Protocol-based care: impact on roles and service delivery*.

Area of Science:

• Healthcare Management
• Nursing Practice
• Health Services Research

Background:

• Protocol-based care (PBC) aims to standardize healthcare delivery.
• Its impact on nursing roles and service efficiency requires evaluation.

Purpose of the Study:

• To assess how protocol-based care influences nursing roles, practice, and service delivery.
• To understand the factors affecting the implementation and perception of PBC.

Main Methods:

• A qualitative case study using realistic evaluation methodology.
• Data collected via observation, interviews (nurses, patients, key informants), patient journey tracking, and document review.
• Study involved 141 participants across five diverse healthcare settings.

Main Results:

• PBC implementation was inconsistent, influenced by context, professional, and individual factors.
• Nurses adopted new skills (prescribing, diagnosing) and increased autonomy, running services independently.
• Concerns about a 'tick box mentality' and restricted judgment were noted, alongside reduced doctor workload.

Conclusions:

• The potential of PBC for standardization is limited by patchy use and negative perceptions.
• PBC can enhance nurses' roles and autonomy, positively impacting service delivery.