Judging the use of clinical protocols by fellow professionals

The objective of this study was to investigate the judgements of British do ctors, nurses and midwives about behaviour which complies with a protocol, violates a protocol, or constitutes an improvisation where no protocol exis ts. Primary data were collected on the judgments of hospital healthcare pro fessionals (N = 310) from three specialties in each of three hospitals. Res pondents were required to judge the appropriateness of the behaviour of a f ellow professional in each of nine hypothetical scenarios generated on the basis of previous focus group discussions. They were also asked how likely they would be to report this professional to a senior member of staff Withi n the scenarios, both behaviour with respect to the relevant clinical proto col and outcome for the patient were experimentally manipulated. Data were collected using a survey questionnaire. The three professional groups studi ed (doctors, nurses and midwives) were found to make significantly differen t judgements. Crucially, doctors judged the violation of a protocol as less inappropriate than did nurses or midwives. Midwives were disapproving of v iolations, even when the patient outcome was good. These differences were r eflected in the ratings of reporting likelihood. The proliferation of clini cal protocols likely to occur in Britain in the coming years will need to b e managed with great care if the regulation of clinical behaviour is the go al. Particular care will be needed to avoid the exacerbation of professiona l tensions. (C) 2000 Elsevier Science Ltd. All rights reserved.