Back @ the EPR Arms: February 2019 Time for a change


“If we always do what we always did, then we will always get what we always got.”

‘…..every Thursday. Regular as clockwork they come in, sit at the same table, order the same food, and drink the same drinks. Amazing.’ said Trev, pointing my half-filled glass to a couple in the corner.


‘Steak and kidney pie and chips and peas. Always.’ he continued.
‘Well, if that’s what they like.’ I said, taking my beer.


‘Boring!’ said Trev, ‘even if new Year’s Eve falls on a Thursday. Predictable.’ And he turned to greet another customer.


‘Rupert!’ I said, ‘and Norman. Come join me.’ I invited the two Uni guys to my table.
As we sat down, the door opened and Mike the GP and the two surgeons, Bob and John arrived, smiled, ordered their beers and joined us. We had a good team for a debate I thought.

‘Those two over there…’ I subtly gestured with my now half-empty pint.


‘Oh you mean Snake & Pygmy. What about them?’ said Norman.
‘They’re always in the same place, same table; same drinks.’ I repeated Trev’s observations.


‘Resistant to change,’ said Norman. ‘Fearful of anything new and different.’


‘Like us apparently’ said Bob. ‘Us clinicians. We’re resistant to change by all accounts.’
‘Says who?’ I asked.


‘Everyone. What they don’t realise is that we’re not reluctant to change. We just want to make sure we are not changing for change’s sake.’ added John  Draper. He continued, ‘I mean, you look at how we have changed surgery over the last decade: keyhole surgery; lasers; staple guns; tissue glue guns.’ He sounded like an advert for Screwfix.


‘What about Vitamin C?’ I asked,.. ‘or thrombolysis?’


‘Well, yes some things do take a while to filter down.’ Bob admitted.


‘And why don’t I do your post-op checks instead of dragging the patient back to the hospital for an outpatient visit?’ asked Mike the GP. ‘You just don’t want to change the way you’ve worked for years.’ I’ve noticed he drops this in to any vaguely relevant conversation.


I could see from the corner of my eye that the Uni guys were getting ready to throw a quote on the table. They didn’t disappoint.


‘Everett Rogers[i] identified five important factors to getting new ideas across.’


It was going to be one of those formal ‘lecturey’ nights I could tell. Turn your papers over. You have forty minutes to complete…


‘Go on then Norm,’ said Bob Mc Strachan. ‘Bore us with the details!’


Relative advantage: People need to see how change is better than what they currently do.’
‘Yip. Common sense. Why should we change if we don’t know it will be any better? What’s the next one then?’ asked Bob.


Compatibility:  People must see a link to the old ways of doing things.’


‘So you’re saying there would be less of a threat if we could relate the new way of working to the old?’ enquired John Draper.


‘Something like that. Then Simplicity; the new ways must be simple. Even if it’s at the expense of extra functionality. In clinical IT terms, complicated all singing-all-dancing systems will not be used if they’re difficult to find your way around.’
‘I go along with that. And what’s worse is, I don’t want to look daft when I struggle with it. I mean, I’m a surgeon aren’t I?’ said John Draper.


Norman continued.Easy to Test; Give people an environment when they can play with the technology and test it out.’


‘Like a vision centre?’ I suggested.
‘Yes. Exactly that,’ continued Norm. ‘And finally Observability: Most people adopt an innovation after seeing how it works for other people like them.’


‘Evidence based IT. I’d go along with that. And I want to hear it from my peers and not some salesman’ said Bob.


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‘But not everyone can immediately appreciate the potential of this new technology and that’s why they appear resistant to it.’ I said.


‘Like?” asked Bob.


‘President Rutherford Hayes in 1876 "That's an amazing invention, but who would ever want to use one of them?" He was talking of the telephone.’


Norman’s contribution.


‘And "People will soon get tired of staring at a plywood box every night,"


said Darryl F. Zanuck, head of Twentieth Century-Fox, in 1946 talking about Television,’ added Rupert.


I thought I’d better join in ‘Ken Olson, President of Digital Equipment Corp., 1977 said of computers - "There is no reason for any individual to have a computer in their home." ‘


‘..and Decca records turned down the Beatles!’ said Mike.


There was a pause while we assessed the significance of that remark and deciding there wasn’t any, Norman continued.


‘Yes, it’s not just about change, it’s also about appreciating the potential that change could bring. People have different views, some are enthusiasts some cynics’


‘Some are teckies others luddites’


‘Some are optimists and some pessimists’


I was beginning to drift away from the conversation and wondered if a pessimist's blood group is always B-negative. Rejecting this as a useful contribution to the serious debate, I decided instead on:


‘And there’s more to life than steak and kidney pie. Another pint?  It’s my round.’


‘Well that does make a change! ’ they chorused.





[i] Rogers E. Diffusion of Innovations. The Free Press 1983

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