Breaking the Silly Rules for Better Care
What if breaking ‘rules’ could actually improve health and care?
That’s exactly what the ‘Silly Rules’ initiative—led by the Bevan Commission in partnership with Llais and the Institute for Healthcare Improvement—is all about. We’re on a mission to identify and challenge the unnecessary, outdated, and counterproductive ‘rules’ that get in the way of delivering great care.
Since launching the campaign last November, we’ve received 784 submissions from staff and the public highlighting the ‘rules’ that don’t make sense, waste time, or feel counterproductive.
We’ll be sharing the results of the survey very soon, along with exciting opportunities to rethink how we work, remove the barriers, and create a more efficient, people-focused health and care system.
What is the ‘Silly Rules’ Initiative?
Originally developed by the Institute for Healthcare Improvement (IHI), the Silly Rules Initiative is a bold and empowering campaign designed to give voice to those who know the system best—health and social care staff, and the public.
Its purpose? To identify, challenge, and eliminate unnecessary or outdated rules, ways of working, policies, and processes that create frustration, inefficiency, and poor experiences across health and care settings.
At its core, the initiative is about removing barriers to deliver better care—faster, smarter, and with more compassion. By shining a light on the ‘silly rules’ that get in the way of good care, the campaign aims to free up time, reduce bureaucracy, and empower frontline staff to focus on what really matters: people.
Due to its clear and measurable success, the Silly Rules Initiative is being adopted across Europe, demonstrating its wider value and international relevance in transforming health and social care systems. It’s a simple yet powerful tool for cultural change, sparking meaningful conversations, encouraging critical thinking, and driving practical improvements from the ground up.
In partnership with Llais and the Institute for Healthcare Improvement, the Bevan Commission is proud to lead this work in Wales—capturing real stories and insights from those on the front line, and turning them into actionable solutions for a more efficient, people-centred health and care system.
Because better care starts by asking a simple question: “Why do we do it this way?”
Resources
Guides
Health Organisation Guide – English
Health Organisation Guide – Welsh
Social Care Organisation Guide – English
Social Care Organisation Guide – Welsh
Public Information Pack – English
Public Information Pack – Welsh
Posters
Examples of Silly Rules
Rules that need
Clarity
Myths and habits that are perceived as rules but aren’t actually policies. These can be clarified by debunking myths, tying rationale back to the rules, and seeking clarification from the entities responsible.
“We must have three signatures for every order, even for small purchases.”
Rules that need
Redesign
Administrative rules that we, as leaders, have the power to change. These rules can be revised by engaging with colleagues and professional associations to tackle similar challenges.
“Staff must fax documents instead of emailing them, even when emails are faster and more secure.”
Rules that need
Advocacy
Rules that are in place due to regulations or policies beyond organisational control. By using collective advocacy, these rules can be addressed with the appropriate entities for change.
“Healthcare professionals are required to fill out a specific form for every patient visit, even though the information is already captured digitally.”
How Silly Rules Are Changed
1. Survey of Silly Rules
Staff and patients submit their ‘silly rules’ through our survey, sharing any unnecessary rules or practices that may hinder care delivery or staff efficiency.
2. Collation of Feedback
The Bevan Commission gathers all the feedback, sorting and categorising the rules into actionable themes.
3. Feedback to Organisations
The compiled feedback is then shared with relevant health and care organisations, allowing them to review the rules and understand how they affect their services.
4. Review of Rules
Health and care organisations assess the rules, determining which ones need clarification, redesign, or advocacy for regulatory changes.
5. Implementation
Finally, health and care organisations work on implementing the changes to improve care processes and eliminate unnecessary bureaucratic barriers.
Watch Don Berwick’s Masterclass on Silly Rules
