Policies provide structure and guardrails in high-stakes industries, ensuring operations run smoothly and efficiently. But sometimes, rigid adherence to policies leads to absurd or harmful outcomes. Consider the check-in line at the airport; we all know that the rule is that everyone must start at the end of the line and wait their turn. Yet, when folks run late, often due to no fault of their own, most of us are kind enough to let them hop in front. We all know the rules, but we bend the rules when appropriate.
In healthcare, policies are designed to standardize care, ensure safety, and reduce errors. But as Brad Spellberg, MD noted in his recent JAMA article, "The Policy to Override Policies—One Policy to Rule Them All," rigid adherence to rules can sometimes harm the very patients they aim to protect. It’s time to consider a new approach that trusts frontline workers to make real-time decisions for the greater good, just as some of the most successful organizations outside healthcare do.
Policies aren’t one-size-fits-all
Rules are comforting. They create predictability, structure, and fairness in systems that can otherwise descend into chaos. Yet, as anyone who’s worked in a dynamic field knows, no rule can anticipate every possible scenario. Successful organizations understand that flexibility is critical in industries where human needs are central.
Consider the Ritz-Carlton hotel chain, where employees are empowered to override rules to delight their guests. Housekeepers, bellhops, and all other staff are encouraged to spend up to $2,000 to solve customer problems without asking a manager. The implicit trust in these employees underscores the Ritz-Carlton’s dedication to customer satisfaction and loyalty. This empowerment model begs the question: why aren’t healthcare workers, arguably some of the most dedicated, caring, and well-trained professionals, afforded the same latitude to do what’s right?
Exclusive hotel chains don’t have a monopoly on employee empowerment. Airlines often allow their staff to make on-the-spot decisions, such as upgrading passengers or offering perks, to rectify service lapses. Retailer Nordstrom built its brand around a flexible return policy that trusts employees to prioritize customer happiness over rigid rules.
These businesses recognize that empowering employees to act in the moment fosters loyalty, improves outcomes, and builds trust. However, healthcare, which operates in a far more complex and emotionally charged environment, still struggles to give its workers similar authority to bypass harmful or nonsensical policies.
Why healthcare needs a “policy to override policies”
Dr. Spellberg shared vivid examples of how rigid policies harm patients. Consider the patient in dire need of surgery who was denied care because they didn’t have identification—a policy designed to prevent administrative errors, not to turn away victims of mugging. Or the patient who lives alone and couldn’t schedule a medically necessary procedure because hospital rules required someone to physically escort them home. In both cases, the policies—however well-intentioned—became barriers to care, only overcome after frustrating escalations to senior leadership.
Such examples are not anomalies. Healthcare is filled with policies that, when inflexibly applied, exacerbate patient harm instead of mitigating it. For frontline workers who understand these stakes better than anyone, such scenarios can be demoralizing and deeply frustrating. When policy adherence conflicts with their professional judgment or moral compass, workers face impossible choices: follow the rules or do what’s right. The latter often means taking personal or professional risks, while the former can lead to patient harm.
The lesson from other industries is clear: empowering staff to act in exceptional circumstances isn’t about undermining policies—it’s about ensuring they achieve their intended purpose. A “Policy to Override Policies,” as implemented by Dr. Spellberg’s hospital, Los Angeles General Medical Center, is a pragmatic way to ensure that policies don’t inadvertently cause harm.
A culture of empowerment in healthcare
What would such a policy look like in healthcare? It starts with clear guidelines. Staff must have both a reasonable belief that overriding a policy serves the best interest of the patient or the staff, and their rationale must be documented. Oversight mechanisms ensure these exceptions are monitored and used responsibly.
For instance, during end-of-life care for a patient in isolation, family members may wish to hold their loved one's hand, but policy restricts direct contact without full protective gear. Staff facilitate safe contact by providing appropriate protective measures, allowing the family to say goodbye in time. These sorts of decisions wouldn’t be made lightly, but the point is that frontline staff—those closest to the patient—are often best positioned to make them.
This isn’t a call for chaos or an abandonment of structure. Instead, it’s about creating a framework where staff feel trusted to use their judgment, knowing that leadership has their back. The Ritz-Carlton leadership team doesn’t empower employees because the executives enjoy breaking rules; they do so because it’s good for business. In healthcare, the stakes are even higher: empowering workers isn’t just good for business—it’s good for patients and those who care for them.
Empowerment and the fight against moral injury
Empowering healthcare workers isn’t just about logistics; it’s also about addressing the emotional toll of their work. Increasingly, clinicians are facing what’s known as moral injury—the psychological distress that arises when they’re forced to act against their deeply held values due to institutional constraints. A rigid policy that prevents a clinician from helping a patient in need isn’t just an operational failure; it’s a betrayal of their moral obligation to care.
Moral injury contributes to burnout, a crisis already devastating healthcare workforces worldwide. By creating a “Policy to Override Policies,” organizations send a clear message to their workers: we trust you to do the right thing. This trust alleviates moral injury and empowers clinicians to re-engage with their work, knowing they can advocate for their patients without fear of reprisal.
The ripple effects are profound. When workers feel supported, they’re more likely to go above and beyond for their patients. Morale improves, turnover decreases, and patient outcomes get better. As Dr. Spellberg notes in the article, simply knowing they have the authority to act can reduce the need for policy overrides altogether.
Balancing lawfulness with compassion
As healthcare leaders, the challenge is clear: how can we create systems that uphold the integrity of our policies while empowering our staff to address the nuances of real-world care? The answer lies in balance. A “Policy to Override Policies” offers a pragmatic framework that trusts clinicians to act in their patients’ best interests while maintaining accountability and oversight.
Other industries have already shown the way. It’s time for healthcare to follow suit—not because it’s easy or risk-free, but because it’s necessary. In a system where many decisions have life-or-death consequences, we must trust the dedicated individuals who’ve committed their lives to making those decisions.
Healthcare workers don’t need more rules; they need more trust. By giving them the freedom to do what’s right, we honor their expertise, protect their well-being, and ultimately ensure better outcomes for the patients they serve.