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One stunning development is the proliferation of checklists asking simple questions before surgery. These checklists, although clearly useful, often meet with hostility because they challenge doctors’ self-image as grand soloists.
Here’s how Dr. Atul Gawande, a surgeon and author of The Checklist Manifesto, suggests that doctors can speed up innovation.
1. Be the first. “If you try to impose a new practice by simply telling the front line, ‘Do this,’ it will fail,” Gawande says. “We asked the chiefs of surgery, anesthesiology and nursing to be the first people to use checklists.”
2. Drop the Lone Ranger act. “We’ve celebrated cowboys, but what we need is more pit crews,” Gawande says. “There’s still a lot of silo mentality in health care—the mentality of ‘That’s not my problem; someone else will take care of it’—and that can be a very dangerous situation.”
3. Train early in teamwork. Teams deliver most medical care, yet nobody trains doctors how to be team captains. At the University of Nevada at Reno, the schools of medicine and nursing have merged; now students learn to work together. “It’s a brand-new thing,” Gawande says.
4. Think big. “We like to imagine we can be infallible and be that heroic healer,” the doctor says. “But the fact is, it’s teams and, often, great organizations that make for great care, not just individuals.”
It seems hokey, he admits, to have surgical team members go around the room and introduce themselves. “But when you do it, people say, ‘I’m Bob, the anesthesiologist; I’m Susan, the anesthesia resident; I’m Tim, the nurse.’ So when it comes to you, are you going to say, ‘I’m Dr. Gawande’? Or are you going to use your first name?” This exercise changes the culture and is especially appealing to nurses and younger professionals.
5. Follow protocol. Gawande points to Chesley “Sully” Sullenberger, the pilot who landed a doomed plane in the Hudson River. Everybody sees him the same way they see doctors, as unbelievably skilled. He was the hero. Sullenberger keeps insisting that it was adherence to protocol and teamwork that let everyone survive.
“Heroism in medicine ought to mean having the humility to recognize that we are more likely to fail on our own,” Gawande says.
— Adapted from “Health Care Needs a New King of Hero,” Atul Gawande interviewed by Gardiner Morse, Harvard Business Review.