physician using a screen in the emergency room

The International “Break the Rules for Better Care” Week ran this year from Feb 13-17. This is an initiative run in 20+ countries annually, coordinated by the Institute for Health Care Improvement, and it is a time to ask staff a somewhat offbeat question: “If you could break any rule in the service of a better experience for patients or your co-workers, what would it be, and why?” 

This year, all staff in the KGH ED and HDH UCC were invited to participate as a pilot study for KHSC. We advertised the program for two weeks in advance, and it was promoted by nursing and physician leaders during morning huddles and casual hallway conversations. The survey was sent out via email, and QR codes linking to the survey were posted around the department for the week. ( As an aside, this turned out to be a camaraderie builder, as younger staff were seen teaching older staff how to use QR codes :) )

The response was truly fantastic: within the first 12 hours, we had 52 responses! By the end of the week, we had 170 responses, many with multiple suggestions. These were analyzed & combined into 127 rules: 55 rules pertained to both sites; 60 to KGH & 12 to HDH.

What was instantly clear was just how deeply the ED/UCC staff care about making things better for patients, families and their colleagues. This is even more remarkable given the current clinical conditions. Even in this unprecedented state of extreme crowding, our staff remain engaged and hopeful that things can be better. 

So what was the number one rule? Drinking water at the desk rather than at hydration stations! There were 15 separate comments about this! 

Other themes that came through: 

  • rules related to patient comfort, often for our more vulnerable patients: providing extra food; spare clothes to go; extra dressing supplies; phone chargers; PJ pants; waiting room TV. 
  • processes that may interfere with efficient admission flow: report, transfer sheets
  • rules related to ergonomics: standing mats, desks, chairs, computers, bedside cart design, hallway crowding
  • rules related to building camaraderie: staff pot-lucks and break room gathering

We have lots of information to work with. Over the next month and with the support of IHI and the KHSC ED/UCC team, we will identify some easy wins and other priority rules to clarify, redesign and advocate for improvement. Some things will be too big or too hard to fix just yet, but with everyone’s input maybe we can make some things a little bit better. And that’s a start.  A truly huge thank you to all staff for sharing their ideas so honestly and for their amazing willingness to engage and hope for better. Way to go, rule breakers!