From: A realistic evaluation: the case of protocol-based care
What works | New ways of working: standardised care approaches that supported the development of new services such as nurse and/or midwife led care were consistently used. |
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 | New roles: standardised care approaches that enabled the extension of nursing roles tended to be used. |
 | Location and visibility: standardised care approaches that are readily available and are highly visible are more likely to be used. |
 | Incentives: standardised care approaches linked to financial rewards were consistently used. |
 | Buy-in: generally when the whole team (multi/uni-disciplinary) has been actively involved in the development of a standardised care approach it tends to be used. |
 | Making a difference: standardised care approaches that practitioners perceived as making difference to their practice and patients were used. |
For whom | Mainly nurses, midwives, and health visitors: despite existence of multi-disciplinary standardised care approaches, medical staff rarely used them (for exceptions see below). |
 | Medical staff: some junior doctors found standardised care approaches useful. General Practitioners consistently used Quality Outcomes Framework related protocols. |
 | Students, newly qualified, temporary, and new staff: standardised care approaches were perceived to be a useful heuristics to organising care for those who do not have experience (usually nurses but also medics and Allied Health Professionals). |
 | Nurses taking on new roles: standardised care approaches gave nurses confidence for delivering care autonomously (e.g., nurse/midwife-led clinics and services). |
How | Explicit use: some standardised care approaches were being used on-screen and shared with the patient -- usually as checklists or prompts. Additionally they could be useful sources of information for some staff. |
 | Implicit use: some standardised care approaches were not explicitly referred to, but their principles may guide care. |
 | Embedded in documentation: some standardised care approaches were embedded in routine documentation, sometimes replacing or complementing patient's notes. |
 | Embedded in IT systems: some standardised care approaches were part of routine systems and worked effectively as a prompt. |
In what circumstances | Nurse/midwife-led services: standardised care approaches supporting the running of nurse and midwife-led services and clinics were more likely to be used. |
 | Protection from litigation: when nurses were practising outside their traditional scope of practice standardised care approaches were consistently used because they provided a safety net. |
 | Mandatory: when the use of standardised care approaches was compulsory they were consistently used, and supported with regular audits and training. |
 | Financial reward: for outcomes of use, encouraged commitment to and use of linked protocols. |
 | Ongoing project lead: the existence of such a role seemed to facilitate active involvement of the multi-disciplinary team. The lead also enabled on-going monitoring of use. |
 | Strategic support: for the development and sustained implementation of standardised care approaches. |