Operational friction causes physical and emotional harm to patients and the healthcare workforce

It’s critically important to measure operational friction’s negative impact on healthcare. Friction hurts everyone involved—and in more than one way.  

New research from Press Ganey’s enterprise analytics and data science team reveals that at least 50% of patients encounter operational friction at some point during their interactions with the healthcare industry. That number should stop you in your tracks. From the patient’s standpoint, this friction is often marked by inconvenience, wasted time, and frustration—like long wait times and a sense that providers don’t know their medical history. This can drive down experience scores and likelihood to recommend (LTR). But there can also be more severe consequences that impact safety in healthcare. 

As we work toward the shared goal of zero harm for all, we must adopt a broader definition of harm—one that includes both physical and emotional harm. And we must reliably design systems that reduce operational frictions that lead to these harms. 

How operational friction impacts patient safety in healthcare  

Consider, for example, a patient who needs an antibiotic for a painful urinary infection. It’s Friday morning, and “Courtney” has tried to make an appointment with her primary care provider, calling multiple times with no success getting a same-day appointment. Finally, it’s evening, she hasn’t heard back, and the office is closed until Monday. So, what does she do? Most likely, she goes to an urgent care facility or the emergency department, where she has to wait to be seen. When she finally leaves with a prescription in hand, it is after 11 p.m. But if she had been able to get in touch with her doctor earlier in the day, she could have started her medication hours ago. Now, she is at least 12–18 hours behind in treatment. 

Delayed diagnosis and other diagnostic errors are common and harmful. They're the most common cause of malpractice claims in the ambulatory setting. In this example, the friction Courtney encountered caused physical harm, due to delayed treatment (not to mention the potential harm of her infection worsening as time went on). She also most likely felt stressed and frustrated with her experience (a type of emotional harm).  

This is just one example of the many ways operational friction is directly connected to patient safety. When patients can’t get in touch with their physician, have to wait for care with little to no communication regarding delays, or feel that their doctors aren’t up to date on their medical histories, patients feel as if they’ve been hung out to dry.  

No doctor or care provider wants patients to feel that way—or to encounter any friction in the first place. But leaving caregivers to “right the wrong” of operational friction puts undue pressure on them to make up for gaps in processes, technology and systems, or people. It wasn’t necessarily the fault of Courtney’s doctor that she wasn’t treated in a timely manner. Blaming whoever or whatever—the person, system, or process—was responsible for the delay isn’t what really matters. The key issue is the potential effect on Courtney’s physical and mental well-being. Pinpointing the underlying causes, and improving them with the objective of zero harm, is essential to preventing other patients from having the same frustrating experience. 

How operational friction impacts physical and emotional safety among healthcare employees 

Relying on physicians and clinical staff to recover from incidents of operational friction fails to truly solve the problem. In fact, it can make things even worse from both a physical and emotional harm standpoint.  

One of the many examples of physical harm that can occur is violence, particularly against caregivers. The subject has been top of mind for healthcare leaders across the country, as violence against healthcare workers has increased significantly since the onset of COVID-19. When patients feel anxious or frustrated, they can lash out physically and/or verbally against clinicians and other healthcare employees, adding more fuel to the fire in a highly fraught environment. 

The constant need to address operational friction can also lead to emotional harm in the workforce, which can impact employee engagement and retention. When employees feel they need to repeatedly apologize to patients for issues outside of their control, it can be draining and exhausting. This can lead to burnout and turnover among top-performing nurses and physicians—in a time when we are experiencing a nationwide staffing crisis, no less.  

So how do we design systems that reduce operational friction and prioritize patient and workforce safety?  

5 guiding principles for reducing operational friction and driving zero harm in healthcare 

  1. Make safety a core value, and understand the impacts of friction on harm. When safety is a core value, it is so embedded in the culture that it guides everything the organization does. This means we must broaden our definition of harm to include emotional harm, as well as physical harm, to patients and employees across the care continuum. Understanding the true causes of harm from a system standpoint can help identify and improve frictions that lead to harm. 
  2. Improve communication. Clear, consistent communication is critical to improving patient safety and reducing operational friction. Consider a patient who doesn’t receive or understand discharge instructions before leaving the emergency department. This type of communication breakdown can lead to a patient safety event. Direct and transparent communication with patients about wait times is also critical. Keep patients up to date about wait times and delays through text message alerts or electronic signage in the waiting room that indicates the current time to be seen.  
  3. Elevate the voice of the patient. Using patient and family advisory councils, focus groups, and patient surveys, you can harness the voice of the patient and learn where they’re experiencing friction within your organization. Working with patients and their family members can help organizations better understand pain points and frustrations and better inform care flow, care team deployment, training, and patient outcomes.  
  4. Understand that operational friction isn’t a one-size-fits-all experience. Inequities must be addressed in every aspect of the work we do—including reducing friction. It’s important that we understand operational friction at both an aggregate and individual level, realizing that its impact on people can be different based on age, gender identity, race and ethnicity, location, and more. It can also be different based on the specialty practice or clinical condition—for example, a person who’s pregnant might experience different friction than a person undergoing cancer treatment.  
  5. Design processes that reduce friction. Healthcare organizations must strengthen their focus on safety by reliably designing systems and processes that reduce friction and ensure access. Can organizations measure the experience of telehealth visits, or set expectations around answering questions submitted through the patient portal? Safety and high reliability consultants can assist in finding ways to meet patients’ needs, which is paramount to improving safety culture in healthcare. Press Ganey’s team of safety and high reliability consulting experts can help you leverage your patient experience, safety, and engagement data to create customized plans to reduce friction.

To learn more about operational friction’s impact on patients, employees, safety, and more, download our e-book, “The hidden costs of operational friction.”

About the author

As Chief Safety and Transformation Officer, Dr. Gandhi, MPH, CPPS is responsible for improving patient and workforce safety, and developing innovative healthcare transformation strategies. She leads the Zero Harm movement and helps healthcare organizations recognize inequity as a type of harm for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing healthcare disparities and the impact of racial inequities on patients and caregivers. Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.

Profile Photo of Dr. Tejal Gandhi, MPH, CPPS