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In 2016, we examined the connection between naturalistic decision making and the trend toward best practice compliance; we used evidence-based medicine (EBM) in health care as an exemplar. Paul Falzer’s lead paper in this issue describes the historical underpinnings of how and why EBM came into vogue in health care. Falzer also highlights the epistemological rationale for EBM. Falzer’s article, like our own, questions the rationale of EBM and reflects on ways that naturalistic decision making can support expertise in the face of attempts to standardize practice and emphasize compliance. Our objectives in this commentary are first to explain the inherent limits of procedural approaches and second to examine ways to help decision makers become more adaptive.

There is a growing popularity of data-driven best practices in a variety of fields. Although we applaud the impulse to replace anecdotes with evidence, it is important to appreciate some of the cognitive constraints on promulgating best practices to be used by practitioners. We use the evidence-based medicine (EBM) framework that has become popular in health care to raise questions about whether the approach is consistent with how people actually make decisions to manage patient safety. We examine six potential disconnects and suggest ways to strengthen best practices strategies.