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Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in the UK

Published in:
BMJ Open

Kriznik N. M., Lamé G., Dixon-Woods M., (2019), Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region. BMJ Open. doi: 10.1136/bmjopen-2019-031771


Why it matters

Standardisation can seem like a common-sense way to deal with challenges in healthcare. It offers the potential to improve efficiency, reduce variation, and remove uncertainty. But standards comes with their own set of challenges.

When a regional health system in the UK wanted to improve its line-labelling processes, standardisation seemed like a natural solution. Lines are ubiquitous medical devices like intravenous infusions, feeding tubes, and catheters that allow patients to receive food and medication or drain substances from the body. They are so commonly used that people may have a number of lines in close proximity. Because they are inconsistently labelled, the risk of confusion, infection, and errors may be increased.

Some health systems have tried to reduce the potential for error by standardising how lines are labelled. In the absence of a nationwide policy, one UK regional health system launched its own line-labelling policy.

This case study examines the design and implementation of that policy, seeking to better understand how standardisation occurs through sociotechnical processes in healthcare, and to inform similar improvement efforts in the future.

Our approach

For this single case study, we took an in-depth look at how this particular line-labelling policy was created and rolled out.

We interviewed policymakers involved in the working group that designed the standards, as well as frontline NHS staff who were directly involved in implementing them at three hospitals. We also analysed documents related to the policy.

What we found

  • Though the working group believed that line-labelling standards were the obvious answer to the problem, others were less convinced that standardisation was the solution, and some didn’t even think there was a problem that needed solving.
  • Little prototyping and piloting were done before the labelling system was rolled out. And so some issues – like the quality and stickiness of the new labels – weren’t discovered until after implementation.
  • Not all managers were behind the policy, and so not all of them ensured the policy was implemented in their organisation or adequately supported staff to implement it.
  • The project illustrates that new standards are not implemented in a vacuum. They have to fit with pre-existing systems, norms, behaviours, and established practices.

Related content from our open-access series, Elements of Improving Quality and Safety in Healthcare

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