Improving the value of healthcare to those we serve requires us to examine not only the quality delivered but also the associated cost. Since quality and cost are interdependent and occasionally at odds with each other, managing the dynamic between the two is essential. Utilizing and practicing evidence-based medicine delivers proven enhanced quality outcomes. Thus, many experts believe focusing on quality will inherently decrease costs.
However valid this logic sounds, obtaining proof is challenging, but essential. Accordingly, a recent study in Health Affairs by Fremont, et al., One in Five Fewer Heart Attacks: Impact, Savings, and Sustainability in San Diego County Collaborative substantiated that practicing evidence-based medicine decreased the number of acute myocardial (heart attacks) and lowered costs. As it stands one in four deaths in the US every year are related to heart disease.
Furthermore, when we begin to witness the value created by evidence-based medicine, clarity of purpose is achieved. So, how do we improve this uptake of newer learnings? Is it purely educational or are there behaviors or habits in play?
The science of habits plays a vital role in any behavioral change. Charles Duhigg in his book The Power of Habit, postulates a continuous loop; a cue which leads to a routine, followed by a reward, then has us seeking the cue. In medicine, our cue is the presentation of a complaint; our routine is delving into our mind to seek our historical knowledge and experiences and our reward is (hopefully) a positive outcome.
In this cycle, the cue and reward can remain the same, but the routine must change. However, if evidence shows improved outcomes, the reward changes, we do not routinely visualize our patient within the context of the new evidence, as it is difficult to change behaviors when we will not necessarily observe the change in that one individual.
For us to change, we first must show that evidence-based medicine drives value, and not just improves quality. Then education must occur, and finally “re-learning” requirements must happen. In this latter phase lies the concept of habits. Newer learning techniques incorporates these concepts.
Since the problem we are attempting to solve is complex, oversimplifying the answer will merely lead to disappointment. Let us first embrace the support evidence-based medicine delivers. Then, let us remember the importance of affecting our behavior and habits. If we do this, not only will we provide increased value to those we serve, we will also enhance the joy of our vocations. We are inherent learners and drivers of health improvement. No better combination for success exists.