Procedures and the professional: the case of the British NHS

The introduction of procedures to guide medical practice is a growing phenomenon in the British National Health Service. It is thought to be a useful way of managing risk, standardising practice and ensuring that research evidence is incorporated into patient care. However, the mere development and introduction of procedures does not ensure that they are actually followed. In the research reported here focus group methodology was used to investigate the perceptions and opinions of doctors, nurses, midwives and health service managers. Twenty-four focus groups were convened across three hospitals, with discussion focusing on the purpose, development and implementation of clinical protocols. The effect of proceduralisation on professional autonomy and on the working relationships among professional groups also emerged as important themes. The paper concludes that successful implementation of protocols or guidelines in the NHS depends on achieving the right balance between standardising practice and allowing professionals to use clinical judgement. Successful implementation of clinical guidelines also requires that the culture of the health service and the beliefs, attitudes and norms of its employees are taken into account.