The High-Order Bit

The high-order bit of infection control, research, life:  "If you really look at the ones that ended up being successful..., often times it's the ones that are successful who loved what they did, so they could persevere when it got really tough. And the ones that didn't love it, quit. Because they're sane, right? Who would put up with this stuff if you don't love it? So it's a lot of hard work and it's a lot of worrying constantly. If you don't love it, you're going to fail." -Steve Jobs

 

h/t Richard Savel

The user experience

I was going to start this post by explaining how busy I’ve been, why I haven’t posted in a while, blah, blah, blah. Then I realized I would undercut that immediately by revealing that I’ve just finished reading Walter Isaacson’s biography of Steve Jobs. I read it on an iPad, of course, so didn’t realize it was over 600 pages long until I had finished it and saw it on display at a Detroit airport bookstore yesterday.

I highly recommend it. I enjoyed learning more of the story behind the personal computer revolution that still seems so recent to me (I vividly recall using the Commodore 64, and then the Mac, both of which were released while I was in college). But I mostly marveled at the fierce vision (and meanness) of Jobs, and how he was still able to motivate people and channel this vision into so many great products.

Does it contain any lessons for healthcare epidemiologists and infection preventionists? I hesitate now, because I hate facile comparisons of other industries with healthcare delivery (yes, I understand that we can learn lessons from the airline industry or FedEx, but I’ll be more receptive when FedEx starts delivery packages that arrive at their drop-boxes with multiple co-morbidities, or when Delta can fly me from Boston to Moline without a missed connection due to multiple small system failures—explaining why I was browsing Detroit airport bookstores yesterday afternoon). I was taken, though, with Jobs's laser-like focus on “end-to-end integration”, and maintaining control of the entire user experience (hardware, software, and content):

“His quest for perfection led to his compulsion for Apple to have end-to-end control of every product that it made…This ability to integrate hardware and software and content into one unified system enabled him to impose simplicity”

Simplicity means that users can actually enjoy, and benefit from, the products in an easy and intuitive way. While digital enthusiasts and computer geeks might want malleable open systems, most of us just want to be able to download that cool song we heard yesterday onto our music player without using too much profanity in front of our kids.

Meanwhile, the U.S. healthcare system might be the least integrated “system” in the world. Hence the “user experience”, to borrow one of Steve Jobs's favorite phrases, “truly sucks.” Having just navigated an elderly family member’s transition through acute care, assisted living, skilled care, and home again, I can honestly say that having some inside knowledge of the system doesn’t help much—it still sucks. Many patient safety initiatives, including infection prevention initiatives, are akin to software patches, temporary fixes to problems that wouldn’t exist if we had a truly integrated system—integrated not around RVUs, profits or operating margins, but around the patients’ simple goal: to get better, and not to be harmed in the process.

iPad as a metaphor for the future of infection prevention

I've been doing a lot of thinking lately. This is perhaps because I'm between jobs and have some occasional downtime but it's more likely the result of not actually owning a computer these past two weeks, unless you count my phone. What I've been thinking about is why I ended up in hospital epidemiology in the first place. I mean, who, in their right mind, would choose to go into a profession that is under appreciated, under funded and lacks the proper scientific data to make rational clinical decisions. I could go on, and I'd be happy to if you meet me at the local pub...

What keeps sticking in my head is how little we've advanced since Semmelweis described the benefits of hand disinfection. For one, we're still doing quasi-experimental studies, although Semmelweis's design was at least controlled (midwives). It also seems that most of our contentious debates, including those around active detection and isolation, would be unnecessary if we'd followed his advice and had 100% hand hygiene. As for recent advances, the CLABSI checklist popularized by Peter Pronovost is probably the most important. Why was this advance made by someone who wasn't an ID physician or hospital epidemiologist? I think it's because as a profession we're stuck. Perhaps more clinical trials will advance things, but I have this suspicion we'll just end up proving what we already know - where will the advancement come from?

So, what does this have to do with the iPad? I just came across this article by Daniel Eran Dilger on how Steve Jobs utilizes creative destruction to change the world. The article is a little tech heavy and perhaps Apple biased, but I don't think that detracts from it's main points which I believe have relevance for a potential 'new' future for infection prevention. Dilger's main points are: (1) "Jobs understands death as a creative force better than most people. For society, culture, and technology to progress, old thinking has to die off to make way for fresh new ideas. People who don’t die are dragged kicking and screaming in the future..." and more importantly (2) "When something works, you don’t need to kill it. But in some cases you should."

So what does this mean for infection prevention and what should be "killed off"? I don't know. It's only been two weeks! However, I think we need to discuss what old ideas we are unnecessarily holding on to and we shouldn't back away from killing off things that work. Yes this is easier said than done and is perhaps a useless exercise. I'm just one guy, I don't even own a computer and I'm not even sure I know what a metaphor is.