Implementing standardised flow: navigating operational and professional dependencies

Purpose
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.

Design/methodology/approach
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.

Findings
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.

Originality/value
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.