Reconciling Standardisation Processes and Improvisation Practices in Health Care: How to Deal with Structural, Clinical and Performative Unpredictability
Author(s)
Pascuci L1, Carvalho TXVD1, Meyer Jr. V2, Mamédio D3
1Federal University of Espirito Santo, Vitória, Brazil, 2Pontifícia Universidade Católica do Paraná, Curitiba, Brazil, 3International University of Rabat, Rabat, RAB, Morocco
Presentation Documents
BACKGROUND: Hospitals are non-linear systems in which inputs and outputs are not necessarily proportional or predictable. Unpredictability is a key factor in these systems and improving their performance implies the responsiveness of the clinical staff in situations of uncertainty.
OBJECTIVES:
This study explored how medical staff combine the use of protocols and improvisation practices to deal with unpredictability when seeking efficiency in health care. The heavy pressure for innovation and creativity, means that the management of the unexpected in this kind of organization is strategic. How can the gap between rationality and improvisation practiced by medical staff seeking to keep processes reliable be addressed, while at the same time, allowing learning and the evolution of clinical practices?METHODS:
A qualitative, comparative case study was adopted, based on two non-profit Brazilian hospitals, with forty in-depth interviews from September 2019 to February 2020.RESULTS:
Our findings revealed that, although relevant, protocol-oriented clinical practices were not sufficient to deal with the constant mutations in the clinical condition of patients. These situations require the competence of medical professionals combined with effectiveness of nurses in dealing with unexpected events. The improvisations were mainly triggered in three ways: 1) procedural demands (related to infrastructural and technological gaps, scarcity of resources and interaction difficulties); 2) patient demands (owing to the patient’s clinical condition); and 3) professional demands (attempts to improve techniques). Five main managerial implications are presented for health care practice.CONCLUSIONS:
When dealing with structural, clinical and performative unpredictability, standardized procedures and improvised practices, despite obeying different logics, are interrelated in the daily life of the medical staff with better performance in health care. PRACTICAL IMPLICATIONS: We contribute to organizational practice with new dimensions of improvisation in health care that are (i) structural; (ii) clinic; and (iii) performative nature, being represented by an empirical framework.Conference/Value in Health Info
2023-05, ISPOR 2023, Boston, MA, USA
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
OP12
Topic
Clinical Outcomes, Organizational Practices
Topic Subcategory
Academic & Educational, Best Research Practices, Performance-based Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas