Breaking the Rules for Better Care
December 13, 2017
Orlando, FL
Amar ShahAmelia BrooksSaranya Loehrer
Agenda
Background on
Breaking the
Rules Initiative
Generating
Rules to Break
Results and
Collective
Action
Generating a
Plan for Your
Organization
Who We Are
Saranya Loehrer
Institute for Healthcare Improvement
Head of the North America Region
Amelia Brooks
Institute for Healthcare ImprovementDirector, Patient Safety & Europe Region
Amar Shah
East London NHS Foundation TrustAssociate Medical Director (Quality) & Consultant Forensic Psychiatrist
New Rules for Radical RedesignChange the balance of power: Co-produce health and wellbeing in partnership with patients, families, and communities.
Standardize what makes sense: Standardize what is possible to reduce unnecessary variation and increase the time
available for individualized care.
Customize to the individual: Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of
what matters to the person in addition to “What’s the matter?”
Promote wellbeing: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require
health care.
Create joy in work: Cultivate and mobilize the pride and joy of the health care workforce.
Make it easy: Continually reduce waste and all non-value-added requirements and activities for patients, families, and
clinicians.
Move knowledge, not people: Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits
and institutional stays. Meet people where they are, literally.
Collaborate and cooperate: Recognize that the health care system is embedded in a network that extends beyond traditional walls.
Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
Assume abundance: Use all the assets that can help to optimize the social, economic, and physical environment, especially those
brought by patients, families, and communities.
Return the money: Return the money from health care savings to other public and private purposes.
“Breaking the Rules for Better Care” Week 2016
January 11 – 15 was
our inaugural “Breaking
the Rules for Better Care”
Week
24 participating
organizations
375 rules submitted
Exercise
Reflect on the following: If
you could break or change
any rule in service of a
better care experience for
patients or staff, what
would it be?
Write it down on a post-it
note
Get ready to share with
your table mates
Key Themes
1. Rules related to policies and regulation
2. Rules related to patient and family experience
3. Rules related to workflow and processes
4. Rules related to staff experience
5. Rules related to culture and mindset
From Collection to Action
Rule Type Rule Category Response
Rules that need
clarity
Regulation myths or
an opportunity to tie
the rationale back to
the rule
Debunk
organizational myths
or hear directly from
entities to clarify
Rules that need
redesign
Administrative
prerogative or habits
User-centered design
Rule breaking
mentors
Rules that need
advocacy
Real regulation or
policies
Collective voice
Rules that Need Clarity
Christina Heide, Senior Advisor for HIPAA Policy, Office
for Civil Rights, attended our May 4 workgroup call and
gave us clarity around HIPAA related rules.
Rules that Need Redesign
Engaged rule breaking mentors within the
Alliance who had successfully broken rules
that other members were keen to break
Rules that Require Advocacy
Alliance members met with CMS and requested
specific actions for improvement in the areas of
measurement, EHRs and the SNF 3 day rule
Top Lessons Learned
• Embrace and encourage a change in mindset
• Seek input from patients whenever possible
• Keep it simple and inclusive- one clear question for all stakeholders
• Make sure you are engaging staff at all levels of the organization
• Agree to a process in advance re: how you will review and prioritize the rules
• Commit to a follow-up communications plan
• Don’t be afraid to start small (one team, one unit, etc.)
HIAE Principles from Year 1
• Accept and encourage messiness
• Share assets and ideas – be solution focused
• Be energising and fun
• Leave with stronger relationships
• All teach, all learn – wealth of perspectives
“Breaking the Rules for Better Care” Week 2017
March 27-31 was our
inaugural “Breaking the
Rules for Better Care”
Week
10 participating
organizations
Over 550 rules submitted
Participating Organisations
• Belfast Health and Social Care Trust
• East London NHS Foundation Trust
• NHS Ayrshire & Arran
• NHS Highland
• NHS Improvement
• Northern Health and Social Care Trust
• PAQS (Plateforme pour l'Amélioration continue de la Qualité des soins et de la Sécurité des patients)
• Royal Free London NHS Foundation Trust
• Scottish Ambulance Service
• Scottish Government
Good idea to try or
adopt more widely:
Examples from Palm ward: “Ward business card”
Playing music on the ward
“Now we’ve got your attention we want you to let us know over the next couple of weeks what kind of rules you’d like to see stopped in the Trust…”
Suggestion boxes
Dedicated telephone line to
leave a voicemail with
your idea
Electronic suggestion box
Or… Visit the travelling video booth!
Record a short film telling us what you’d like to see swept away.
Hundreds of ideas were submitted…These were collated and
scored by a panel of judges. All the ideas were also
shared with staff to vote on…
Key Themes
1. Rules related to policies and regulation
2. Rules related to patient and family experience
3. Rules related to workflow and processes
4. Rules related to staff experience
5. Rules related to culture and mindset
Exercise
Now that you have identified
a rule that could be broken
in order to improve care,
how would you go about
breaking that rule?
Think about how you could
use PDSA to test breaking
the rule and changing the
system
Get ready to share!
Going Global
• IHI Leadership Alliance & Health Improvement
Alliance Europe
• Global Breaking the Rules Week in 2018
• Open to all: individuals, teams, organisations,
regions, countries and continents
• The power of our collective voice…
Thank you and we hope to hear from you…[email protected]@ihi.org