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A qualitative study of organisational response to national quality standards for 7-day services in English hospitals

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journal contribution
posted on 12.05.2021, 09:14 by E Sutton, Julian Bion, Russell Mannion, Janet Willars, Elizabeth Shaw, Carolyn Tarrant
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.

Funding

The study was funded by the NIHR’s HS&DR Programme, grant no 12/128/17. This article presents independent research funded by the National Institute for Health Research (NIHR)

History

Citation

BMC Health Serv Res 21, 205 (2021). https://doi.org/10.1186/s12913-021-06213-w

Author affiliation

Department of Health Sciences, University of Leicester

Version

VoR (Version of Record)

Published in

BMC Health Services Research

Volume

21

Pagination

205

Publisher

BioMed Central

issn

1472-6963

Acceptance date

24/02/2021

Copyright date

2021

Available date

12/05/2021

Language

en