I just sat through Atul Gawande's APIC keynote speech. I was expecting to be inspired and amazed. What I wasn't expecting was Deb Yokoe. Dr Gawande spent the first 30 minutes pacing the stage and discussing the day he followed Dr. Yokoe and her team around the Brigham. He described her as a smiling, occasionally giggling with dimples and tennis shoe wearing hospital epidemiologist. It must have been a very busy day as I think he mentioned 7-8 outbreaks she was dealing with at the time including tularemia and a frozen strawberry foodborne outbreak. Having worked with Dr Yokoe as a fellow in a research capacity, I have always appreciated her work and felt she never got enough credit for her contributions. It is very nice to see that changing.
A particularly touching part of the hospital tour with Dr Yokoe was when Gawande described the staff flowing in and out of the ICU rooms and realizing that this was far different than the controlled OR environment and then he realized one of the MRSA isolated patients was his own and that he might have given MRSA to the patient. He got his biggest applause when he quoted Deb as saying "I don't want to be an infection control cop.". Gawande agreed with her and spent some time discussing the importance of team work and getting infection control out of the police business. Well, he has every right to be hopeful. An important effort made at the Brigham that others should consider copying is that infection control is now a rotation for medical students. I suspect it isn't mandatory, but it is a start.
My favorite part of the talk, apart from his discussions of the surgical checklists that were highlighted in his latest book, was when he was asked a question about mandates. He described that in any advance there are early adopters, medium adopters and late adopters. He then added in a class of people called exceptionalists, people who say they are different or their hospitals are too different to do things like clabsi checklists. His point was that there is a time when mandates are needed but the key variable is the timing. One must wait to mandate until after the early adopters are on board and worked out all of the implementation details. Any mandate that comes too early, alienates these early adopters and hurts implementation. Food for thought.