Breaking the rules: a conversation analytic study of hospice multidisciplinary team meetings

Rule-breaking occurs in healthcare settings and is typically pro-social. However, rule-breaking within a hospice setting has not been previously studied. This study investigates rule-breaking within hospice multidisciplinary team (MDT) meetings using Conversation Analysis. Eight video and audio recordings of approximately 45-minute-long MDT meetings at one UK hospice were systematically analysed to identify how staff break rules. Rule-breaking was present throughout the data and was characterised by the minimisation of accountability through collectivising pronouns, extreme formulations and laughables. These three features supported rule-breakers to voice potentially transgressive opinions and recommendations that may have provoked criticism from MDT members. Rule-breakers were therefore able to evade social and professional sanctions whilst carrying out pro-social actions that benefit hospice patients, meeting participants, as well as the organisation and progression of the meeting itself. These findings contribute to the existing understanding of rule-breaking and have implications for how institutions understand and address it.