Standardisation and localisation in health care policy implementation

Abstract

There is a gap in the health policy literature regarding how policy or best practice guidelines might be implemented in a robust and systematic manner. In particular, there is a need for analyses that account for local contingencies coupled with the top down perspective of policy adherence in a systematic and integrated manner. In this paper we use themes of standardisation and localisation to analyse the policy implementation process. We analyse the implementation of large-scale evidence-based health care policy to understand the negotiation process required to achieve a goal of comparability across locations with adaptability to the local setting. We argue for more robust policy implementation in health, where standardisation is acknowledged and supported but there is also an imperative to accommodate local infrastructure and context. Rather than a top-down or bottom-up perspective, standardising policies need to continuously engage with, and learn from, local settings, thus forming a local universality.