Abstract
In this study, we investigate the tensions found in knowledge intensive operations: between the autonomy of professional workers (to make judgments whilst complying with independent, externally enforced standards: Lewis and Brown, 2012) and the standardized work systems that allow operations to be effective and efficient. The research is built upon an in-depth longitudinal case study that investigated the adoption of national standardized stroke care process in a UK general hospital. This study identified many tensions previously discussed in the OM literature, reinforcing the idea that the challenges of standard work must be understood via multi-level tensions lens and any implementation mechanism must also be multi-faceted and dynamic. Detailed observation of pathway implementation confirms the vital influence of professional autonomy on flow and we show how not considering this in the process design and implementation mechanism is contested. Our analysis reveals novel insights regarding the improvisation of professionals in managing tensions and supporting standardized work.
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