The impact of process standardization and operational failures on a clinical outcome

Purpose This study examines whether operational failures – such as missing supplies, information and equipment shortages – moderate the relationship between process standardization and outcomes that depend on the timely execution of tasks, which in our setting is hospital-acquired pressure injuries (HAPI). Design/methodology/approach We use a previously validated, multi-source dataset that links survey responses from 4,741 nurses (35% of 13,497 eligible) across 63 US hospitals with patient-level clinical audit data from the National Database of Nursing Quality Indicators, encompassing 21,965 patients in 262 nursing units from 56 hospitals, to examine how process standardization and operational failures jointly influence an important clinical outcome – hospital-acquired pressure injuries. Findings We find that process standardization is associated with lower rates of HAPI when operational failures occur frequently, likely because it helps stabilize the timely execution of preventive care routines amid operational disruptions. When operational failures are infrequent, which is indicative of a work environment that enjoys a high level of operational reliability, the marginal benefit of process standardization is smaller. Practical implications Managers should align the degree of process standardization with the prevalence of operational failures, using process standardization to stabilize unreliable environments while recognizing that its marginal benefit may diminish as operational reliability improves. Originality/value This study advances operations management theory by demonstrating that the benefits of process standardization are contingent on operational reliability.