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

Background on Breaking the Rules

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

Rule Breakers

Generating Rules to Break

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

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.)

Stretch…

Health Improvement Alliance Europe

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

Red tape spotted around ELFT!

“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…

Staff voted for their favourite idea via an online form…

We’re now breaking the rules at ELFT!

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…sloehrer@ihi.orgabrooks@ihi.org