10 Health Care Rules We Desperately Need to Break

10 Health Care Rules We Desperately Need to Break

Seriously, there are some things that we do in health care that are just too prescriptive. Occasionally, we get health care so wrong that we do silly things – like waking patients up to give them sleeping tablets.

Sometimes, breaking the rules is exactly what’s needed to improve patients’ experience of their care.

The Leadership Alliance (Alliance), convened by the Institute for Healthcare Improvement, consists of approximately 40 North American hospitals, associations, and other care systems committed to delivering on the promise of the “Triple Aim”

In 2016, organisations forming the Alliance asked this question of patients and staff:

“If you could break or change any rule in service of a better care experience for patients or staff, what would it be?”

Below, Berwick et al list the top 10 most frequent suggestions.

Breaking Health Care Rules to Improve Care https://ja.ma/2OZftzh

Breaking the Rules for Better Care JAMA

Break Down the Bureaucrats in 8 Steps.

Break Down the Bureaucrats in 8 Steps.

I came across these eight symptoms of bureaucratic breakdown whilst listening to The Personal MBA: Master the Art of Business by Josh Kaufman.These eight symptoms resonated with me and align almost poetically with my experiences in health care. I hope that you will find them to be of value. Does this ring true for you? Let me know what you think.Josh Kaufman attributes this to Dr Michael Sutcliffe from the University of Cambridge.

  1. The Invisible Decision – No-one knows how or where decisions are made (there is no transparency).
  2. Unfinished Business – Too many tasks are started but very few carried through to the end.
  3. Co-ordination Paralysis – Nothing can be done without checking with a host of interconnected units.
  4. Nothing New – There are no radical ideas, inventions or lateral thinking—a general lack of initiative.
  5. Pseudo-problems – Minor issues become magnified out of all proportion.
  6. Embattled Centre – The centre battles for consistency and control against local/regional units.
  7. Negative deadlines – The deadlines for work become more important than the quality of the work being done.
  8. In-tray Domination – Individuals react to inputs, that is, whatever gets put in their in-tray, as opposed to using their own initiative.

Josh states that “If any of these qualities describe your daily work experience, your team is probably suffering from a case of Communication Overhead.

The solution to communication overhead is simple – make your team as small as possible. Read more on PersonalMBA.

One of the take home messages is that beyond 8 people, each new team member requires more investment in communication than they add in productive capacity. Including them is causing more work than it is adding in benefits.

Make teams as small and autonomous as possible – “Keep teams elite and surgical” – ‘Peopleware’ by Tom DeMarco and Timothy Lister

Equally, a team of one is also not productive, as can be the case in general practice. This guides some of the philosophy behind creating pods and teamlets such as in the Patient-Centred Medical Home model.

Would love your thoughts!!