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A qualitative study of organisational response to national quality standards for 7-day services in English hospitals
BACKGROUND: National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national s...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937294/ https://www.ncbi.nlm.nih.gov/pubmed/33676507 http://dx.doi.org/10.1186/s12913-021-06213-w |
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author | Sutton, Elizabeth Bion, Julian Mannion, Russell Willars, Janet Shaw, Elizabeth Tarrant, Carolyn |
author_facet | Sutton, Elizabeth Bion, Julian Mannion, Russell Willars, Janet Shaw, Elizabeth Tarrant, Carolyn |
author_sort | Sutton, Elizabeth |
collection | PubMed |
description | BACKGROUND: National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day services (7DS), from an organisational behaviour perspective. METHODS: We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. RESULTS: Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. CONCLUSIONS: National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by resources and tailored support for improvement, taking into account local context and organisational culture. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06213-w. |
format | Online Article Text |
id | pubmed-7937294 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-79372942021-03-09 A qualitative study of organisational response to national quality standards for 7-day services in English hospitals Sutton, Elizabeth Bion, Julian Mannion, Russell Willars, Janet Shaw, Elizabeth Tarrant, Carolyn BMC Health Serv Res Research Article BACKGROUND: National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day services (7DS), from an organisational behaviour perspective. METHODS: We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. RESULTS: Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. CONCLUSIONS: National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by resources and tailored support for improvement, taking into account local context and organisational culture. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06213-w. BioMed Central 2021-03-06 /pmc/articles/PMC7937294/ /pubmed/33676507 http://dx.doi.org/10.1186/s12913-021-06213-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Sutton, Elizabeth Bion, Julian Mannion, Russell Willars, Janet Shaw, Elizabeth Tarrant, Carolyn A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title | A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title_full | A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title_fullStr | A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title_full_unstemmed | A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title_short | A qualitative study of organisational response to national quality standards for 7-day services in English hospitals |
title_sort | qualitative study of organisational response to national quality standards for 7-day services in english hospitals |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937294/ https://www.ncbi.nlm.nih.gov/pubmed/33676507 http://dx.doi.org/10.1186/s12913-021-06213-w |
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