Howzat: what does the game of cricket have to do with evidence based practice?

Recently, I had the privilege and the opportunity to present to a wide range of health care stakeholders, whose interest lay in the management of chronic conditions, on the topic of evidence based practice (EBP). It is common knowledge that much of the western world, and some sub-sections of populations of the developing world, is confronted with increasing prevalence of chronic conditions. While some have labelled this an epidemic, the management of chronic conditions poses significant challenges to health care stakeholders. It was in this context that I was invited to present my perspectives of EBP and how EBP can be one of the many tools which can be utilised to confront this challenge. While I was researching this topic, and planning my presentation, I came across an interesting, albeit unusual, relationship between the game of cricket and EBP.

For those who are not familiar with the game of cricket, here is a quick overview. The game of cricket has its historical origins in 16th-century England. In the 21st-centrury, the game of cricket is highly popular in Australasia, the Indian subcontinent, the West Indies, Southern Africa and the British Isles. Cricket is a bat-and-ball game which is played between two teams of 11 players each. The playing field is oval in shape and at the centre of which there is a rectangular 22-yard long pitch. The teams take turns to bat and bowl (and field), with the batting team trying to score as many runs as possible, while maintaining their wickets (number of batsman remaining). The bowling and fielding team try to dismiss as many batsmen as possible thereby limiting the number of runs scored by the batting team. The teams’ then switch batting and bowling at the end of an innings. There are different forms of cricket including test match and limited overs (such as one-day, 20/20).

As with any sport, the game of cricket has a number of rules and regulations and one such refers to an appeal. An appeal is the act of a player (from the bowling and fielding team) asking an umpire for a decision regarding whether a batsman (from the batting team) is out or not. Curiously though, according to the cricket laws, an umpire may not rule a batsman out unless the bowling and fielding side appeals. There have been many occasions when a batsman has been out but because the bowling and fielding side did not specifically appeal, the umpire did not give the batsman out. If any of you are a cricket tragic like myself, who spend a good part of the summer glued to the television or radio (or increasingly the internet), watching and listening to cricket, you will recognise the importance of getting the appeal right. Many cricket games have been won or lost by a solitary wicket (or a run).

Therefore, in the game of cricket, despite evidence to indicate a batsman is out, unless the evidence is operationalized by the bowling and fielding team by instigating an appeal, the umpire will not give the batsman out. Just as in the game of cricket, where evidence has to be operationalized in order to have an impact on the outcome, health care is no different. Despite the availability of evidence, which has been steadily growing over the years, unless it is operationalized and implemented, it will have no impact on health care process and outcomes. There are several examples in health care where despite the availability of a rigorous and consistent (large) body of evidence, evidence is not operationalized or implemented in health care. They include underuse of hand washing by health care professionals, overuse of diagnostic tests (such as x-rays) for acute low back pain and misuse of soft collars to treat acute whiplash associated disorders. In chronic conditions management, despite available evidence, only half of patients receive optimal quality of care and outcomes in general practice settings in Australia.

Readers of my previous editorials will recognise the numerous factors which can influence the uptake of evidence into clinical practice and ultimately influence behaviour and practice change. While I am not suggesting implementing evidence based practice in health care is as simple as voicing an appeal in cricket, it does highlight the importance of recognising the opportunity, taking ownership and initiative and leading the charge in facilitating change by the collective. As is often said in the cricket field "all you need is one good delivery to get the batsman out”, in health care all we need is to seize the moment and opportunity. That, as is in the game of cricket, may well be the game changer.


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