In his most recent New Yorker essay, Atul Gawande, M.D., examines the complex question, "Why do some innovations spread so swiftly and others so slowly?"
The first couple of pages provide some historical perspective as Gawande details the different paths the medical community carved out for anesthesia and antiseptics. The former caught on like wildfire, the latter took decades to become the norm (in the case of antiseptics and hand washing, you could argue that we are still waiting for universal acceptance).
Briefly, anesthesia first was used in October 1846 at Massachusetts General Hospital. As word of its promise in reducing patient pain spread, hospitals in the United States and Europe began using the gas for a variety of procedures. By the following June, it was being used worldwide, Gawande reports.
Antiseptics took a far different course. In 1867, Joseph Lister published an article in The Lancet detailing the benefits of carbolic acid for cleaning hands and wounds. "It was a generation before Lister's recommendations became routine and the next steps were taken toward the modern standard of asepsis — that is, entirely excluding germs from the surgical field … ," Gawande writes.
There is variety of reasons why the one concept caught on and the other didn't, which Gawande explores. The bulk of his essay looks at the modern phenomenon of death at childbirth. Across the globe, 300,000 women and more than 6 million children die annually around the time of birth.
Gawande has teamed with the World Health Organization, the Gates Foundation and Population Services International to create the BetterBirth Project. The idea is to spread best clinical practices, especially in poor countries.
Domestically, there is a different sort of movement, but one that is also aimed at care for mothers-to-be and babies, as detailed by Geri Aston in our latest Clinical Management installment. A big part of this effort is the drive to eliminate early elective deliveries. The clinical evidence is indisputable; the closer to full gestation a mother goes during pregnancy, the better it is for her and the baby. The federal Hospital Engagement Network initiative made reducing early elective deliveries a top priority in reducing patient harm.
In his New Yorker article, Gawande notes that the most common objection to the BetterBirth Project is that the solutions aren't scalable, a criticism he refutes. With early elective deliveries, the solutions are most certainly scalable. Our special report on the HRET HEN profiles efforts at Exeter Hospital and Touro Infirmary, both of which have driven their rates to zero.
It's also worth noting that the latest data from the Federal Interagency Forum on Child and Family Statistics show preterm births fell for five consecutive years. Births at fewer than 37 weeks dropped to 11.7 percent in 2011, down from 12 percent in 2010 and 12.8 percent in 2006.
"To create new norms," Gawande writes, "you have to understand people's existing norms and barriers to change. You have to understand what's getting in their way." If you watch our HEN reports, I think you'll see that these organizations are charting new behavioral patterns and rapidly adopting innovative solutions.
