Does Knowing Something, Do Anything?

L&D ward of the 1850s

The year was 1847; the place, Vienna Austria.  Many women were dying of “the fever” (infection) after childbirth … but mostly only if their baby was delivered by the doctor, rather than the midwife.    Dr. Ignaz Simmelweis figured out the reason, decades before Louis Pasteur and Robert Koch deduced germ theory.  Turns out the midwives washed their hands between deliveries, the docs didn’t. Nice.

simmelweis portrait ca 1857

For the last 150 years the medical profession has known that washing hands, vigorously and often, saves lives.  Yet plenty of observational studies in hospitals today reveal we doctors (and other healthcare personnel) don’t wash our hands as frequently as we should (i.e., prior to and immediately after touching a patient or bedside equipment).   For more information, read the recent series of articles in the Atlanta Journal-Constitution (AJC), “Hospital infections: deadly, preventable“.  Or if you prefer: Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009 Dec;73(4):305-15.

“I know how to fix that!” you say, “… just educate the docs to do it!”  Well, we’ve been educated about it for 150 years.  We humans (even altruistically minded, warm-hearted healthcare workers) don’t always behave according to “what we know”.  How many times have you run the yellow traffic light, when you “know” you shouldn’t?  How many times have you left your coffee on the kitchen counter, when you ‘knew” you wanted to drink it in the car?  How many times have you skipped your morning exercise, despite “knowing” how important it is to you?

sick of taking the blame for your shennanigans

In the realm of human behavior (and medical leadership, for that matter), this is referred to as “the knowing-doing gap”.  We imperfect humans, even smart, highly-motivated doctors, need help doing everything the patient needs, 100% of the time.   That’s the beauty of “systems-thinking”.


knowing doing gap, cover of book

You see, when hospitals increase the number of hand-washing stations, place alcohol foam outside every room, make available hand-lotion to prevent dry skin, and nurture an authentic culture of patient safety (all systems-thinking), patient infection rates fall dramatically.  Forward thinking institutions such as The LeapFrog Group routinely rank Kaiser Permanente hospitals tops in the country for all sorts of reasons, including lower rates of hospital acquired infections.

Systems-thinking works in ambulatory care too.  We have screen pop-ups in our electronic medical record (KP HealthConnect) to notify doctor and patient about needed preventive care, medication monitoring, or attention to a particular condition, even when that’s not necessarily why the patient came to the office today.  We also have a rich culture of patient safety – we train and practice the many techniques of “highly reliable teams”, with great results for patients.

mind the gap

I’m a lifelong advocate for education and a lifelong learner.  That’s why I know education has its limitations in optimizing human behavior inside an integrated delivery system. It pays to design healthcare knowing that human beings need workflows and information technology to cover their back, enabling optimally effective and safe care.

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