IHI Leadership Alliance: Breaking the Rules for Better Care

​​“You broke the rules for us, and it made all the difference.”

This statement, made by a family member recalling how a nurse “broke” a hospital rule regarding visitation so that a new mom and her baby were able to visit one another inspired an idea. It got members of the IHI Leadership Alliance thinking: How many rules do we currently have in place that were likely created with the best of intentions but don’t benefit patients, families, or staff?

So they decided to ask. In January 2016, leaders from 24 Leadership Alliance organizations asked a simple, but galvanizing question to patients, families, providers, and staff:

“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?”

The question sparked a movement. And now…

In 2018, Breaking the Rules Goes Global

More than 240 organizations from 21 countries participated in a global Breaking the Rules for Better Care week on February 26–March 2, 2018.

Organizations could tailor their participation in Breaking the Rules Week to fit their needs — a day, a week, on a unit or department, or throughout the entire organization.

Host Your Own Breaking the Rules for Better Care Week


What happened in response to the simple question back in January 2016?

Within a week, Alliance members collected 400 proposed rules. They then reviewed the rules surfaced within their organizations to determine a course of action. They found that many of the rules submitted were either habits (i.e., not actual rules) or that they were issues well under their control to change.


In 2017, 10 members of the IHI Health Improvement Alliance Europe conducted their own Breaking the Rules for Better Care week, amassing 500 proposed rules by means of feedback boxes in cafeterias, postcards, stickers, comment boards, and staff brainstorming sessions. One organization even ran an underground “guerilla campaign,” covering its hallways and doorways with red masking tape to illustrate “breaking the rules” in action.