Healthcare professionals often face situations where strict rules conflict with what they believe is best for patients, leading them to make thoughtful, pragmatic decisions that may go against protocol. These actions are not acts of defiance, but responses to overly complex, sometimes impractical regulations that don’t reflect real-life care. Instead of punishing such behaviour, organisations should value and learn from these insights, as they can drive meaningful improvements in healthcare.
Colouring outside the lines
A nurse in a care home is working an evening shift alone due to staff illness. She does everything she can to care for all 23 residents on her ward, until a problem arises. When administering a patient’s daily medication, she notices a pill is missing. To retrieve it, she would need to walk to the medicine cabinet on the other side of the building, leaving all 23 residents temporarily unsupervised.
So she makes a pragmatic decision. The medication is packaged in a continuous strip, which she fully unrolls. She takes the final pill, gives it to the resident, and immediately orders new supplies to prevent future shortages. A sensible solution, you might think. Yet she is reprimanded by colleagues for not following protocol.
Elsewhere, a care professional supports a patient whose motor skills are declining, causing him to spill food occasionally. According to the guidelines, he should be given adapted cutlery. However, he experiences this as humiliating, and it clearly affects his self-esteem. The caregiver chooses to give him regular cutlery instead and quietly cleans up afterwards. Sometimes, they even organise a “finger food” dinner, something the entire ward genuinely enjoys.
These are just two everyday examples of the dilemmas healthcare professionals face. Time and again, they must weigh strict adherence to rules against providing the best possible care. What do you do in such situations?
A persistent misunderstanding
A common misconception about rebelliousness is that it is mainly about defiance, as if rebels, by definition, ignore rules, oppose everything, and complain constantly. In reality, that picture is misleading. Most rebels are deeply committed to their work and strive to do it as well as possible.
In practice, they are often constrained by rules and protocols created by people who don’t do the work themselves, making processes harder to carry out. When they do deviate from the rules, it is not because they want to, but because they just see no viable alternative.
Lost in a maze of regulations
Healthcare has developed an extensive framework of quality standards, guidelines, and procedures to ensure safety. Over time, however, this framework has grown so complex that rules can contradict or even undermine one another. Many focus narrowly on a single aspect of care, while overlooking equally important considerations.
Moreover, these standards are often based on an ‘average’ patient who rarely exists in reality. This becomes especially problematic in complex or long-term care. As a result, professionals must regularly adapt or deviate from the rules to deliver care that is truly appropriate and effective.
Creativity under pressure
Healthcare professionals who think beyond the rules are often highly dedicated and guided by a strong moral compass. When faced with dilemmas, they don’t act recklessly but carefully consider their options. This often leads to creative, thoughtful solutions that prioritise patient well-being without compromising safety, as seen in the examples above.
This presents a valuable opportunity. Instead of reprimanding professionals who deviate from protocols, such moments can be seen as signals that something in the system needs improvement. By embracing this kind of ingenuity, organisations can solve problems more sustainably, improve working conditions, and keep professionals engaged and motivated.
Embracing constructive dissent
The real opportunity lies in the largely untapped potential of healthcare workers themselves. They are closest to daily practice, understand where problems arise, and often already have practical solutions. What they need is an environment where thinking differently is encouraged and safe.
Give these professionals the space to speak up. Listen to their insights. Involve them in shaping policies and procedures. Because in the end, those who challenge the system are not troublemakers, but the ones driving meaningful change and innovation.
This article was originally published in Dutch on the platform DeSpreker.nl, the best agency for booking high-quality speakers in the Netherlands.
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