In this study, we investigate the process of standardising people-centric, knowledge-intensive, professional work, specifically attempts to adopt a common standard for hospital stroke care. In operations management (OM), standardization (i.e. eliminating various aspects of process variation) is central to increased control but in professional work, managerial influence is more limited because (medical) professionals deploying specialized knowledge enjoy, by definition, significant autonomy. The research is built upon an in-depth longitudinal case study in a UK hospital that confirms the value of standardization in healthcare work but also strongly emphasizes that it must be understood as a multi-dimensional puzzle. The findings confirm established but under-developed, insights regarding limitations of the dominant OM process design logic, namely flow dependency. Our analysis clearly shows that variation is also driven by sharing (i.e. sub-optimal layouts, high-utilisation and high-variability of resources) and fit (i.e. conflicting KPIs) dependency considerations. More specifically, we observed – often via the use of shared (or not) pathway artefacts (maps, etc.) - that autonomy has negative and positive impacts on inter-professional collaboration. Autonomy frequently led to minimally shared mental models of care, perspectives on the best interests of the patient, etc. and (often highly dysfunctional) competition between individuals and groups. Where we observed effective inter-professional collaboration, it had been achieved through relational resources (i.e. shared goals, interests etc.) developed via continuous interaction and knowledge sharing mechanisms. However, pathway capacity issues (i.e. staff and bed availability, etc) moderated such interactions. The paper concludes by discussing how these insights can help healthcare operations managers and other professionals to design better process and implementation strategies that improve the delivery of care.
|Publication status||Published - 13 Aug 2019|
|Event||Academy of Management 2019 - Boston, USA United States|
Duration: 9 Aug 2019 → 13 Aug 2019
|Conference||Academy of Management 2019|
|Country/Territory||USA United States|
|Period||9/08/19 → 13/08/19|