Are there things you do every day because it’s how you’ve always done them? Author Seth Godin beautifully illustrates this point in a podcast where he describes why some changes take decades to become widespread.
He starts with a story dating back to 1847 when a Hungarian physician named Ignaz Semmelweis proposed the practice of hand washing when delivering babies in the clinic. The amazing part of this story is that it took more than 20 years for the scientific community to prove this theory to be correct and for other doctors to accept it as standard practice.
This interesting piece of history defines the term neophobia, or the fear of something new. Are there are evolutionary reasons for neophobia? Norweigan rats, it turns out, are very resistant to trying any new foods because humans have gotten much more clever with rat poison. On the other hand, a rat who is neophilic (likes to try new things) isn’t going to live too long and will not pass on any protective genes to the next generation of rats. So a majority of the population is genetically wired to see new ideas just like a Norweigan rat sees new foods, with skepticism and a reluctance to change from “what I’ve always done,” even when the data is clear and scientifically sound.
Godin’s podcast drives home the same point as the recently published book Ending Medical Reversal: Improving Outcomes, Saving Lives by Cifu and Prasad. The authors describe numerous gold standard practices that have been reversed and some that are still being practiced today to the detriment of quality patient care; knee arthroscopy and spinal surgery to name two examples from the book.
We see the same phenomenon in the world pediatric emergency care where doctors, nurses and paramedics are performing complex math problems right in the middle of an already messy situation, aka the pediatric code.
Here’s what will allow health care providers to improve the care they give to sick and injured children:
- Focus on provider confidence is critical
- Recognition that provider confidence and ability to control the situation are of paramount importance
- Train providers to initiate care once they know the age of the child
- Similar to what is done for adults
- The requirement to measure a child with a length based tape reduces the ability to gain the required confidence prior to arrival.
- Remove all mathematical equations
- Requiring math while treating critically ill child has been scientifically proven to be frought with errors
- This can only be accomplished with 100% customization of medications and equipment
- Require real time verification of all medications
- Ensure real time electronic documentation
- Integrate electronic charting into the pre-hospital or emergency department’s electronic health record
These are all things we are doing today at Handtevy as we recognize that the treatment of critically ill children is not a simple problem to solve, it’s complicated.
The one thing we do know is that the “way it’s always been done” isn’t working and the data proves this to be true. The AHA published data in 2015 that states that outcomes from out of hospital pediatric arrest haven’t changed since the 1980’s.
Hand washing for health care professionals is now an expectation but it took decades to change practice. We’ve waited over 4 decades and haven’t seen a change in pediatric outcomes. It’s time to become a neophile!