Written by three leaders from the Institute for Healthcare Improvement — Donald Berwick, MD, president emeritus, senior fellow and former CMS administrator; Saranya Loehrer, MD, head of the North America region; and Christina Gunther-Murphy, executive director — the viewpoint details an initiative to identify and eliminate unnecessary rules. Some were originally well-intended, but outdated; some were misinterpreted and their application no longer provided value; while others were simply obstructive regulations.
To identify rules perceived as unnecessary, 24 healthcare organizations from the IHI's Leadership Alliance tapped staff and patients for their feedback during a "Breaking Rules for Better Care Week" in January 2016. They asked, "If you could break or change any rule in service of a better care experience for patients or staff, what would it be?" Across the organizations, 342 rules were identified — and a few common themes emerged.
Here are the 10 most common rules, norms and/or habits staff and patients say hospitals should break.
- Visiting hours and policies that restrict visitors' time with patients — 15 mentions
- CMS' three-day rule, which requires three consecutive days of inpatient stay for Medicare to cover skilled nursing facility care — 13 mentions
- Licensure rules that prohibit clinicians from working to the top of their license — 13 mentions
- Limited same-day appointments and direct access to physicians over the phone —10 mentions
- Long wait times for appointments, surgeries and discharges (i.e. no double booking, providing discharge schedules, etc.) —10 mentions
- HIPAA regulations and misunderstandings that lead to delays and communication issues — 8 mentions
- Lack of engagement with family members and loved ones — 6 mentions
- Unnecessary interruptions to patient sleep throughout the night — 5 mentions
- Duplicative paperwork — 5 mentions
- Infrequent patient ambulation — 5 mentions
"Healthcare leaders may be well advised to ask their clinicians, staffs and patients which habits and rules appear to be harming care without commensurate benefits and, with prudence and circumspection, to change them," the authors concluded.
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