NON-ADHERENCE TO PATIENT SAFETY GUIDELINES: AN EVOLUTIONARY, ECOLOGICAL HYPOTHESIS

Abstract

Often well meaning health care workers do not adhere to patient safety guidelines or recommendations, with serious consequences; patient injuries and mortality. Non-adherence has been attributed to external limitations, such as heavy workload, the non-availability of resources or how health care workers perceive the expectation of their superiors towards their performance. This paper presents new thoughts and ideas on such non-adherence. It presents a theoretical argument for how current policies for promoting patient safety in health care delivery might be hindered by a particular evolved mechanism that has not been considered. Non-adherence is argued to be an adaptation, or, more specifically, it is argued to be structured in such a way to generate adaptive outcomes when elicited by those in positions of power in dominance hierarchies wherein it is an efficient strategy. The core explanatory dynamics of non-adherence to patient safety guidelines are presented in terms of the social dominance hierarchy within which physicians function and that accounts for these evolved adaptations that enable maintenance of dominant status and cohesive (cooperative) group living and social rank-related mate selection behavior. Applied approaches to minimizing non-adherence to patent safety guidelines among health care workers (primarily physicians) are also presented.