My take relates to crisis management & influencing behavior 1/
I’m not qualified to comment on whether school closure should continue or not. (personally, as a parent of a 4yr old...please re-open! but not the point here)
Some considerations
2/
1. Transparency: when reports are leaked, there’s high prob for misunderstanding. Transparency in the long run is often the preferred approach (except maybe national security) but it is very true that lack of transparency fosters further mistrust. bit.ly/397ihX8
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The gov’t decided to keep schools closed…that should be paired with data that informed that decision (e.g. school reports)
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2. Hind sight bias: This point is for us as the public. We’ll inevitably 2nd guess gov’t officials but lets remember they made a decision with the information they had then, not what we have now. This drastically influences how we evaluate decisions.
5/
Also, decisions should be thought of probabilistically. E.g. "we think with 90% certainty, closing schools is the right move." That doesn't mean it's right...in 10% of futures, its wrong. Unfortunately this isn't an intuitive method for humans...but the media can help here.
6/
3. Quick first step: we teach this in crisis management, take action but favor safety. Tbh, that’s what the gov’t did. They made the decision, extend school closures. I support that, not because I want them closed but because they didn’t have control over the situation. 7/
If you don't have control...select the safest option ("fail safely"...temporarily), buy yourself time, evalulate options then decide on whether to pivot. But let your "team" or "the public" know exactly what you're doing...there's that term again...transparency.
8/
This buys time. But time must be used wisely to build a plan to reduce risks in schools (has this happened?). Also add the “why”…which hasn’t been well articulated. We hear schools are both safe & unsafe. This is confusing. Rather abandon this talk risk as a spectrum
9/
4. Data driven decisions –we heard from CMOH that we need <150 ICU patients and <1000 cases/d before lockdown opens. This needs to be more closely linked with why these numbers are chosen.
Many have discussed NB of data incl @ASPphysician@BogochIsaac@jkwan_md@IrfanDhalla
10/
5. Show the public what you’ve done during this lockdown to invest in re-opening. We’ve all locked down, now time for the relationship to be reciprocal
11/
6. More transparency: Feb 10th…many of us literally can't wait until this day...but there's a chance schools still don't re-open...which I accept if this is based on best available information & risks to our society...
12/
…but we can provide several models that would/wouldn’t allow schools to open. E.g. “Feb 10, we plan to open schools if we can achieve X & Y. We also know theres some unpredictable factors that might force us to continue closures...
13/
...but we believe with high degree of certainty they’ll re-open, so let’s make it happen...and here's what we need from each of you”
14/
7. If you want people to buy into a plan, you only get blind trust for so long before they question goals/objectives and need the "WHY". And probably needs to be more than just "because our system is overwhelmed".
15/
While that is true, recognize the message may be losing its power/influence.
Summary:
- Help us understand the WHY, as intelligent individuals.
- Favour transparency when in doubt
- Be explicit with metrics (but call out ahead of time...we may get it wrong)..honestly.
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THREAD: Amazing article how McLaren improved their F1 pitstop times by undertaking a deeper understanding of their teams. & how this relates to healthcare.
They used eye tracking tech to identify the pit crew wasnt focused on the car entering the pit 1/ wired.com/story/book-exc…
Once issues were identified they implemented several design and training strategies:
1. specific actions for each team member 2. train to focus on wheels 3. painted wheel nuts orange
Net result = record setting speed for pit stops and more wins. Impressive work
2/
This is the detailed approach that we must take in healthcare to get those 1% gains (and in fact, probably opportunity for 5-10%) gains.
We use simulation to help understand issues and subsequently design solutions that work....
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2/ Why does it matter? Somewhat self evident, but we want to design & test a process that optimizes the number of people who be vaccinated while also ensuring a pleasant & safe experience
Great clip from "the Founder"... example of design #simulation
3/ We began with core objectives/principles for the project.
This informed the blueprints for the design of the space
But we all know, things may look good on paper, but don't necessarily translate to real-life
More importantly, people's behavior can be difficult to predict
THREAD: 5yrs ago we began the TRUST study. Excited to see it finally published in @BMJ_Qual_Saf . This kicked off my interest in using simulation to support patient safety and simulation-informed clinical design.
My mentor, @HumanFact0rz taught me the importance of pitching an idea to the right people. When we started simulation for systems eval & patient safety was uncommon
This SR/MA provides a more fulsome look at the data including this brand new evidence.
2/
The results?
In pooled analysis, TXA likely has no effect on mortality or disability.
A few considerations when I try to contextualize the clinicaly relevance. Not all TBI are equal. GCS 3 =/= GCS 12. A SDH is not the same as SAH or EDH etc. So their are limitations here
3/
For example, my kids go to school, so they are exposed to ~20-30 people/day. An all or nothing approach says it doesn’t matter how I socialize because I can’t achieve perfection (isolate the way public health advises) since my kids are in school.
3/