In This Section      

Quality Update - A Lesson from Bees

Fall 2009

A Lesson from Bees

By: Peter Pronovost
Date: October 15, 2009

Hopkins' patient safety expert explains how mimicking nature could improve decision-making in health care.


I’ve found an unlikely source of inspiration for how we can improve health care.

Swarms of honeybees, it turns out, have an uncanny ability to select the best location for a new hive. And the traits they use to reach decisions could also help the health care community to make better choices.

When a swarm needs a new home, hundreds of bees explore potential locations. Upon returning, these scouts perform a “waggle” dance to indicate their ratings of a site’s quality. As the dancing builds, scouts test locations promoted by others and bring back their own reports. Eventually, a consensus emerges.

While scientists have long known about the bees’ decision-making acumen, a recent article explains why their process works so well: It demands a sophisticated interplay of independence—the scouts’ objective assessments of locations—and interdependence—advertising their findings so that others can test the sites.

Using computer simulations of bee behavior, the researchers discovered that an imbalance of these components swayed the swarm’s success. Investigating sites without advertising them caused the selection process to slow down dramatically, leaving the bees homeless. But blindly heeding the scouts’ initial recommendations without independently evaluating these sites created quick decisions that frequently missed the best choice.

We can see examples of how the health care community would benefit from more independent feedback and information-sharing.

Take the Joint Commission national patient safety goal for medication reconciliation. Certainly, prescribers should consider a patient’s current drug regimen before ordering medications. But the requirements didn’t account for a wide range of providers and settings.

For example, if an ophthalmologist needs to prescribe drops to dilate a patient’s eyes before an outpatient procedure, does that physician feel comfortable reviewing this person’s medications for diabetes and heart failure? It’s certainly different than reconciling medications when an inpatient is discharged.

Health care organizations received little guidance on how to develop policies that address many different patient-physician encounters, and many of them consequently failed to comply with the standard. So in March the Joint Commission decided not to penalize organizations for falling short on this goal. Meanwhile, it is gathering feedback from caregivers—a move in the right direction—so it can revise the requirement.  

The lack of independent review and information-sharing also can stymie quality-improvement efforts. Consider the best-practice guidelines issued by medical professional societies and government agencies, which may contain 100 recommendations in such areas as preventing infections.

Once guidelines are put forth, there’s often no mechanism for health care professionals to relay the challenges of following them. Are the guidelines practical in every clinical situation? Are any ambiguous? How can caregivers follow them all? It’s no wonder that widespread adoption of guidelines often takes a couple decades, if it occurs at all.

If you want to reach a wise decision and do so quickly, it’s not sufficient to gather a group of smart people. You need to create learning communities in which members—much like the bees—test guidelines and share what they’ve discovered.

At Hopkins, we have fostered such communities through statewide collaboratives that target ventilator-associated pneumonia (VAP) and catheter-related bloodstream infections. We took guidelines from the Centers for Disease Control and Prevention, identified specific steps within them that were most important to our efforts and created tools helping caregivers to follow them. As feedback came in, we revised the tools.

And our efforts have worked. Not only are hospitals following the guidelines more closely, but they have greatly reduced both VAP and infections.

We need more health care workers to do the waggle dance.