Situated Standardization in Hematology and Oncology Care
Situated Standardization in Hematology and Oncology Care
After discussing the value of experimentally scrutinizing patients’ compliance to treatment regimes, this chapter turns to the study of clinicians’ compliance to standards. Following a similar rhetorical structure as the compliance debate on the actions of patients, the low adherence rates of healthcare professionals to clinical guidelines is often seen as highly problematic by health scientists and policy makers. However, as in the debate on patient adherence, the common ‘solutions’ to improve the success rate of implementation initiatives tend to leave the epistemological status of aggregated medical knowledge untouched. Such initiatives are caught up in a dichotomy of universal clinical knowledge and particular patient characteristics, which is not a productive rendering of the problems encountered in clinical practice. To explore a different notion of standardization, this chapter explores the experimental interventions in a healthcare improvement project at a hematology/oncology outpatient clinic. This project articulates the value of situated standardization for both clinical practice and for the integrated pathway movement, rather than following the above-mentioned extremes of striving for full rationalization of medical practice, or of celebrating complexity that boycotts standardization.
Keywords: Standardization, Situated standardization, Niche standardization, Care pathways, Integrated care pathways, Hematology, Oncology
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