​​​​​​​For better patient care, providers must break the rules

Regulations can create a major time suck for staff in healthcare facilities, but digging a little deeper into protocols that hospitals follow rigidly could reveal that some rules are made to be broken.

That's the conclusion of Don Berwick, M.D., president emeritus of the Institute for Healthcare Improvement, and coauthors from the organization, in a Viewpoint article published in the Journal of the American Medical Association.

The administrative burden on clinicians contributes to widespread burnout. Many doctors spend more time with electronic health records and paperwork than patients, so some providers are outsourcing compliance tasks to outside groups.

So last year, the IHI's Leadership Alliance hosted a “Breaking the Rules for Better Care Week," where participating providers would circumvent rules that they felt could prevent them from offering the best care to patients. And many of the participants found that these policies weren’t legally required to be rules at all, according to Berwick, Saranya Loehrer, M.D., head of the IHI's North American Region; and Christina Gunther-Murphy, the group's executive director.

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Over the week, the 24 provider participants identified 342 rules that had little or no clinical value to patients. The IHI then categorized those rules into three groups:

  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.

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“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,” they wrote.

Many of the participating providers took action on the unneeded hurdles after the weeklong experiment, including taking steps to change policies on the local level and debunking long-held myths among staff members. Some also joined together to meet with the Centers for Medicare & Medicaid Services on issues like the three-day rule.