This morning’s Reith Lecture by Atul Gawande calls for a rethink of medical systems to transform healthcare. At the heart of his powerful message is a statement that medical professionals “are graduating from the century of the molecule to the century of the system.” In the last century, he says, we’ve discovered the gene that underlies disease or the neuron that underlies the way our brain works, we know the super-specialist that can deliver on a corner of knowledge - but as we graduate into the future, we are faced with a world where it’s how the genes connect together that actually determine what our diseases actually do. It’s how the neurons connect together and form networks that create consciousness and behaviour, and it’s in fact how the drugs and the devices and the specialists all work together that actually create the care that we want. Gawande draws evidence from his work with the World Health Organisation (WHO) several years ago when he was commissioned with the heavy task of trying to reduce deaths in surgery. Having worked with experts from different industries, including aviation and design, they created a checklist that was made specifically to catch the kinds of problems that even experts will make mistakes at doing. “The checklist had some dumb things – do you have the right patient, do you have the right side of the body you’re operating on? But the most powerful components are does everybody on the team know each other’s name and role, has the anaesthesia team described the medical issues the patient has? Has the surgeon briefed the team on the goals of the operation? Has the nurse been able to outline what equipment is prepared? Are all questions answered? And only then do you begin.”
When the checklist was tested in eight cities around the world - including St. Mary’s Hospital in London - in every hospital that used the checklist, the experts found that their complication rates fell. The average reduction in complications was 35 per cent. The average reduction in deaths was 47 per cent. And it’s been replicated in multiple places.
Gawande added his own personal anecdote, that when his mother had a knee replacement surgery, 66 people were involved, at one point or another, in her treatment. That’s 64 more than in an aeroplane’s cockpit. But it took a lesson from Boeing, who collaborated on the WHO project, to point out the need for better communications. Gawande concludes that, in spite of the expertise and dedication of experts, you need some basic communications systems to make things happen right.
I love it when someone who is regarded as an expert in a different field – in this case surgery and medical research – calls on better communications between professionals to solve their problems.
And take note of the message: a good checklist will ask the right questions and engage a team in making sure the answers are visible and shared; great things happen when people working together know each other, share their knowledge and communicate.