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Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region

OBJECTIVE: To identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system. DESIGN: Single case study involving qualitative interviews and documentary analysis. SETTING: A devolved health system in the UK Nat...

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Autores principales: Kriznik, Natasha Marie, Lamé, Guillaume, Dixon-Woods, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887013/
https://www.ncbi.nlm.nih.gov/pubmed/31780591
http://dx.doi.org/10.1136/bmjopen-2019-031771
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author Kriznik, Natasha Marie
Lamé, Guillaume
Dixon-Woods, Mary
author_facet Kriznik, Natasha Marie
Lamé, Guillaume
Dixon-Woods, Mary
author_sort Kriznik, Natasha Marie
collection PubMed
description OBJECTIVE: To identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system. DESIGN: Single case study involving qualitative interviews and documentary analysis. SETTING: A devolved health system in the UK National Health Service (NHS). PARTICIPANTS: NHS staff (n=10) and policy-makers (n=8) who were involved in the design and/or implementation of the standardised policy. RESULTS: Though standardising labelling of invasive tubing and lines was initially seen as a common-sense technical change, challenges during the process of developing and implementing the policy were multiple and sociotechnical in nature. Major challenges related to defining the problem and the solution, limited sustained engagement with stakeholders and users, prototyping/piloting of the solution, and planning for implementation. Some frontline staff remained unconvinced of the need for or value of the policy, since they either did not believe that there was a problem or did not agree that standardised labelling was the right solution. Mundane practical issues such authorisation and resourcing, supply chains for labels, the need to restructure work practices to accommodate the new standard, and the physical features of the labels in specific clinical settings all had important impacts. CONCLUSIONS: Newly standardised tools and practices have to fit within a system of pre-existing norms, practices and procedures. We identified a number of practical, social and cultural challenges when designing and implementing a standardised policy in a regional healthcare system. Taking account of both sociocultural and technical aspects of standardisation, combined with systems thinking, could lead to more effective implementation and increase acceptability and usability of new standards.
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spelling pubmed-68870132019-12-04 Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region Kriznik, Natasha Marie Lamé, Guillaume Dixon-Woods, Mary BMJ Open Health Services Research OBJECTIVE: To identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system. DESIGN: Single case study involving qualitative interviews and documentary analysis. SETTING: A devolved health system in the UK National Health Service (NHS). PARTICIPANTS: NHS staff (n=10) and policy-makers (n=8) who were involved in the design and/or implementation of the standardised policy. RESULTS: Though standardising labelling of invasive tubing and lines was initially seen as a common-sense technical change, challenges during the process of developing and implementing the policy were multiple and sociotechnical in nature. Major challenges related to defining the problem and the solution, limited sustained engagement with stakeholders and users, prototyping/piloting of the solution, and planning for implementation. Some frontline staff remained unconvinced of the need for or value of the policy, since they either did not believe that there was a problem or did not agree that standardised labelling was the right solution. Mundane practical issues such authorisation and resourcing, supply chains for labels, the need to restructure work practices to accommodate the new standard, and the physical features of the labels in specific clinical settings all had important impacts. CONCLUSIONS: Newly standardised tools and practices have to fit within a system of pre-existing norms, practices and procedures. We identified a number of practical, social and cultural challenges when designing and implementing a standardised policy in a regional healthcare system. Taking account of both sociocultural and technical aspects of standardisation, combined with systems thinking, could lead to more effective implementation and increase acceptability and usability of new standards. BMJ Publishing Group 2019-11-27 /pmc/articles/PMC6887013/ /pubmed/31780591 http://dx.doi.org/10.1136/bmjopen-2019-031771 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Services Research
Kriznik, Natasha Marie
Lamé, Guillaume
Dixon-Woods, Mary
Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title_full Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title_fullStr Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title_full_unstemmed Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title_short Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region
title_sort challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a uk region
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887013/
https://www.ncbi.nlm.nih.gov/pubmed/31780591
http://dx.doi.org/10.1136/bmjopen-2019-031771
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