The Creepiest Rule

A deficiency during a survey. An accident involving a resident. An employee committing a terrible wrong.

What do all of these dreadful things have in common?

They usually end in a new rule and set you on the path to rule creep: it’s that knee-jerk reaction that involves addressing negative situations with a new policy, process or form. I call it rule creep.

Come on…you know you have been guilty of it!

It starts out innocently.

You are required to write a plan of correction.  You want to address a glitch that should never happen again. You need to address a staff member’s mistake.

Before you know it you have more policies and procedures than employees and more forms than residents.

Exceptional Cases Make Bad Rules

bike_fall-1-300x204Often I see rules that were put into place because of a single incident.

In a presentation I did last year for LeadingAge CT, I shared my “sticky, gooey story.” It’s my tale of preparing to compete in a triathlon. When I signed up for the race I didn’t even know how to swim, but I had lots of determination.

I practiced swimming twice a day. I was running. I was biking.  Then one day while riding my bike it happened…in my eagerness to track my exact time as I was riding, I was setting my timer with one hand and hit the brakes with the other one. (I should say brake, as in one brake.)

I went right over the handlebars and landed on my head and shoulder.  Luckily I was fine (and gained a tough looking scar that I like to make up stories about).

But I always think if the rules of engagement for aging services applied to my life I would definitely not be riding a bike anymore.

An interdisciplinary team would deem me unsafe to ride. Someone would surely say, “We were lucky this time; we can’t take that chance again.”

My dream of participating in a triathlon would be over and there’s a really good chance that my bicycling friends would have their rights to ride stripped too.

Don’t believe it?

Think about the last major incident or accident that occurred in your community or home.  Chances are it resulted in some sort of rule that affected lots of people. Most of them probably weren’t even involved with the original issue.

A resident falls down outside and gets injured? Residents now have to be accompanied by a staff member if they are outside.  A deficiency is given involving a resident volunteer? Residents can no longer volunteer. Sadly, these are both true stories.

In my bike story, really all I needed was to be taught the basic knowledge of how to ride a bike downhill (with an iPhone in one hand). Yes, that’s pathetic, but true. An individualized approach to my situation would reveal this fact.

In his fantastic article, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist, Dr. Donald M. Berwick makes the case that truly patient-centered care would require a radical shift for most and would come up against some hard pushback. He says:

I can imagine just as easily as my critics can a crazy patient request—one so clearly unreasonable that it is time to say, “No.” A purely foolish, crazy, or venal patient “want” should be declined. But my wife, a lawyer, told me long ago the aphorism in her field: “Hard cases make bad law.” So it is in medicine: “Exceptional cases make bad rules.” You do not successfully rebut my plea for extreme patient- centeredness by telling me that, on rare occasions, we ought to say, “No.” I say, “Your ‘rare occasions’ make for very bad rules for the usual occasions.”

Is Rule Creep Creeping Up on You?

Are you making rules for the usual occasions based on your rare occasions?

Here are some signs that rule creep may be taking over your organization:

  • An incident that occurred years ago is still driving a policy or process.
  • It’s been a long time (maybe you can’t remember how long) since you looked at the rules, procedures or forms in your organization to see what you can get rid of.
  • It’s been so long since that rule was put in place that you don’t even know what the edict is supposed to be addressing.

Obviously rules are necessary, but too many and you run the risk of stifling staff’s creativity and initiative.

You also increase the likelihood that residents will be treated as author Beth Baker describes, like “generic old people.” It’s all too easy to start to see them as a single entity, when nothing could be farther from the truth.

Each resident is an individual, with individual needs, wants, hopes, fears, and yes, perhaps even individualized rules.

Take a look at your community’s own policies and procedures. Which are based in common sense and which were constructed out of fear?  Which are absolutely necessary and which were created as a knee-jerk reaction to a one time situation?

I want my bike back.