Tightrope Walking: Standardisation Meets Local Work-Practice in a Hospital

Traditionally, uniform and standardised IT-solutions in health care are considered mechanisms for increased control, efficiency and quality. Unfortunately, in spite of existing studies of the actual experiences of standardisation, such as how they come into being, and how they are intertwined with local practice, unreasonable belief in standardisation seems to prevail. Acknowledging the origin of standardisation and its local character, however, does not mean that standardisation is futile or should be avoided. It rather means that standardisation efforts should balance the management level’s need for increased coordination and control, and the local level’s need for flexibility. The aim of this paper is to strike this balance as it elaborates the implications and the ‘costs’ for local practice in order to make a standard work. Empirically, the paper draws on a standardisation effort of discharge letter production in the University Hospital of Northern Norway.