Are Rules Really Meant to Be Broken?
October 1, 2025 4 minutes read
By Gregory Freeman
Risk managers spend a lot of time and effort promoting policies and procedures meant to improve patient safety and protect the organization from liability. But is there ever a time to condone breaking those rules?
The question most often arises in a clinical setting, in which an experienced clinician thinks deviation from standard procedure is in the best interest of the patient, says Jennifer Flynn, CPHRM, risk manager with Healthcare Providers Service Organization in Fort Washington, PA. That request cannot be approved without substantial clinical judgment, she says, but the request itself should be reason to reevaluate the policy.
The more such requests for deviation arise, or reports of deviation after the fact, the more seriously the risk manager should consider revising the policy to be compatible with the recommendations of clinical leaders, she says.
“We know that managers and providers work collaboratively. When a policy and procedure is made originally, it’s done so to protect patients and to protect providers alike,” Flynn says. “Managers should have an open relationship with the providers that are working on their behalf, because they want to know about any scenario that either creates liability or could create potential harm. So having that good relationship with your staff, knowing and understanding how the policy is working or not working, is critical in not only enforcing and implementing these policies, but improving it once a policy is made.”
The risk management cycle does not stop with creating a policy or procedure, Flynn notes. The final step is ongoing as you monitor and review the policies and procedures, she says.
“If it’s on an annual basis, that’s great, but having a mechanism in place to review those matters allows you to see if they’re still working, if they’re still effective,” Flynn says. “You can make changes along the way — adjustments or improvements as needed to really have those patient safety goals in mind and to protect workers and patients alike.”
Deviations from policy procedure often happen with the best intentions, Flynn says. A nurse might know a patient well because they have been coming into the facility for a long time and wants to be nice to them, so they bend the rules about some process that might be inconvenient, she says. But clinicians should remember that such efforts may put them, and possibly the patient, at risk.
“We know providers have the best intentions for giving the best care that they can, but I think, with bending the rules or breaking the rules, there can be significant consequences for them as employees and for their patients,” she says. “A lot of healthcare systems are set up with policies and procedures so that they can have consistent outcomes. They know that everyone is attesting to understanding the rules, and healthcare systems don’t put rules in place just to have rules. They put rules in place because they’re rooted in patient safety goals and inpatient safety principles, so that each person at the facility can provide safe and ethical care.”
If the clinician deviates from an established protocol or the standard of care and a patient is harmed, a liability lawsuit or malpractice lawsuit can result, she says. “Even if it doesn’t give rise to an injury or a malpractice suit, there could still be patient dissatisfaction because you treated them differently than someone else in the practice. You can have a matter brought up against your license at the state board level, which could bring penalties or fines along with violations against your license,” Flynn says. “There can be damage to not only your reputation as a provider but also to the facility. If someone is dissatisfied and is posting something on social media, the facility might look into that and say, ‘Well, how were our rules not followed in this instance? Why was the provider not in compliance with what we’ve outlined?’ They might launch their own investigation about that.”
When found deviating from policies and procedures, clinicians often argue that they were acting in the best interest of the patient, Flynn says. But that best interest does not include stepping outside of accepted practices for any reason, she says.
“If it’s a one-time isolated incident, maybe it doesn’t lead to anything. But then the provider might say to themselves, ‘Well, I did it before, maybe I can do it again.’ So, it leads to a little bit of a slippery slope that can create a pattern of behavior,” Flynn says. “That’s not what healthcare facilities want to say to their employees.”
Bending the rules can lead to dangerous boundary violations, she says. It can start innocuously by making appointments outside of accepted hours because you want to accommodate a certain client or by revealing too much personal information to a patient or client, Flynn says. It might include communicating with them outside of accepted channels.
“We always warn providers about the risk of friending on social media, especially if there is still a patient-provider relationship there that can lead to allegations against you if the relationship were to sour,” Flynn says. “You might be wanting to ask yourself why you are doing this and then remind yourself of your policies and procedures that will bring you back to center so that you can maintain a healthy professional relationship with your patients and clients.”
Greg Freeman has worked with Clinican.com and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Clinician.com products. In addition to his work with Clinician.com, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Source
- Jennifer Flynn, CPHRM, Risk Manager, Healthcare Providers Service Organization, Fort Washington, PA. Telephone: (215) 773-4513. Email: [email protected].
Risk managers spend a lot of time and effort promoting policies and procedures meant to improve patient safety and protect the organization from liability. But is there ever a time to condone breaking those rules?
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