What if breaking “rules” could actually improve health and care?
That was the question at the heart of the Silly Rules initiative, led by the Bevan Commission and Llais in partnership with the Institute for Healthcare Improvement. The initiative set out to identify and challenge any presumed, outdated, or counterproductive “rules” that get in the way of delivering high-quality care.
Launched in November, the campaign generated significant engagement, with 784 submissions from staff and members of the public. These highlighted perceived rules that don’t make sense, appear to waste time, or create barriers to providing effective, compassionate care.
We are now pleased to share the results of the national survey through our Publications Page, alongside the Executive Report Summary in Englsih and Welsh, available via the links below.
Building on this work, further outputs will follow, including a Silly Rules Toolkit and resources to support organisations to rethink how they work, remove barriers, and create a more efficient, people-focused health and care system. An insight webinar is also planned, with details to be shared shortly.
Read the Executive Report Summary below and explore more about the Silly Rules initiative and its impact.
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 that gives voice to those who know the system best—health and social care staff, and the public.
Its purpose is to identify, challenge, and eliminate presumed or outdated rules, ways of working, policies, and processes that created frustration, inefficiency, and poor experiences across health and care settings.
At its core, the initiative focuses on 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 has proven to help free up time, reduce bureaucracy, and empower frontline staff to focus on what really mattered: people.
The initiative’s clear and measurable success led to its adoption across Europe, demonstrating its wider value and international relevance in transforming health and social care systems. It proved to be 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 the Institute for Healthcare Improvement, the Bevan Commission and Llais successfully led 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.
The Silly Rules Initiative demonstrated that better care starts with asking a simple question: “Why do we do it this way?”
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
