Implementing standardised flow: Navigating operational and professional dependencies

Marianna Frangeskou*, Michael A. Lewis, Christos Vasilakis

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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
JournalInternational Journal of Operations and Production Management
Volume40
Issue number7/8
DOIs
Publication statusPublished - 2020

Keywords

  • Case study
  • Flow implementation
  • Operational dependencies
  • Standardised work
  • Professional work
  • HEALTH-CARE
  • ORGANIZATIONAL IMPROVISATION
  • KNOWLEDGE WORK
  • LEAN THINKING
  • ROUTINES
  • PHYSICIANS
  • SYSTEM
  • COOPERATION
  • PERFORMANCE
  • HOSPITALS

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