All Hail the Healthcare Simpleton — Easy Interventions Produce Dramatic Improvements
Dr. James Reason, M.D., is credited with creating the heuristics for identifying the causes of error… not in healthcare, but, instead, for the airline industry. He identified and catalogued the causes of human error, and the Federal Aviation Administration took them to heart in an effort that significantly reduced the frequency of airline accidents.
Dr. Reason, however, should not be considered a great catalyst of success in an altogether different industry without taking into account Jay Forrester. Forster, the father of Systems Thinking and Systems Dynamics, identified the causes for why we tend to get precisely the opposite result from those our systems and practices are designed to produce. He recognized that small influences at the start of a process tend to promote significant consequences at the end of the process, and that this works for, both, good and ill.
In “The Tipping Point,” Malcolm Gladwell describes the efforts of the Giuliani administration in New York to combat crime – focusing on arresting turnstile jumpers and whitewashing graffiti artists. While the law and order crowd credits the eventual success in reducing New York City crime to a “zero-tolerance” posture on infractions large and petty, it appears that this relatively low cost focus on turnstile jumpers and graffiti artists achieved precisely what Jay Forrester advocated. Namely, focusing on small and seemingly insignificant leverage points early in the process to achieve dramatic outcome improvements. ["The Tipping Point" book, lecture by Gladwell at the TED on spaghetti sauce and at the 2007 New Yorker Conference on genius.]
In healthcare, our experience has been precisely the same; although, we tend to forget them with the passage of time. Specifically, we emphasize our successes in the areas of advancing medical science, hang our credibility on the complexity of the human anatomy and our treatment of it, and advertise our caring dispositions as though this were laudable because, given all this complexity and our full work schedules, we can still find the time to care.
All of this, you might imagine, accounts for the near doubling of life expectancy from 1900 to 2000. Instead, the majority of that advance had nothing to do with health care. Instead, we began to bath more regularly, brush our teeth, and wash our hands. It may be hard to believe, but simple advances in human hygiene were responsible for the most significant advances in human health.
That is why this New York Times article is so amazing. It describes the impact made by simple interventions, such as handwashing, in health-care settings, to combat central line infections and other simple steps that prevent avoidable patient harm. Healthcare is, indeed, complex, but, surely, those intelligent enough to grasp and apply its complexity are capable of remembering and using the simple solutions from our recent past.
