smacc gold final when to change what to believe for slide share

What to believe?

When to change

You

1. We want to do the best for our patients.2. We want to be evidence based practitioners.

3. We want our patients to get the best diagnostics and treatments4. We want to be the sort of clinicians who champion the best care.

What do you believe?

http://lifeinthefastlane.com/ecg-library/basics/inferior-stemi/

….we don’t always know what we think we know…..

….practice is defined by belief as much as evidence….

Lignocaine for VT Betryllium for cardiac arrest

Endotracheal drug use in cardiac arrest.Large volume crystalloid for trauma resuscitation

Steroids in head injurySteroids in spinal injury

Magnesium in acute severe asthmaHypothermia for cardiac arrest.

Half of What We Taught You Is Wrong:The Problem Is We Don't Know Which

Half

We have a necessity for change

Are we good at change?

https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia

Change is slowIs this important?

Mortality without new treatment

Mort

alit

y

Time

16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum

Evidence

Mortality without new treatment

Mort

alit

y

Time

Mort

alit

y

Time

Vs. ??????

Vs.

16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum

Vs.

16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum

TXA for UK shock patients

Late adopters kill patients

Early adopters kill people

We don’t do what we are supposed to do.

We are slow to change.

Why?

http://www.ncbi.nlm.nih.gov/pubmed/17967963

ACP Journal Club March/April 2005 | Volume 142 • Number 2

ACP Journal Club March/April 2005 | Volume 142 • Number 2

….it is the customary fate of new truths to begin as

heresies….

Cognitive Dissonance

1. Change behaviour (belief)

2. Seek exceptions

3. Justify past behaviour

become motivated to change

what needs to change

make the change stick

Is our behaviour consistent?

So what can we do?

change is hard

Do I know my history.

get social

consider all technologies and

therapies

focus on patient related outcomes

final thoughts

There's only one corner of the universe you can be certain of improving, and that's your own

self.

thanks for listening