A Practice That Should Stop

In practice

A unit takes routine four-hourly observations on stable postoperative patients overnight. A clinician asks what supports it and finds tradition rather than evidence, and documented costs to waking stable patients. This is deimplementation, and it is harder than adoption for reasons the course has already established. Practices without evidence persist because they are established; supported practices go unused because they are new. Both are the same failure running in opposite directions. Exnovation — the deliberate removal of a practice — happens alongside innovation and renovation rather than after them. The barriers are the ones already catalogued: a culture steeped in tradition, and resistance reinforced by peer pressure, because the clinician proposing to stop something is proposing that colleagues have been doing unnecessary work. Adherence to traditional practice is a documented pattern rather than an accusation about this unit. The approach mirrors adoption: state what the evidence shows, name what stopping would look like, define the outcome that would detect harm if the practice was protective after all, and monitor it deliberately. The monitoring is what makes the proposal survivable: it converts an argument about whether the practice matters into a measurement that will answer the question either way, and it gives the people who disagree something to hold you to.