The social life of chemotherapy protocols in a UK cancer network

Abstract

Aims and objectives: This paper explores the development of chemotherapy protocols in a UK NHS cancer network, using data from a study of a Macmillan-funded cancer network pharmacist post. Setting: A UK NHS cancer network. Method: Qualitative case study drawing mainly on interviews with stakeholders. Key findings: The paper outlines the importance of protocols in addressing problems associated with service variability in cancer networks. It explores the development of a set of network-level chemotherapy protocols co-ordinated by a network pharmacist. The work to establish common protocols is seen in light of the congruent and conflicting agendas of constituent organisations. The potential for protocols to embody organisational interests is considered in the context of the network's particular political landscape. Whereas protocols could represent the interests of the network organisation, the latter also offered a bureaucratic process through which protocols might transcend their specific organisational origins. This depended on the democratic engagement of locality (hospital trust) specialist and generalist pharmacists in the network-level enterprise. The need for protocols to convince as network and locality documents entailed an ongoing process of negotiation, particularly around the extent to which documents could acknowledge and incorporate local practices. Conclusion: The development of chemotherapy protocols in the cancer network was outlined as a complex and ongoing process, requiring collaborative work from a range of stakeholders. We note the relevance of Timmermans and Berg's analysis of the 'local' and 'universal' dimensions of protocols. The development process, co-ordinated by the network pharmacist, involved the negotiation of these two aspects with the aim of achieving standardisation in local contexts. Network structures and the network pharmacist served to promote a dialogue between local and universal domains. This enabled the network to embody local interests, while also encouraging adoption of an 'extralocal' perspective by locality stakeholders.