Implementing standardised flow: navigating operational and professional dependencies

Marianna Frangeskou, Michael Lewis, Christos Vasilakis

Research output: Contribution to journalArticlepeer-review

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The study had two aims: (1) to extend insight regarding the challenges of implementing standardised flow, via care pathways, in a healthcare setting by considering interactions with other operational (i.e., resource sharing, portfolio alignment) and professional (i.e., autonomous expertise) dependencies, and; (2) to develop novel insights regarding a specific flow mechanism, the stroke nurse practitioner, a form of flow ‘pilot’ or guide.

This was a longitudinal case study of implementing the acute stroke care pathway in a National Health Service (NHS) hospital in England based on 185 hours of non-participant observations and 68 semi-structured interviews. Archival documents were also analysed.

The combined flow, operational and professional dependency lens extends OM understanding of the challenge of implementing standardised work in healthcare. One observed practice, the process pilot role, may be particularly valuable in dealing with these dependencies but it requires specific design and continuous support, for which we provide some initial guidance.

Research limitations/implications
The research was a single case study and was focused on a single care pathway. The findings require replication and extension but offer a novel set of insights into the implications of standardised work in healthcare.

In addition to confirming that a multi-dependency lens adds conceptual and practical insight to the challenges of implementing standardised work in a healthcare setting, the findings and recommendations regarding flow ‘pilots’ are novel. Our analysis of this role reveals new insights regarding the need for continued improvisation in standardised work.
Original languageEnglish
Pages (from-to)1177-1199
Number of pages23
JournalInternational Journal of Operations & Production Management
Issue number7/8
Early online date29 Jun 2020
Publication statusPublished - 31 Dec 2020


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