Department of Health Sciences, University of Leicester, Leicester, UK.
Intensive Care Medicine, University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK.
BMC Health Serv Res. 2021 Mar 6;21(1):205. doi: 10.1186/s12913-021-06213-w.
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.
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.
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.
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.
国家标准通常被用作医疗保健的改进策略，但组织可能会以不同的方式，有时甚至是消极的方式对外部质量要求做出反应。本文从组织行为学的角度描述了英格兰的一组 NHS 医院信托机构对 7 天服务国家标准（7DS）的引入做出了怎样的反应。
我们在 8 家 NHS 信托机构中进行了 43 次半结构化访谈，访谈对象为执行/主任级别的员工和临床人员。这些信托机构在规模、地理位置和周末专科人员配备方面存在差异。我们探讨了在当地实施标准的方法，以及组织文化和当地环境对组织反应的影响。
大多数信托机构的高级管理人员都专注于实现目标并遵守标准。基于合规的反应与层级式组织文化和对外表现的关注有关。在少数信托机构中，高级管理人员描述了调动以承诺为基础的策略。在这些信托机构中，高级管理人员将外部标准重新定义为组织价值观，并采用合作策略来实现变革。采取以承诺为基础的方法的信托机构往往被描述为具有发展性的组织文化，并在整体表现方面有着较高的历史记录。针对 7DS 的审计数据显示，大多数信托机构都在标准方面取得了改进，但以承诺为重点的信托机构在 7DS 审计方面不太可能表现出改进。当信托机构因整体表现不佳或资源限制而面临压力时，它们对外部标准的反应能力就会受到限制。
国家标准和服务水平审计在不同的地方会产生不同类型的反应。在全国范围内推动改进的方法需要伴随着资源和针对改进的定制支持，同时考虑到当地环境和组织文化。
