“We train, hire and pay doctors to be cowboys. But it’s pit crews people need.” – Dr. Atul Gawande
The commencement speaker who addressed this year’s graduating class at Harvard Medical should be a familiar figure to readers of this blog. It was one of the blog’s heroes – Dr. Atul Gawande – he of “checklist manifesto” and “health care cost conundrum” fame.
Although the tone of Dr. Gawande’s address was uplifting, it was not the typical commencement address larded with platitudes and bromides about life; instead Dr. Gawande delivered a clear clarion call to graduates about the future of medicine. Dr. Gawande stated that the task for this generation of doctors – the task which they must carry out if we are to improve health care and make it affordable – is to work together as members of pit crews work together, while applying data-driven best practices.
Dr. Gawande began his address which you can read here (h/t Cal Consumer Attorneys), by noting the explosion in the complexity of medicine in the last century, an explosion in knowledge and technology that outstripped the gains of all the past centuries of medicine combined.
In the 1930s, 40s and 50s, it was possible for doctors to tote around the whole of medical knowledge in their brains. Doctors were cowboys, lone wolfs, rather than collaborators. They didn’t need to know how to play nice or be part of a team because they didn’t need teammates; the sum total of the body of medical knowledge and treatment was at their fingertips, as it was so small.
But as medicine’s complexity has exploded, so too has the number of nurses, specialists and other health care patients involved in a patient’s care. In 1970, 2.5 nurses and doctors participated in the care of the average patient. By the 1990s, the number was more than 15.
As the number of moving parts in a patient’s care increases, the members of a patient’s health care team need to work together like a pit crew. Like pit crews, the members of a patient’s health care team should follow checklists – checklists that have been shown to reduce medical malpractice by forty-seven percent.
The principles doctors should follow in their checklists should be derived from data-driven research of best practices. As Dr. Gawande notes:
People in effective systems become interested in data. They put effort and resources into collecting them, refining them, understanding what they say about their performance.
When you study the data, you find that the most effective health care techniques are not the most expensive. And that fact means that we can afford health care without having to ration it. As Dr. Gawande notes:
The places that get the best results are not the most expensive places. Indeed, many are among the least expensive. This means there is hope–for if the best results required the highest costs, then rationing care would be the only choice. Instead, however, we can look to the top performers–the positive deviants–to understand how to provide what society most needs: better care at lower cost. And the pattern seems to be that the places that function most like a system are most successful.
By a system I mean that the diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.
If, in twenty years time, you go to the hospital and the staff’s coordinated efforts resemble the coordinated efforts of a NASCAR pit crew more than a traditional hospital, chances are the care that you receive will be better. And cheaper.