Tag Archives: medicine

Dimensions of Medical Altruism

Medical altruism is virtue professionalism suffering and global health

Medical altruism is usually considered a virtue that is critical to defining a physician’s moral character. However, one of its more noticeable manifestations is behavioral, reflecting compassion, responsibility, and a sense of moral obligation. Indeed, medical altruism translates into a commitment by health care providers to use their power, position, privilege, and knowledge in the best interests of others, even at great personal cost and varying degrees of effacement of self-interest. Therefore, medical altruism represents physicians’ spoken and often unspoken commitment to act selflessly for their patients’ well-being, regardless of potentially conflicting professional duties, even at the expense of personal gain, safety, or well-being.

American philosophers Pellegrino and Thomasma thus argued that beneficent altruism was morally obligatory for physicians, placing it at the root of a “virtuous” physician’s character. “No one can make the conscientious professional do what she thinks is not in the interests of the patient or client,” they write, and “The physician of character will…reliably be expected to exhibit the virtues of fidelity to trust and effacement of self-interest.”

Other manifestations of medical altruism might have their roots in a person’s psychological profile. In part, this is because medical altruism is almost always viewed as being individual-centered, and therefore, potentially at the core of a physician’s personal identity. For example, some physicians’ altruistic behaviors are linked to their heartfelt desire to relieve suffering. This is reflected by physician and bioethicist Eric Cassell’s (1928-2021) belief that “The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick.” Dr. Cassell viewed suffering as a primarily subjective experience, describing it as “the state of severe distress associated with events that threaten the intactness of the person.”

A slightly different perspective was presented by Daniel Sulmasy, who is well known for his writings about the connection between spirituality and medicine. He argued to reaffirm Sir William Osler’s declaration that medicine was a calling, not a business. Dr. Sulmasy is a physician and philosopher who once lived as a Franciscan friar. Focusing on a physician’s character, he suggests that altruism is a virtue easily threatened by a malfunctioning or flawed medico-industrial complex. He warns that unsound training environments and the stress/realities of day-to-day medical business practices can potentially erode altruistic ideals.

Richard and Sylvia Cruess argue that if medicine is a profession, then medical altruism is a professional duty. They believe altruism is at the core of the physician-patient contract and a centerpiece of the social contract between physicians and society: “Based on the literature, society’s expectations of medicine are the services of the healer, assured competence, altruistic service, morality and integrity, accountability, transparency, objective advice, and promotion of the public good.” According to this position, physicians have a professional obligation to engage in altruistic behaviors, the degrees of which can be hotly debated. Additionally, medical institutions and health care policies should promote and support altruism from a systems perspective because altruism is both expected and contractually anticipated by society-at-large.

This brief discussion of the various dimensions of medical altruism would be incomplete without acknowledging the work of recently defunct physician and anthropologist Paul Farmer (1959-2022). Dr. Farmer supported Article 25 of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care….” He expanded upon patient-focused boundaries of medical altruism by proposing that health care providers be individual caregivers but also advocates in the battle to overcome social inequalities.

Pellegrino, ED and Thomasma DC. The virtues of medical practice. Oxford University Press, 1993.
Cassell, E. J. 1982. “The Nature of Suffering and the Goals of Medicine.” N Engl J Med 306 (11): 639–45.
Sulmasy, Daniel P. (1993). What’s so special about medicine? Theoretical Medicine and Bioethics 14 (1):379-380.
Cruess SR. Professionalism and medicine’s social contract with society. Clin Orthop Relat Res. 2006 Aug; 449:170-6.
Farmer, P. Pathologies of power: Health, human rights, and the new war on the poor. University of California Press, 2003.

Medical Altruism: It’s not simple

The concept of medical altruism, which is central to health care delivery and both patient and physician well-being, is extraordinarily complex. Filled with nuance and interconnected layers, even its definition is problematic. Usually understood as a dynamic, context-dependent virtue, medical altruism can be viewed as a commitment by medical providers (physicians, nurses, and other providers) to use their power, position, privilege, and knowledge in the best interests of others (their patients) even at personal cost and varying degrees of effacement of self-interest. Seen in this light, medical altruism includes in its essence altruism (“other-regarding,” as coined by nineteenth-century French philosopher August Comte), and the morally obligatory trait of altruistic beneficence (as described by American ethicists Edmund Pellegrino and David Thomasma), which goes beyond the principles of benevolence (wishing others well) and nonmaleficence (not doing others harm).

Regardless of whether medical altruism is approached from a philosophical, psychological, theological, evolutionary, professional, or cultural perspective, it must be distinguished from the concept of altruism in medicine. While medical altruism is individual and profession-centered, altruism in medicine is viewed as a commitment of the health care collective, including its professional organizations, institutions, economics, sociocultural environment, populations, and political systems to address healthcare based on altruistic rather than egoistic or self-centered values. Altruism in medicine, therefore, might also apply to selfless patient-originated decisions to donate blood, stem cells, organs, and other tissues, as well as healthcare provider-originated decisions to volunteer for humanitarian activities, combat global inequities, or share knowledge, time, and experience in degrees that are above and beyond what is expected of their professional duties and, in the case of physicians, their social contract with society.

Further complicating discussions of medical altruism and altruism in medicine is the rapidly changing face of medical practice and health care environments. There are obvious tensions regarding the value and sustainability of selfless motivation, just as there are significant vulnerabilities and systemic weaknesses of existing health care institution-based frameworks and societal policies regarding professionalism and what constitutes ethical medical practice in a technology-driven, soon to be AI-dominated twenty-first century. These and other elements relating to altruism will be the focus of several future reflections on Colt’s Corner. Please subscribe and share.

Pellegrino, ED and Thomasma DC. The virtues of medical practice. Oxford University Press, 1993.
Creuss SR and Creuss RL. Professionalism and Medicine’s social contract with society. Virtual Mentor 2004;6(4):185-188.

Are you a Hedgehog or a Fox?

Hedgehogs and foxes sho general versus specialist knowledge

The philosopher Isaiah Berlin structured one of his most famous essays about the literary masterpiece, War and Peace, by Russian author Leo Tolstoy, on a quote from the Greek poet Archilochus (640-685 BCE): “The fox knows many things, but the hedgehog knows one big thing.” Berlin essentially described a dichotomy of thought, practice, and philosophy, contrasting “hedgehogs,” who might view the world through a single unifying idea, and “foxes,” who thrive on adaptability and their breadth of knowledge and experience.

Berlin argued that Tolstoy, like Shakespeare, Pushkin, and Michel de Montaigne, was a fox who drew on history and experience in formulating his vision of life, but ultimately wished he could be a hedgehog, who, like Plato, Dante, or Dostoyevsky, could view the world through the lens of a single overriding idea. Berlin succeeded in presenting these two very different and opposable approaches to life without favoring one over the other.

Since its publication in 1951, however, philosophers, psychologists, business professionals, educators, political leaders, and scientists have ferociously debated the metaphor of the hedgehog and the fox. For example, just a few years ago, author David Epstein reflected on differences between hedgehogs and foxes in his best-selling book, Range: why generalists triumph in a specialist’s world, writing that hedgehogs (specialists) “tend to see simple, deterministic rules of cause and effect framed by their area of expertise…whereas “foxes (generalists) understand that most cause-and-effect relationships are probabilistic, not deterministic,” arguing the benefits of breadth and diverse experience in a world that incentivizes hyperspecialization.

Medical education, and much of medical practice, is at a crossroads regarding the contrast between specialists and generalists. The fox-like health care provider values breadth, adaptability, and creative problem-solving. Applied to medical education, the fox embodies the need for diverse strands of knowledge, interdisciplinary collaboration, systems thinking, synthesis, and integrating humanities training into medical curricula. The hedgehog approach, however, has dominated traditional medical training to cultivate depth of knowledge, expertise, technical skill, and precise systematic thinking within a well-defined framework to understand and competently manage disease processes.

In my opinion, our challenge is to cultivate “hedgehogs who can think like foxes.” Ambiguity and doubt must not be viewed as weaknesses but as manifestations of our humanity. While alternate ways of thinking about pathophysiology, diagnosis, therapeutics, technology, and scientific discovery must always be considered, a firm and concise direction for each must ultimately be chosen, especially in fields where results are quantifiable and judged on evidence-based results.

Our goal, therefore, is to be deeply grounded in scientific knowledge and understanding as well as to be both rigorous and flexible in thought and medical practice. Knowing the general distinction between hedgehogs and foxes, and recognizing which of these two approaches we align with most naturally during our lifelong journey through a rapidly evolving medical landscape, is an essential step to greater self-awareness.

Isaiah Berlin. The Hedgehog and the Fox: An essay on Tolstoy’s View of History. OceanofPDF.com., Princeton University Press. First published, 1951.
David Epstein. Range: Why generalists triumph in a specialized world. Riverhead books. New York, 2019.

Vulnerability and Resilience

At a recent pulmonary conference hosted by Sharp Healthcare in San Diego, I had the opportunity to discuss vulnerability and resilience issues in healthcare. One of my goals was to raise awareness about the tragedy of suicide among physicians and other healthcare professionals. Recent studies have shown that suicides are on the rise, and that among female physicians, for example, rates exceed those from among the general population. Registered nurses and health care support workers also have higher suicide rates compared to non-healthcare workers (16 versus 12.6 per 100,000 persons) in the United States.

Health care providers, especially in high-stress environments and situations, face the risk of emotional exhaustion, moral distress, and burnout. One recent study, for example, showed that at least sixty percent of healthcare professionals feel burned out, costing the US healthcare system more than four billion dollars annually. As we learned during the COVID pandemic, health care systems are also vulnerable to factors such as economic stress, supply-chain disruption, and dwindling resources that can adversely impact their employees’ well-being.

My point, of course, is not the financial burden of this tragedy, but the cause. Vulnerability in healthcare workers’ health is linked for the most part to structural and cultural factors in the medical profession. Long hours, administrative burdens, emotional distress, and the stigma that prevents healthcare workers from seeking professional psychological support are just a few of the factors that contribute to increased risks of burnout, depression, and professional dissatisfaction. Not surprisingly, these might easily overwhelm one’s personal resilience (defined as the ability to cope with and recover from suffering, often in the face of adversity).

The interconnectedness of resilience and vulnerability underscores the importance of institutional and professional societal structures to strengthen individual coping resources and address systemic contributors that hamper a health care worker’s well-being. It is time that we address these issues explicitly, in journals and national meetings, as well as locally in our medical schools and health care institutions. I am hopeful that, in a collaborative spirit of concern, care, and compassion that extends beyond the patient care arena, the current “younger” generation of health care professionals will give greater value to resilience-building and vulnerability acknowledgment than their predecessors.

Jain L et al. Suicide in Healthcare Workers: An Umbrella Review of Prevalence, Causes, and Preventive Strategies. J Prim Care Community Health. 2024 Jan-Dec;15.
West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences, and solutions. J Intern Med. 2018 Jun;283(6):516-529. Epub 2018 Mar 24. PMID: 29505159.

On friendship and sudden loss

Henri Colt and Yann Vagh musicians and friendship

Like many physicians, my life was surrounded by death, and my professional ambitions were dedicated to postponing its arrival at my patients’ bedside. Yet, when death appeared, I spent hours in its presence, sometimes in silence, sometimes to comfort, and other times rebelliously fighting against its ultimate outcome.

Grief was a constant companion, but not only as a manifestation of humanity. A patient’s death, I thought, was a loss that raised many questions. Could I have done something more, were the right technologies employed, was my care appropriately guided by my desire to offer surgical expertise in the glove of loving kindness. My own grief was almost always accompanied by a degree of self-doubt, professional considerations, and spiritual contemplation that sometimes dominated my emotional state.

When we lose a friend, lover, parent, child, sibling, or any sentient being with whom we are close, especially one whose life we’ve shared for many years in one way or another, there is no alternative to grief. All the more, when a death is sudden, shocking, or unexpected. In the beginning, the numbness caused by such sorrow feels irremediable. Whether by physical separation or rifts in our spiritual being, the separation caused by death is experienced like a dis-appearance, or as the Canadian poet, Anne Carson, might say, a profound absence that disrupts time and memory.

The death of a loved one, therefore, is like a tearing of one’s soul…the French word for it is déchirure. Pronounced deh-shee-RRHEWR, the word’s lingering third syllable is difficult to pronounce. The ‘ru’ is a rough, guttural ‘R’ sound, whereas the final ‘re’ evaporates into space only after a final flow of air is gently expulsed from between the speaker’s lips. The word stops itself. Like death, it is definitive and persistent.

It seems grief is the price of survival. But though it wounds, it also teaches us to love more fully, and to recognize that manifestations of our affections are fleeting gifts, not permanent possessions. We thus learn to cherish each day, and to acknowledge how the departed’s absence is really a transformation, an unbreakable integration of the other into our thoughts, memories, and hearts.

Shortly after learning of Yann’s death, I took a walk through the cemetery of Montmartre, near where I was living, in Paris. The next day, I strolled among the graves in Montparnasse and meditated in the shadow of the mausoleum of a musician we both held dear. I ventured then to the cemetery of Père Lachaise, not looking for the place where my friend’s ashes rest, but for the memory of a moment shared more than fifty years ago.

A memory without words.

Value of courageous and unselfish leadership

doctor displays unselfish support and leadership on mountaintop

Organizations everywhere risk struggling with internal conflicts or resistance to change, lack of transparency, unclear identity and vision, self-serving or ego-driven decision-making, and flawed groupthink. These issues can steer societies away from their goals to provide benefits to their collectives and the communities they serve. Hence, they jeopardize the organization’s future and may irreversibly harm the organization’s reputation.

What applies to other organizations and society at large also applies to bronchology and interventional pulmonology (IP) associations around the world. The IP culture built around technical innovation, science, ethical practice, and unselfish assistance to patients everywhere has evolved favorably over time, but this has not been without facing many challenges.

To cite one example of overcoming internal resistance to change (there are many others), the culture dates from an era when forward-thinking, independent but often self-reliant practitioners were dismissively labeled as “cowboys” by colleagues who were less inclined toward new interventional approaches. For many years, a few leaders had to dedicate significant time and effort to demonstrate the safety and value of their procedures, and to survive academically within more conservative academic medical establishments. Using “show and tell” lectures and retrospective studies – prospective and randomized studies would come later – they proved that certain interventions significantly improved clinical outcomes, quality of life, and patient survival. Gradually, they overcame resistance from colleagues, skeptical referring physicians, other specialists wary of competition, hospital administrators, and members of pulmonary societies who were, at their worst, obstructionists.

Similar resistance was faced by those who challenged existing training methodologies. Significant energy was needed to move beyond the outdated apprenticeship model of medical education to more modern and complementary learner-centric and patient-friendly approaches. These include using inanimate models, simulation-based training, ongoing competency and skill assessments, checklists, faculty development programs, multidimensional curricula structured according to individualized needs assessments, a democratization of learning resources, and computer/instructor-assisted feedback methods. Today, it is universally accepted that patients must not suffer the burden of procedure-related training.

Whether in establishing the value of a technology-driven medico-surgical subspecialty or in championing a novel means for training its practitioners, history demonstrates that persistence and resilience in the face of opposition will ultimately yield rewards. Courageous and unselfish leadership may often go unnoticed, but the benefits gained by practitioners, students, and patients alike are substantial and often life-changing. Leaders who feel disenchanted by their colleagues’ apparent lack of enthusiasm should be inspired by these words from former U.S. President Ronald Reagan: “There is no limit to the amount of good you can do if you don’t care who gets the credit.”

From Novice to Expert: The Dreyfus Skill Model

Dreyfus educational skill model with its six components

The Dreyfus model of skill acquisition was proposed in 1980 and has since been used by educators to explain how learners progress from being novices to becoming experts, passing through stages of being an advanced beginner, competent, and proficient at their assigned task. The authors later added a sixth stage, that of master, to their sequential and somewhat linear progression scale.

The model is intuitively logical and appears to apply to most professional learning endeavors. It suggests that as learners progress, they move from strictly applying rules and guidelines to becoming aware of how their actions might affect and be affected by circumstances and their environment. This “intuitive perspective,” once acquired, is an important aspect of competence. With further work, training, and experience, learners develop what is referred to as “reflexive reorientation,” whereby learners are able to competently respond to changing or unexpected situations without necessarily resorting to reflective decision-making. For the most part, this defines the “expert” level of skill development.

The question is whether the Dreyfus model lends itself clearly to learning interventional pulmonology. Considering how the model stresses the importance of rules, guidelines, and intuitive experience-based decision-making, it helps educators design competency-oriented curricula and develop step-by-step knowledge and skills-related learning and testing materials. It underscores the importance of experiential knowledge and thus reinforces the complementarity of apprentice-style training with simulation-based learning.

The drawbacks, especially as regards bronchoscopy and interventional pulmonology, are based on the fact that one can reside simultaneously in different stages for different procedures, all while being perceived as an expert overall based on certification, place of practice, presumed experience, or academic titles. Furthermore, the boundaries between stages are blurred, and one may progress, regress, plateau, or skip stages depending on clinical context, the degree of technical difficulty of the procedure, or the complexity of the patient’s circumstances and medical environment. By no means, therefore, is there a linear progression universally applicable to all aspects of IP.

Considering these limitations, I wonder whether a limited certification process could be helpful for certain groups of procedures. Obviously, competency-oriented learning materials for each group would address technical, cognitive, affective, and experiential knowledge, complemented by a series of associated assessment tools, simulation-based exercises, and real-life training experiences that help determine competency and level of expertise.

The model also fails to consider individual learning differences, cultural variances, or the importance of having access to experts and masters for guidance and assistance. It ignores differences in experiential training, personality, and decision-making skills that might empower or endanger the effects of intuitive thinking and reflective reorientation, or reinforce personal biases that might hinder rather than promote professional and personal growth. I believe these elements become especially important for those aspiring to practice at the expert level.

HIV/AIDS Awareness

December was HIV/AIDS Awareness Month. It is great to celebrate our many victories over this infectious disease, but we must also remember the extent to which HIV/AIDS continues to affect our global community.

In the United States, about 1.2 million people over 13 were living with HIV in 2018. At least 14% (1 in 7 people) do not know they are infected. Black/African Americans and Hispanic/Latinx continue to be disproportionately affected, accounting for more than 50% of infections¹.

In the WHO/European Union and European economic area (53 countries in the 2018 report), the number of people diagnosed with HIV increased by 22% in the last decade. The number of people living with undiagnosed infection has also increased. Many are diagnosed late in the course of their disease, particularly in the Eastern region. While sex between men remains the prevalent mode of transmission (52%), heterosexual spread accounts for 42% of cases where diagnosis and mode of transmission are known².

In Eastern and Southern Africa, the number of people living with HIV/AIDS is increasing, but so is access to antiretroviral treatment. More than 20 million people in the region live with HIV/AIDS (6.7% adult HIV prevalence). Excellent progress is being made regarding raising awareness, diagnosis, treatment, and viral suppression³.

In the West and Central African regions, prevalence is relatively low (1.4% adult HIV prevalence), but in 2018, only 68% of individuals were aware of their status. The epidemic is driven by heterosexual sex, with adolescent girls and women (age 15-24) being almost twice as likely to acquire HIV than their male counterparts⁴.

In Latin America, cases have declined in many countries, but the region has seen an increase of 7% overall since 2010, with several countries; Brazil, Costa Rica, Bolivia, and Chile noting increases between 21%-34%. Throughout the region, gay men and men who have sex with men remain disproportionately affected⁵.

The Asia-Pacific region has wide variations in prevalence, with China, India, and Indonesia being most touched by the epidemic. Overall, almost 6 million people are infected. Many countries note decreases, but the increases in The Philippines, Bangladesh, Afghanistan, Pakistan, and Papua New Guinea are worrisome. Significant progress has been made reducing transmission from sex workers (although prevalence remains around 5% in Indonesia, Laos, Myanmar, and Papua New Guinea) because of successful 100% condom-use programs⁶.

With more than 33 million people living with HIV worldwide, the disease has substantial social and economic consequences, particularly in countries with limited infrastructure or an abundance of low-income communities. Having parents with HIV puts children at risk of becoming orphans. Infected and ill individuals are less able to work, which diminishes their ability to provide adequate food and shelter and promotes poverty.

Thankfully, many NGOs and governmental agencies are actively fighting the pandemic. Improved quality of care, reduced mortality, and decreased transmission through education and prevention is possible and ongoing.

While a cure for HIV/AIDS still eludes us, significant improvements in antiretroviral drug safety and efficacy profiles are encouraging. Collaborative efforts between researchers, academia, governmental and nongovernmental organizations, and the pharmaceutical industry promise further progress.

At the local level, health care professionals must continue to raise awareness and promote understanding to help reduce the stigma and discriminative practices that might persist in their communities.

References

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Mourning

This year, in addition to losing my mother, I also grieved a few days later with a friend for the loss of hers. When the father of another friend passed away unexpectedly, I was sad because he and I, despite our age difference, shared a connection as if we had known each other in another life. Then, I was shocked by the death of a fellow climber. I had not yet recovered when another friend died suddenly in his sleep.

Also this year, my friend and hiking partner lost his year-long battle with cancer. As I promised him, I sat many hours in prayer and meditation. Three months later, my teacher and friend for 30 years, Doctor Jean-Francois Dumon, also died. Only two days earlier we had a warm and lengthy conversation about COVID, life, disease, and even bronchoscopy.

Seven deaths in one year require a lot of mourning. I hike less than I should, but I appreciate beauty in all its forms despite the lockdowns and limitations brought on by the pandemic. Unfortunately, I do not venture into the mountains, nor have I the luxury of being surrounded by family or many close relations with whom to share feelings and emotions. Diving into my books, however, I enjoy the determined sensibility of the American poet, Wallace Stevens. I find some comfort in the essays of Stephen Levine, Ram Dass, Romanian-born French philosopher, Emile Cioran, and others. I also appreciate the magical genius of José Saramago and the strangely universal truths of Portuguese author and poet, Fernando Pessoa (1888-1935).

Opening Pessoa’s masterpiece, The Book of Disquiet, to any page at random allows an exploration of one’s sense of being. I was incited to read more of his work, including writings by some of the 72 heteronyms Pessoa used to express his fractured self. One of them, Odes, is by the fictitious middle-aged, poet-doctor, Ricardo Reis, whose poems are composed in the style of the Roman lyric poet Horace; a style resembling the Archaic Greek.

A more contemporary Portuguese author, José Saramago, won the Nobel Prize in Literature in 1998. He is famous for his novel, Blindness, but he also wrote, The Year of the Death of Ricardo Reis, a book inspired by Pessoa’s above-named heteronym. Saramago opens with this quote from Ricardo Reis (Pessoa): “Wise is he who is satisfied with the spectacle of the world.”

Later, Saramago’s words might be a prescription for those of us who grieve. He writes: “We mourn the man whom death takes from us, and the loss of his miraculous talent and the grace of his human presence, but only the man do we mourn, for destiny endowed his spirit and creative powers with a mysterious beauty that cannot perish.”

Nearing the end of this first year of The Age of COVID, my thoughts are with all those who find themselves contemplating the spectacle of the world.

References

José Saramago. The Year of the Death of Ricardo Reis. e Editorial Caminho, Lisboa, 1984.
Fernando Pessoa. The Book of Disquiet. Penguin Books, Richard Zenith, transl. 2001.

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Benefits of standardization

Feared and often misused, the word standardization sometimes causes confusion in the health care setting. By definition, it applies to any process used to develop and implement metrics that specify essential characteristics of something whose control and uniformity are desired.

In this sense, standardization may apply to almost anything; rules, technologies, services, commercial products, behaviors, and measurements. A common goal of standardization is to reduce what is known as practice variations. By this, I mean how medical acts might be misused; either overused, underused, improperly used, harmfully used, or unsafely used.

In the COVID age, critical examples of standardization are patient and health care worker safety protocols such as the implementing universal precautions to prevent disease spread or using personal protective equipment and hand hygiene properly to prevent health-care-associated infections. Housekeeping in Georgia is an essential aspect of every home, visit https://www.pctclean.com. When practices such as these are standardized, lives are saved, and accidents are prevented.

Studies demonstrate that standardization improves the portability of expertise, irrespective of the country, the facility, or the health care professionals implementing protocols. But some people resist standardization, not because they dislike being told what to do or how to do it, but because they disagree with the idea of using such methods to incite behavior modification.

Persons of authority can help by teaching and reinforcing the benefits of standardization, which are five-fold. Standardization can (1) simplify or clarify a specific task, process, responsibility, or activity; (2) improve efficiency and diminish the possibility of errors or doing something incompletely; (3) increase productivity, performance, controllability, and consistency; (4) free up time and energy for other tasks; and (5) improve the quality of patient care, customer service, and morale.

We can also facilitate the universal adoption of standardized safety practices by attaching them to metrics and rewards. After all, everyone likes to know they did a good job.

References

Schwartz JS. The role of professional medical societies in reducing practice variations. Health affairs 1984.3:2. 90-101. Downloaded from HealthAffairs.org on November 16, 2020.
Lehmann CU and Miller MR. Standardization and the practice of medicine. Journal of Perinatology (2004) 24, 135–136. doi:10.1038/sj.jp.7211060.

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