Keep change pumping

Last week I heard a story on NPR about CPR protocols in life-threatening situations.  The story starts with Scott Harden, who, just before bedtime, heard his 33 year-old wife gasping for air.

“She was not the right color,” Scott said, and he started giving CPR the way he had been taught 15 years ago: 15 quick chest compressions, then two breaths, then more compressions.  But he said he “couldn’t get the breaths in,” and, guided by the 911 dispatcher, he stuck with the compressions, doing 100 per minute until the paramedics arrived.

Pete Walka was one of the first paramedics on the scene.  According to Pete, Scott saved his wife’s life.  “She’s alive because he did really good compressions until we got there,” said Pete.

A 911 dispatcher in any other state might have given Scott different advice.  Arizona, under the leadership of cardiologist Dr. Gordon Ewy of the University of Arizona, is promoting a compression-only CPR technique, based on Dr. Ewy’s assertion, and research, that it saves more lives.

Dr. Ewy argues that compression-only works better because it keeps already-oxygenated blood pumping.  Stopping compressions to give breaths means, according to Dr. Ewy, that blood stops flowing, leading to worse outcomes.  And the highly-respected medical journal The Lancet conducted a study in which it tracked 4,000 victims of cardiac arrest in Japan: it found that those who received compression-only CPR survived nearly twice as often as those who received compressions plus mouth-to-mouth.

But change is hard to come by.  According to NPR, the American Heart Association has “updated its guidelines to say that compression-only CPR is appropriate for those not trained in the standard method.”   Basically, the AHA is saying, “if you don’t know how to do it the right way, just do the compressions.”  According to Dr. Ewy, these recommendations don’t go far enough, and he’s pushing to have Arizona be at the forefront of a national change in CPR protocols.

On it’s own this is a fascinating story.  For a lifetime we’ve heard that there’s one way to give CPR, so the idea that there’s another, better way out there – lurking behind the unquestioned conventional wisdom – is itself intriguing.  What struck me even more was the argument by Dr. Michael Sayre of the American Heart Association, who helped write the new AHA guidelines.  He said:

“Honestly, I think the research that we have to date shows that the outcomes for patients seems to be very similar regardless of the kind of CPR they get.”

Put another way: if the new way is just as good as the way you’re doing things, and if some data suggests it might be better, that’s not good enough.  The bar is HIGHER when you want to make change.

We hear this argument every day – even though it’s often more subtle.  It’s the “that’s not the way we do things” refrain.

The real reason that “just as good” isn’t good enough is because the people who created the original “just as good” solution have influence and power and something to lose if something better comes along.

So if you’re in the business of making change and stirring things up, you have to keep on hitting a higher bar.  And don’t forget that for many people, “that’s not how we’ve done it before” is argument enough not to change.

The burden of proof is highest for the innovators.

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