Wednesday, July 24, 2013

Person-to-person: a better approach to developing academic chemical safety culture?

Atul Gawande is a physician and a very good writer. His latest long article in The New Yorker is quite good, talking about the different approaches to public health in India and what is actually effective in getting medical personnel in developing nations to change their ways (emphases mine):
The most common approach to changing behavior is to say to people, “Please do X.” Please warm the newborn. Please wash your hands. Please follow through on the twenty-seven other childbirth practices that you’re not doing. This is what we say in the classroom, in instructional videos, and in public-service campaigns, and it works, but only up to a point. 
Then, there’s the law-and-order approach: “You must do X.” We establish standards and regulations, and threaten to punish failures with fines, suspensions, the revocation of licenses. Punishment can work. Behavioral economists have even quantified how averse people are to penalties. In experimental games, they will often quit playing rather than risk facing negative consequences. And that is the problem with threatening to discipline birth attendants who are taking difficult-to-fill jobs under intensely trying conditions. They’ll quit. 
The kinder version of “You must do X” is to offer incentives rather than penalties. Maybe we could pay birth attendants a bonus for every healthy child who makes it past a week of life.... [snip] 
...Besides, neither penalties nor incentives achieve what we’re really after: a system and a culture where X is what people do, day in and day out, even when no one is watching. “You must” rewards mere compliance. Getting to “X is what we do” means establishing X as the norm. And that’s what we want: for skin-to-skin warming, hand washing, and all the other lifesaving practices of childbirth to be, quite simply, the norm. 
To create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way. 
The most affecting portion of the Gawande article is too long to excerpt (imagine that, for this blog!), but I will try to present a summary: Gawande talks to a nurse, Seema, who acted as a trainer for a much more experienced labor and delivery nurse in India. The experienced nurse did not do any of the recommended items for childbirth: the room was not disinfected, vital signs of the mother and newborn were not checked, no emergency supplies were prepared, the infant's vital signs were taken with a hand instead of a thermometer and kangaroo care (the warming of the infant by skin-to-skin contact with the mother) was not performed.

After Seema pointed out these issues, the experienced nurse was unhappy, but she and Seema went to the hospital's organization to get some of the issues (room cleaning, equipment like a thermometer (!)) dealt with. Seema kept visiting the nurse, and kept talking to her and getting her to change her behavior through conversation, not through demand or incentive. Gawande followed up with the experienced nurse months later, and asked why Seema was effective:
“Why did you listen to her?” I asked. “She had only a fraction of your experience.” 
In the beginning, she didn’t, the nurse admitted. “The first day she came, I felt the workload on my head was increasing.” From the second time, however, the nurse began feeling better about the visits. She even began looking forward to them. 
“Why?” I asked. 
All the nurse could think to say was “She was nice.” 
“She was nice?” 
“She smiled a lot.”
“That was it?” 
“It wasn’t like talking to someone who was trying to find mistakes,” she said. “It was like talking to a friend.”
After I read this article, it is difficult not to think about our issues with academic chemical safety. It seems to me that universities rely too much on "Please do X" (please wear your PPE, please don't do that 3 kilogram azide reaction) and "You must do X" (you will wear your PPE! or we will fire you!).

In an ideal world, there would be space in a university for chemical safety educators who would do the work that Seema was doing: he or she would visit labs repeatedly (note that Seema visited at least 4 or 5 times!), befriend students, point out errors in practice and convince, not hector or harangue. I note that said chemical safety educator's job would be harder -- the experienced nurse could see the fruits of her labor, and be convinced that the new way was better. If a chemical safety educator does their job, nothing happens. (I've floated a similar idea in the past about using mid-career chemists for similar positions; I still think it's a good idea.)

The problem with this approach, of course, is that it's extremely labor-intensive and time-intensive; in the U.S., that means that it's money-intensive as well. There are a lot of other reasons why it might not work; I'd be interested in hearing others' thoughts about my policy notional. Readers? 


  1. You would have to be very selective for such a position, otherwise they wouldn't receive the necessary respect. For something like that to work in chemistry it would have to seem like they know more than those they're advising.

  2. Yeah, that's never going to work because of cost these days. I think 50 years ago and more, this was probably the advisor's job. You know, they would actually go into the lab and teach graduate students how to do stuff and not blow themselves up. Probably one of the reasons why PhD were shorter at the time. Learning synthesis was not done entirely by trial and error (I know that's not the only reason they were shorter). Now an entire position would have to be created and this person would be using up waaaaaaay too much paid time with every individual student.

  3. Safety doesn't matter (at least in grad school) because most advisors don't care. Their job is get grants, come up with ideas, and get people to do what they envision. Everything else is your responsibility.

    In that environment, safety and productivity will inevitably conflict, and either safety will lose (and maybe you) or safety wins, and you're not around or employable in chemistry. If the school cares, something might change, but more likely either the advisor cares and it becomes a matter of personal attention or other techniques most effectively growing safety, or he/she doesn't and nothing they do is going to matter.

    In most of Gawande's articles, everyone in theory has the same goals - to get patients to survive or do better after surgery, and probably to do it more cheaply or with less effort. The problems are thus human relations problems, or work process problems that can be solved because (almost) everyone wants them solved. Safety in contrast is a cost - it gets in the way of what people want to do, and so is easily ignored by people who don't want to pay the costs for it. Unlike in industry, in grad schools students aren't likely to have anywhere else to go to deal with safety issues; if their advisor doesn't care, and they have ultimate power over their career and work, how much can safety change?

  4. I always thought older PhD's were shorter was because they were underfed. .gr.

  5. As you describe it, such a position would be more cost-effective the bigger the department was. Cost-effective enough? As you say, the only sign of success is a negative... "XX days since the last lab accident." If there's already safety officers on the payroll, what are they doing that is more important than actually seeing what the labs are doing?

    Another possibility is that a similar role could also be played by (senior) student volunteers who undergo some extra training. (There were trained peer counselors for various substance abuse- and relationship-hotlines in undergrad as i recall, at least at my school.) Or who do it for 1/2 an FTE.

  6. I think hiring some industrial chemists as professors would have a huge impact on the culture in academia.