We know from recent books and articles that surgeries started becoming more and more effective when surgeons discovered the power of simple management and process techniques such as checklists. Peter Pronovost, an anesthesiologist at Johns Hopkins University Medical School, found in a 2006 study that an alarming number of surgical teams were skipping one of the following five essential steps when inserting a central line, or intravenous tubing, into a patient: washing hands; cleaning the site; draping the patient; donning surgical hat, gloves, and gown; and applying a sterile dressing. Dr. Pronovost created a simple checklist that Michigan hospitals started using and thus were able to “cut their infection rate from 4 percent of cases to zero, saving 1,500 lives and nearly $200 million.”
While listening to a recent interview of Dr. Ira Rutkow, a surgeon, I realized that the learning can be a two-way street – managers can learn from surgeons too. In his book, “Empire of the scalpel – the history of surgery”, Dr. Ira Rutkow writes about what makes surgeries effective. He lists four key elements in any surgery: surgeons need to understand our body’s structure well (anatomy), they need to control bleeding so they can continue to see what they are dealing with (bleeding), they need to reduce the patient’s pain (anaesthesia) and they need to prevent infection from germs such as bacteria and viruses (antisepsis).
Managers dealing with a disaster or crisis will want to limit damage, find short-term fixes, ensure continuity in their business operations and provide long-term solutions. They can use these four elements as metaphors:
- Structure. We need to know where everyone is, what the problem is, the location of the impact, what the root causes are. We also need to know who the experts are who can address the problem, what their ETA is and what resources they will need. Experienced crisis managers have well-rehearsed recovery procedures, communication plans and evacuation protocols in place.
- Clarity. In a crisis, we cannot allow anything to block what we are seeing, to distract us from our recovery efforts. Can we differentiate critical from incidental? Signal from noise? In dire circumstances, our emotions can cloud our thinking – can we learn to set aside our anxieties and focus on what needs to be done? Can we also acknowledge to ourselves that we may not have all the answers? Clarity of thought and a bias for action can lead to decisiveness.
- Relief. Can we understand what is needed as a short-term fix? How do we provide quick relief to those who have been affected the most? Long-term solutions will be needed but providing a temporary work-around will give our team time to understand the severity of the disaster, time to respond with empathy, time to communicate to all concerned persons, and time to develop a permanent solution.
- Caution. We should take care that by attempting to solve a problem, we do not introduce new problems. In other words, how do we ensure the cure isn’t worse than the disease? Effective managers know the importance of ‘impact analysis’ and ‘regression testing’. They also ensure that all the necessary stakeholders are aware of the solution and its impact on the system.
It is quite apparent that we can learn from other professions all the time. What have you learned from other fields that have been useful in your work? I would like to hear from you...
p.s. Click here to read a wonderful case-study (sent in by my friend Sridhar Krishnan) on how the Great Ormond Street Hospital for Children in London improved coordination and collaboration between its surgery teams and intensive care units by drawing inspiration from and collaborating with Ferrari Formula One's pitstop crews.
Wonderful post, Ravi.
Be it small or big, about a week or so after the work is done, my plumber calls me up to see if everything is fine. I can tell that the call comes out of honesty and kindness. Not a call looking for more work. A natural ‘customer service’ attitude that he never got to read about in any book or learn from enterprises.
Keep them coming.
An apt comparison…there is indeed much that corporate managers can learn from the surgeon’s approach to his/her work (and vice versa). In addition to the examples you’ve quoted, Atul Gawande’s (https://en.wikipedia.org/wiki/Atul_Gawande) work, such as The Checklist Manifesto amongst others, has contributed much to not only improving surgical outcomes but also how general management methods used by successful surgical teams are also transferable to other domains.
I’m also reminded of Fred Brooks’ recommendation in The Mythical Man-Month (https://en.wikipedia.org/wiki/The_Mythical_Man-Month#The_surgical_team). Though set in the context of software development teams, the principle is relevant in other areas too, especially with respect to situation management.
Nice article, Ravi
Well thought out & written
Excellent article on learning and sharing Ravi. The underlying message that I picked-up was,
‘A passionate professional constantly thinks about his work-related improvement and never misses an opportunity in learning and adopting better ways of doing things’ . The same happened in the case of Martin Elliott, the heart surgeon.
That’s a really interesting comparison! Though the two fields are so diverse, when it comes down to essentials, it’s surprising how similar they are.
Very nice Ravi, a kind of eye opener for managers in the making.
If an organisation can follow / train the employees at seeding stage a lot of pain can be erased from the system / function.
Cheers and keep posting
A novel line of thinking, Ravi! Leadership requires one to be open and willing to learn from every source and opportunity. This is an example of that. Wonderful.
Both in its thinking and in the way it has been expressed, this is a great blog!
How can I be better tomorrow than I am today? The willingness to address this question leads one to find answers from different people and situations. You have beautifully distilled this philosophy to make us ponder about the joy of learning. Thank you!
Good analogy. Thanks for sharing, Ravi.