The dark side of standardisation: when is it safer to 'work around' a protocol?
For many years, standardisation has been regarded as the cornerstone of improving healthcare safety by increasing reliability and reducing variation. Yet, variation in the delivery of healthcare remains high and there are questions around the extent to which unquestioning application of standards supports safe care.
Safety II theory views healthcare as a complex system with safety being regarded as the ability to succeed in varying conditions. At the heart of this theory lies the assumption that variation is not inherently risky, and that complex systems actually rely on adaptations in response to varying conditions to work effectively. This PhD aims to understand how and in what circumstance a flexible approach to safety management supports safety.
A scoping review will be used to identify when, why, and what type of standards are commonly worked around within healthcare. A focused ethnography within a range of different healthcare settings will then be conducted to observe adherence to or deviation from specified standards. These data will be used to inform a series of stakeholder workshops, aiming to gain a consensus around what are acceptable adaptations (workarounds) and in what circumstances these adaptations to the specified standards can be safely applied. The adapted standard (with workarounds) will then be tested against the exemplar standards in a simulated environment, to explore the impact of workarounds on pre-determined outcomes such as efficiency, teamwork, and safety.
Clark, D., Lawton, R., Baxter, R., Sheard, L., O’Hara, J. (2023) Do nurses work around safety standards and should we be worried? A scoping review. Submitted as a poster presentation to RCN International Research Conference. Manchester.