With the backdrop of vision, strategy and sales pitch, Atul Gawande gave a poignant talk on saving lives. As a surgeon, saving lives is his day job. Here, he was talking saving lives of soldiers. From American Civil War to Persian Gulf war in early ‘90s, and average of 25% wounded soldiers died. In that period, there has been tremendous increase in killing machines and healing machines. Although the number of wounded, died substantially decreased, the percentage remained about the same until Afghan-Iraq war. Suddenly, the percentage of soldiers died dropped to 10% of the wounded.
What happened? Was there a miracle drug or medical breakthrough?
One bright person after another asked, how can we save more?
Surgeons know, first hour after injury – called the golden hour – is the most critical. Smaller, agile troops go farther from the base and trip back to the base will take longer. Army created cavalry of about 6 trucks who could reach much farther than typical bases and could be setup to perform 4 patients simultaneously in about 60 minutes. This was an improvement of logistics.
these clinic outputs, they wouldn’t try to heal the patients completely and
many times wouldn’t even complete the surgery itself. They would bring the patients to a stage so
they could be transported to the big base. Doctors would wrap the wounds and patients;
leave a clear note on diagnosis, procedures done, next steps on the patient. The base would do the similar effort and
transport the soldier to the American base in
When army saw too many soldiers were dying because it was too heavy, they made it responsibility of the commanding officer to ensure this was enforced and change the culture.
When army saw too many soldiers were getting eye injuries from data analysis, they interviewed the young soldiers, who said, the protection goggles were ugly. Army redesigned the goggles’ with the help eyewear designing companies. Now, the very same soldiers wouldn’t even take them out even indoors.
Even though, changing the percentage from 25% to 10% was dramatic, at every stage, someone had to provide the data (doctors who send the information from the battle field after 20-hour work!) analyze the data deeply, be on the field to understand and verify.
Samuel Gorovitz and Alasdair MacIntyre wrote human deficiency has two reasons: ignorance and ineptitude. Ignorance is not knowing the right answer and ineptitude is lack of applying known, proven knowledge consistently. Until recently, in most fields, ignorance was the issue. In the last century, there has been so many improvements, ineptitude is catching up to be an issue. Modern work is complex. Any tool that removes the practitioner to remember things is a good thing. Feature built into product or an external checklist can help.
Lesson is, dramatic improvements in any field do not have come from Nobel winning ideas, although they are helpful. Consistent application of state of art will reduce the number of customers, patients who fall on the wrong side of statistics.
Everyone can do more with data: provide, analyze, feedback.
Now, what can you provide and what can you analyze?
-- I’m writing this more than a week after I listened to this talk. This was about 25 minute talk. This is what I recall. Any mistakes are mine.
-- I had a brief conversation with Atul when I got his autograph on Checklist Manifesto. When I thanked him for giving the idea for my checklist, he asked me if I was the one who blogged about using it and he would be interested in seeing the full checklist. I was pleased he knew about it.