Implementing standardised flow: navigating operational and professional dependencies

Marianna Frangeskou, Michael Lewis, Christos Vasilakis

Research output: Contribution to journalArticlepeer-review

4 Citations (SciVal)
71 Downloads (Pure)


Purpose: The purpose of this study had two aims: (1) to extend insight regarding the challenges of implementing standardised work, 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 “pilo” or guide. Design/methodology/approach: This was a longitudinal case study of implementing the acute stroke care pathway in a National Health Service hospital in England based on 185 hours of non-participant observations and 68 semi-structured interviews. Archival documents were also analysed. Findings: The combined flow, operational and professional dependency lens extends operations management 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 the authors provide some initial guidance. Research limitations/implications: The research was a single case study and was focussed 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. Originality/value: In addition to confirming that a multidependency 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. The authors' 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

Bibliographical note

Funding Information:
The authors would like to thank for their help and support all the staff of Royal United Hospital NHS Foundation Trust (RUH) who participated in this research. Special thanks to Dr Monica Baird, Prof Carol Peden and Prof Mark Tooley. This research was partially supported by RUH.

Publisher Copyright:
© 2020, Marianna Frangeskou, Michael A. Lewis and Christos Vasilakis.


  • Case study
  • Flow implementation
  • Operational dependencies
  • Professional work
  • Standardised work

ASJC Scopus subject areas

  • Decision Sciences(all)
  • Strategy and Management
  • Management of Technology and Innovation


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