Every year our company brings a significant presence to the FMC Medical Director’s meeting. Last week Frank Maddux led a very successful meeting in Las Vegas, a meeting I had the good fortune to attend. The theme of the conference was The Power of Collaboration. There were several presentations throughout the three-day meeting which highlighted this power, including the keynote presentation by Dr. Atul Gawande. Contrary to the popular saying, some things that happen in Vegas should definitely not stay there.
To categorize Dr. Gawande as simply an endocrine surgeon practicing his craft in Boston widely misses the mark as he is indeed one of the best communicators I have had the privilege of hearing speak. In addition to frequent contributions to The New Yorker, Atul is an accomplished book author. His most popular book, The Checklist Manifesto, is a fabulous story and one that I would highly recommend. In The Checklist Manifesto he convincingly makes the case that when talented individuals tackle complex problems they can achieve better results by utilizing simple, carefully constructed checklists. His book includes poignant examples from industries as diverse as aeronautics, skyscraper construction and medicine.
I suspect it would have been easy for him to repurpose one of the topics from his recent literary successes, but to his credit, Atul chose to share a different story with us in Vegas. During his PowerPoint-free oration entitled “Cowboys and Pit Crews,” he established the historical context within which modern medical training emerged, and subsequently explained that the product of that training was by design an autonomous, independently functioning physician—a Cowboy, in the classic sense of the word.
He went on to postulate that as medicine has become more complex, healthcare delivery would be better served by coordinated teams (Pit Crews) instead of Cowboys. He argued Pit Crews functioning in coordinated harmony would consistently deliver better results within a complex system such as the one we face each day in healthcare.
Expanding on this concept, Dr Gawande suggested that having fantastic parts (a lot of very good Cowboys) is not only an incomplete solution, but occasionally a problematic one. Real success in this arena requires effective system design or redesign as the case may be. He then outlined three skills required for successful system design:
- The ability to recognize failure
- The development of scalable solutions
- The ability to implement those solutions
Perhaps exposure to the desert heat has affected my judgment, but I believe he is right on the money. The days of the rural country doc being all things to all patients are numbered. Today the average ESRD patient interacts with a large number of healthcare providers concurrently and there are plenty of examples in which the care delivered could be improved if the care team functioned more like a Pit Crew than a collection of independently minded Cowboys.
Atul developed a few more concepts and then he left us with a parting thought. He said making systems work in healthcare is the greatest challenge we face as a medical community. I believe there is truth in that statement, and I also believe that when we succeed in meeting that challenge, health information technology will be an integral part of the solution. Perhaps you have read one of Dr Gawande’s books, or better yet, you too were in the audience last Tuesday to hear him speak. If so join the conversation and let us know what you think about the perspective he brings to the table.
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