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1. Introduction
Healthcare organizations face increasing pressure to improve their operations (Radnor et al., 2012). This explains the growing interest in applying industrial and business management concepts to patient care (Young et al., 2004). As a result, management techniques originating in manufacturing have begun to spread throughout the healthcare sector (Kaissi, 2012; Daultani et al., 2015). One major example of this is process management in the form of, for example, total quality management (TQM), lean and six sigma. A commonality of these approaches is that they pursue standardization in the sense of reducing variation whenever possible as a function of operational improvement. Generally, standardization is about ensuring that important elements of a process are performed the same way every time. This brings order and consistency to processes by introducing repeatable fixed patterns. A lack of consistency can cause the process to generate defects and to compromise safety (Timmermans and Epstein, 2010). Standardization also provides predictability, which allows the process owners to prevent problems before they can affect the customer. Standardization can be applied to all parts of production, including the input, the transformation and the output (Sorensen and Iedema, 2011).
The most familiar form of standardization in healthcare is evidence-based medicine (EBM) (Jasti and Kodali, 2015; Adriaenssens et al., 2018). EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Timmermans and Mauck, 2005). The general goal of EBM is to improve quality and safety by standardizing medical care (Romana, 2006). EBM is typically implemented through clinical guidelines, protocols, clinical pathways and best practices, all of which are used to standardize patient care. However, while EBM addresses improvements in clinical performance, one might wonder whether this automatically improves operational performance (Van Vliet et al., 2011). Conversely, there is little evidence that the standardization pursued in process management approaches does in fact lead to better clinical performance (Roemeling et al., 2017). In this paper, we therefore make a distinction between clinical practice standardization (CPS) and operational process standardization (OPS).
We define “clinical practice standardization” (CPS) as the development and implementation of clinical guidelines through protocols and procedures that are used in the treatment of patients by healthcare providers in...