Peter Drucker is widely considered to be the world's foremost authority on management. He's advised major corporations and authored numerous best-selling books on the topic, so perhaps it's not surprising that his teachings would also have an impact on pediatric medicine.
"In his book, 'The Theory of Business,' Drucker says, 'Every organization is built on a set number of assumptions that dictate its decisions about what to do or what not to do,'" says Andrew Costandi, M.D., MMM, anesthesiology director of abdominal transplantation and radiology at Children's Hospital Los Angeles (CHLA). "And it’s true—I think our practice of medicine is often dictated by assumptions that are usually based on our individual and organizational experience."
Paraphrasing Drucker, Costandi calls it "the theory of medicine." He says health care providers—both individually and organizationally—can fall into a pattern of trusting assumptions because those practices have always proven successful. "But we must challenge and examine our theory of medicine—our assumptions—against evidence-based medicine and changes in health care," Costandi says. "We must ask ourselves, 'Does my theory of medicine still hold true?'"
Costandi and his team put this concept into practice in developing its Enhanced Recovery After Liver Transplantation (ERAL) protocol. Pediatric liver transplant surgeries typically involved sending patients to the ICU post-operation still intubated, though there was mounting evidence that operating room (OR) extubation in adult liver transplant patients resulted in faster recoveries. Costandi tested that assumption and since CHLA implemented ERAL, post-transplant ICU stays have fallen by 57%.
"We challenged our theory of medicine here at CHLA and developed a protocol that has worked well," Costandi says. "Challenge your theory of medicine—and do it against the most recent evidence-based medicine—and you will be surprised."