Breaking the Rules for Better Care


Since 2001, ten "simple rules" proposed by the Institute of Medicine have served as guideposts for health system leadership and redesign. Recognizing a changing health care landscape in need of an updated set of guiding principles, Leadership Alliance members co-created “Ten New Rules for Radical Redesign in Health Care" in 2015.

Using these radical redesign principles as their guide, Leadership Alliance members came together on January 11-15, 2016, for the first “Breaking the Rules for Better Care” Week to ask patients, families, and staff a simple, but galvanizing question:

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

This week of "rule-breaking exploration" resulted in nearly 400 rules submitted by 24 participating Alliance organizations. Alliance member organizations then worked locally to explore whether the rules and habits surfaced by their patients and local providers could, in fact, be broken.

Breaking the Rules work continues with vigor at a national and international level as health care organizations drive toward results on the Triple Aim. Continue reading for the Leadership Alliance’s helpful list of tools, resources, and success stories to inspire you on your own improvement journey.


Breaking the Rules Resource Guide

With great thanks for Alliance member innovation and input, this Breaking the Rules Resource Guide will help your team run your own Breaking the Rules initiative.

Whether you’re part of a team, lead a department, or serve as a senior leader, we invite you to share this resource guide with your organization and lead your colleagues through this meaningful exercise.

JAMA Viewpoint "Breaking the Rules for Better Care"

Leadership Alliance network publication “Breaking the Rules for Better Care” has registered more than 40,000 online views, putting it in the top 5% most-accessed JAMA pieces in recent years. Co-written by Alliance members, this article breaks down 300+ rules gathered by member organizations over the "Breaking the Rules" Week in 2016.


WIHI: Breaking the Rules: Lessons from IHI’s Leadership Alliance

In this WIHI audio program, Leadership Alliance leaders from across North America discuss the challenges and successes discovered during “Breaking the Rules” Week at their own organizations. Listen for insight into the rules staff and patients continue to run up against, the frustrating persistence of old rules that interfere with the care experience, and how old or misinterpreted rules can be “broken” and improved.


Health Improvement Alliance Europe "Breaking the Rules for Better Care" Week

HIAE BTR 2.jpg 

Leadership Alliance principles crossed the Atlantic in March 2017 for the first Health Improvement Alliance Europe (HIAE) “Breaking the Rules for Better Care Week.”

Ten participating organizations collected and submitted more than 500 rules by means of feedback boxes in cafeterias, postcards, stickers, comment boards, staff brainstorming sessions, and an underground “guerilla campaign” covering one ward with red masking tape to illustrate rule-breaking in action.


Want to run your own "Breaking the Rules" Week? Use and share this Leadership Alliance resource guide to learn more, mobilize your team, take action, and report back on your results!