Things that survive, survive

Sometimes a passage in a book keeps coming back to me. When this happens I reflect on how it might be connected to other ideas or events. Such is the case with the book This Explains Everything. In this book edited by John Brockman, many writers, thinkers, and scientists have provided essays, responding to the question “What is your favorite deep, elegant, or beautiful explanation?” Susan Blackmore suggests that Darwin and Alfred Russel Wallace offer such an explanation in the saying of “things that survive survive”. As we know, not everything survives and competition is fierce. In health care organizations are bought, they go out of business when the owner retires, and in many ways cease to exist. Other organizations survive, at least for a while. What is elegant about the saying “things that survive survive” is the idea that what allows an organization to survive today is not what it needs to survive tomorrow. The rules will change, by the survival of those that make it through to today.

It is so simple, yet very complex. We want to take a deep breath and relax a minute; we just won the race and made it across the finish line. But we can't relax, the race is still going only now with just the winners of the first event. A book that has a similar message, except for individuals, is What Got You Here Won't Get You There, by Goldsmith. As a professional you used certain skills and talents to achieve your current role, but you need other skills to tackle the next one. This seems exhausting and defeating. However it doesn't have to be that way. The answer is to keep learning.

Another essay in the book edited by Brockman is written by Brain Eno and talks about the elegance of the ideas that determinism isn't predictable and humans are not good at intuiting the outcome of predictable rules. If I bring these two essays together I see that survival in the next race requires us to avoid working with our “gut feelings” and instead collect and process data. Our past experience will likely lead us astray; we have to be thoughtful and analytical. A small change in the rules, due to the survival of some organizations, throws off the outcomes. The next set of winners won't rely on what was true in the past, instead they will be diligent and pay attention to today.

Bombs in Boston - Rehearsing to improve outcomes

When tragedy strikes, such as the bombs that exploded in Boston this week, my heart aches for the families and victims. I am also proud and appreciative of the medical response, especially with so much chaos following the destruction. The people working the marathon, as well as the knowledgeable participants and supporters, knew what to do and executed it very well. They were trained, and it made all the difference.

I have been drawn back to the Power of Habit at least ten times in the last few weeks. This book keeps popping up in conversations and in my thoughts. Just like it popped up when I was watching the first-responders in Boston. The emergency response was rehearsed. Not that they knew this day and event would happen, yet they were rehearsed. Just like the professional soccer player who becomes one with the field and knows just where to fire the ball to reach an open teammate, the scene was assessed and triage performed to provide the greatest good to the greatest number. Having a habit of safety, delivering high-quality care requires rehearsal. As professionals we have to rehearse responses so they become memorized by our brains and muscles, allowing us the time to identify the nuanced differences and respond accordingly. I don't think we rehearse enough.

Organizations are usually good at writing policies and procedures. Often we will have books or electronic files full of information on what to do if something unexpected happens. I have written many of these. They are well intended and usually correct, at the time they are written. Then they sit unused, and often not reviewed. For some policies this is probably fine. I am reminded of a HIPAA policy that addresses a situation not likely to ever happen, such as ophthalmology records needed for national security reasons. That being said, other occurrences are not a rare. Rehearsing the response can improve the outcome for patients.

Here are some situations that medical practices could rehearse and by doing so will improve responses; transfer of care, slip and fall, medical emergency (seizure, diabetic reaction, fainting, stroke, chest pain, etc.), and weather-related problems (tornado warning, power failure). Instead of just talking through the situation, rehearse the solution. Let your muscles and neurons learn what to do so your brain is free to understand the differences and make adjustments. I saw focus and clarity in the faces of the first responders; they knew what to do and made it happen.

Currently I am reading This Explains Everything edited by John Brockman. An essay by Seirian Sumner was right on point for this discussion. Cooperation and helping behavior is “beautiful and simple”. We want to help and it is done best when practiced.