“Educate the young, regulate the old”

“Educate the young, regulate the old”. That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was needed to create cultural change in healthcare from a safety standpoint – not an easy task to say the least and one for which I knew I had no silver bullets.

With my background and expertise in patient safety education, the microphone often ended up in my hands when related questions were raised which is exactly where it was when an audience member asked each of the panel members to summarize our thoughts in one simple, easy to understand sentence. Without hesitation, and I should also say without thinking, I quickly said “Educate the young, regulate the old”. My face froze, my hands squeezed the microphone. Oops…did I just say that? Can I do another “take” or delete that last comment? Too late. There was a mixture of laughter and hissing, clearly a sign I had hit a nerve. After a pause that seemed to last about an hour, I tried to explain what I meant.

Just before leaving the states for Sydney, at my previous position in Chicago our SCIP committee had reviewed our hospital data on compliance with the SCIP measures. It was a good meeting – data on the most recent quarter showed us to be 98% compliant. Committee members were happy and satisfied they were helping move the hospital in the right direction. We should have been happy…our previous quarterly data showed us consistently below 60% compliance. It begged the question “what had changed?”

For the previous two years, we had met regularly with the surgery specialties and anesthesia personnel to educate them on the SCIP measures and their importance in reducing infection and other perioperative risks. We had searched the literature for best-practice models we could implement within our environment. We put new process improvements in place to make antibiotic ordering and administration as simple as possible…yet we could not get our numbers above 60%. Now, all of a sudden in one three month period we were rapidly approaching 100% compliance? It took a few seconds of reflection to realize what had changed. CMS put new rules in place tying payment to compliance. Once it became a reimbursement issue, discussions in the operating room about antibiotic administration before the surgical incision now became routine. One new CMS regulation accomplished what two years of education, training, process changes and pleading had not.

I was devastated. Don’t get me wrong, I was delighted to see the positive results. But as someone who has spent a significant part of their career in health professions education, I was deflated. So still hurting from this harsh new view of the world attacking my educational psyche, when the question was asked, I responded without thinking and with emotion that had built up over a 20 hour plane ride and a couple days of jet-lagged sleep deprivation…“educate the young, regulate the old”.

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