Breaking the rules: understanding non-compliance with policies and guidelines.

Healthcare staff in the National Health Service are expected to comply with and keep up to date with numerous policies covering every aspect of their daily work. The National Institute for Health and Clinical Excellence (NICE) has guidelines on a huge number of clinical issues ranging from how to treat breast cancer to how to insert a central venous catheter. 2 Other guidelines are generated by external bodies such as the royal colleges and professional bodies, the General Medical Council, or the Care Quality Commission and reflect the external regulatory framework in which healthcare operates. The NHS Litigation Authority requires trusts to have clinical governance and risk assessment policies in order to get a discount on their insurance contributions. Additionally, many guidelines are locally generated and cover routine activities and the management of different types of risk. Although policies and guidelines are important, the large number of guidelines and many different sources make it impossible for staff to comply with all of them. Information overload