Cooperating for better care.

Don Berwick. M.D.

Tag Archives

Breaking (perceived) rules in order to improve care


Don Berwick, M.D., and the other co-authors of a JAMA piece suggest that the providers may well need to break rules to improve patient care and improve the working lives of clinicians.

This flows from the Institute for Healthcare Improvement Leadership Alliance’s hosting a “Breaking the Rules for Better Care Week.” For that matter, many participants have found that what might have seen as rigid rules  weren’t legally required to be rules at all.

Two dozen  provider participants  have identified 342 rules that had little or no clinical value to patients. The IHI then categorized those rules into three groups, summarized by FierceHealthcare below:

  1. “Habits formed by organizational behaviors, which generally have no legal, regulatory or administrative requirements. An example of this would be preventing staff from keeping bottled water at nursing stations.
  2. “Organizational rules that could be changed without impacting regulatory compliance. For instance, some may charge for parking or have restricted visiting hours.
  3. “Rules required by regulations and statutes. The most frequently cited was the “three-day rule” for patients’ access to skilled nursing facilities.

“The majority of rules identified (62%) were of the second type. Sixteen percent fell into the first group, and 22% fit the third.”

“Contrary to initial expectations, although wasteful statutory and regulatory barriers existed, the majority of obstructive and wasteful rules identified by patients and staff were fully within the administrative control of healthcare executives and managers to change,” the JAMA co-authors wrote.

To read the JAMA piece, please hit this link.

To read an analysis of the JAMA article by FierceHealthcare, please hit this link.


Contact Info

(617) 230-4965

Wellesley, Mass