Implications Done Right

Clean water source. Hygiene. Ebola containment.  These public health priorities and crises often seem like issues that only matter for developing countries.  Indeed, the CDC and other authorities have issued ample assurances that given the quality of our healthcare system and our very different cultural practices, the risk of an ebola outbreak in the US is very low.  That doesn't mean that we've learned our lessons.

As Aaron E. Carroll of the New York Times points out in an excellent article, Guinea worms (and ebola) aside, we are still battling issues of clean water, hygiene, and quarantine in the US.  And we pay for not learning such lessons with illnesses, deaths, and high costs.  As he writes:

The Centers for Disease Control and Prevention estimates that 48 million Americans become ill from food-borne illnesses each year. More than 125,000 hospitalizations are caused by food-borne illness, and about 3,000 deaths. Many, if not most, of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food correctly. 

Between 1976 and 2007, deaths from influenza ranged from 3,000 to 49,000 a year. The vast majority of deaths from influenza occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are still mainstays of flu care. But we also have a vaccine for this illness. Too few people get it. It’s estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70 percent, up from the 45 percent we achieved, we could have prevented an additional 4.4 million illnesses and 30,000 hospitalizations.

Carroll connects global health crises with your health and deftly demonstrates the importance of persuasive communication as well as practicing what we preach.  We know what the answers are and we need to be compelled into putting them into practice.  Lives and dollars are at stake.

Counter Culture

Contrary to what my summers at the Center for Talented Youths may suggest, I was not a gifted science student.  Labs made me especially nervous because they put my knowledge to test amidst combustibles and corrosives.  But all that changed in Professor Paul Baures’ Organic Chemistry II Lab.  He was unflappably patient when we asked questions we should have learned in lecture, and unfailingly kind whenever we drained the wrong layer, knocked solutions over, or broke yet another pipette.  Professor Baures created a culture where instead of diluting solutions with water to ‘look right,’ we felt safe and encouraged to work until we got it right.  I even went on to be an orgo lab assistant*. 

(Goggle Gang, 2007.  One of my favorite pictures.)

I hope you have felt the magic of a Professor Baures.  They demonstrate how much setting the right tone and culture matters.  It’s no surprise that positive work cultures are associated with better outcomes.  In the hospital context, that means fewer adverse events and medication errors.  But does that mean we’re all doomed if we don’t have a Professor Baures in our workplaces and hospitals? 

Not quite.  Professor Baureses are rare, precious things.  But public health has figured out interventions that can be implemented on a systemic level to change workplace culture.  These cultural interventions recognize that it’s often not enough to just have a good solution; solutions need to be accepted by the team using them.  The Comprehensive Unit-based Safety Program (CUSP) at Johns Hopkins is one example.  It involves training staff in the science of safety, a lot of talking about safety, learning from defects, and adding tools for improvement.  All this may sound common sensible and maybe even too touchy-feely for the workplace, but the results are astounding.  At Johns Hopkins hospital, bloodstream infections in many ICUs dropped 90% over 18 months after CUSP implementation.  When the program was replicated across the state of Michigan, it reduced hospital deaths by 10%. 

The effectiveness of this CUSP intervention has a few good lessons for public health.  We don’t always do what we ought to do, and when we mess up, it can be hard to speak up and learn from the mistakes.  Public health once again succeeds by focusing not on the individual, but the bigger picture.  By building a culture of safety, interventions like CUSP change the norm of what we should do; the rules become easier to follow when everyone follows them.  With the system in place, every workplace can feel safe and conducive to effective workers, whether you have a Professor Baures on hand or not.   

*Actual conversation I had as lab TA: “Is aluminum chloride corrosive?” “Well, does it burn?”  “Sort of.”  “Wash your hands more often, James.”