Tag Archives: Atul Gawande

Those First Few Seconds – This Is When You Can Move Towards Winning, Or Lose Entirely

This is short, and to the point.  You don’t have long to make that good first impression.  And that first impression is close to the whole ball game.

Or, let me put it this away.  You may not “win,” (the job, the girl, the contract, the sale) in those first few seconds.  But you can certainly “lose” in those first few seconds.

Here’s the latest reinforcement for this.   It is from the gripping, lengthy article by Atul Gawande in The New Yorker: Letting Go: What should medicine do when it can’t save your life? (If you read this blog much, you know that I am a raving fan of Atul Gawande’s work). The subject is dealing with end of life issues.  It’s not an easy article to read.  But, I suspect, it is an important article to read.

But this blog post is not about the article itself, but about those first few seconds.  The quote comes from Sarah Creed, a nurse for a hospice service.  Here’s the quote:

The initial visit is always tricky, but she has found ways to smooth things over.
“A nurse has five seconds to make a patient like you and trust you. It’s in the whole way you present yourself. I do not come in saying, ‘I’m so sorry.’ Instead, it’s: ‘I’m the hospice nurse, and here’s what I have to offer you to make your life better. And I know we don’t have a lot of time to waste.’ ”

Here’s the life/business lesson:  in every encounter, ask yourself – “how do I set myself up to ‘win’ in those first few seconds?”

A Quote for the Day from The Power of Positive Deviance – “There are solutions”

So what does a surgeon like me do?  We look to those who are unusually successful — the positive deviants.  We watch them operate and learn their tricks, the moves they make we can take home.
Although the solutions to our health-cost problems are hard, there are solutions
.
(from the foreword by Atul Gawande).  The Power of Positive Deviance:  How Unlikely Innovators Solve the Word’s Toughest Problems by Richard Pascale, Jerry Sternin, Monique Sternin.

Let’s Call It The “We Can’t Keep Up” Syndrome

Here’s what I’m trying to say:  we don’t yet know how to do everything we are trying to do.  And that can be a real problem.

The totals are now beyond what most of us could have only imagined — and feared.  The total number of gallons of oil that have spewed into the Gulf from the BP disaster has probably surpassed 200 million gallons  (The figures are not precise — I did the math from this web site).  This is 18x the number of gallons from the Exxon Valdez disaster.  It seems like such a long time ago that Tony Hayward, and Haley Barbour, and others, stated that the Gulf was a big ocean and would easily disperse the oil harmlessly.  They were, sadly, wrong.  We have learned that lesson the hard way.

And the new iPhone is running into turmoil that is building day after day.  Partly because, in my opinion, AT&T was not yet ready to provide the infrastructure for all that technology.  It was too much innovation and implementation too soon.  The capacity to execute can not quite keep up with the needs of the era, with ever more challenging products and projects.  Consider this excerpt of AT&T CTO: ‘We will move heaven and Earth’ to improve our network by Anthony Ha (full article here):

When VentureBeat Editor in Chief Matt Marshall got a chance to ask AT&T Chief Technology Officer John Donovan a few questions on-stage, he asked what kinds of issues are holding back network quality. It’s a little bit of everything, Donovan replied. With a flood of new chipsets, phones, and applications, the traditional device testing and rollout methods have “broken down.” In addition, AT&T recently faced a shortage of the components needed to improve its network.

“I’ll tell you the things it’s not been,” Donovan said. “It’s not been capital, it’s not been conviction and commitment.” AT&T “will move heaven and Earth” to meet its customers’ growing data needs, he said.

I have blogged before (a few times) about the formulation from Atul Gawande’s The Checklist Manifesto, re. the two great problems:  ignorance and ineptitude.  Here’s the key quote:

We have just two reasons that we may fail.
The first is ignorance – we may err because science has given us only a partial understanding of the world and how it works.  There are skyscrapers we do not yet know how to build, snowstorms we cannot predict, heart attacks we still haven’t learned how to stop. The second type of failure the philosophers call ineptitude – because in these instances the knowledge exists, yet we fail to apply it correctly  This is the skyscraper that is built wrong and collapses, the snowstorm whose signs the meteorologist just plain missed, the stab wound from a weapon the doctors forgot to ask about.
For nearly all of history, people’s lives have been governed primarily by ignorance.

But there is a third problem, one that does not quite have a name yet.  Let’s call it the “we can’t keep up” syndrome.  Maybe it is a subset of one of the two by Gawande.  But it presents a unique challenge to the modern business environment.

It is not entirely new.  In the early days of television, there were television set makers dependent on television networks dependent on television makers.  It was a circle of interdependency, a complex set of interconnections, with officially disconnected but very interdependent companies needing every company in the mix to keep up.  And keeping up was tough.

Just in the last year, television stations have switched to HD, needing the cable channels to provide slots for their new HD channels, with the cable channels needing the stations to broadcast in HD.  Everything is so interconnected, interdependent.  Everyone has to succeed for anyone to succeed – one has to succeed for all to possibly succeed.

And then, the ripple effects.  There is now no doubt that people working in companies with much better safety records than BP are paying the price for BP’s failures.  Jobs are leaving the Gulf for other oceans across the globe.  The moratorium, which many object to (but – can you imagine if a second well had this kind of disaster right now?) means that costly equipment has to go where there is work.  And then the equipment will be run by a new set of workers.

But here is the deal.  Companies, entire industries, need to learn, adapt, innovate as they go…and it is tough to keep up.

Maybe the problem is not incompetence.  Maybe the problem is not ineptitude (though there were serious mistakes made).  Maybe it is simply that we are in a perpetual growth/innovation/need-to-get-it-right era, and there will always be a need for version 2.0 and 2.8 and 7.0 in nearly every arena.

If all it means is that I have to wait for the next software update on my iPhone, I’m ok with that.  But if it destroys the environment on the Gulf Coast for hundreds of miles, then it becomes a much more serious matter.

What Went Wrong? – A Question Worth Asking (wisdom from James Bagian)

James Bagian

Slate.com has a terrific interview up with James Bagian.  It is in their The Wrong Stuff: What It Means To Make Mistakes series.  This interview is titled: Risky Business: James Bagian—NASA astronaut turned patient safety expert—on Being Wrong by Kathryn Schulz.

Mr. Bagian was scheduled to be on the Challenger mission, and his crew was switched out.  He has studied failures/mistakes for many years.  His current job is director of the Veteran Administration’s National Center for Patient Safety. The entire interview its absolutely worth reading, but here is one brief excerpt:

You were part of the team that investigated the Challenger accident. Were you satisfied with how that investigation was handled?

Overall I didn’t have big problems with it. But one thing that was deliberately buried was what happened to the crew. I did that part of the investigation, and there was tremendous political pressure not to tell anyone what happened—not even the other people in the crew office. They didn’t learn for months, which was totally inappropriate. They wouldn’t even let us put in checklists about what to do in the case of a breakup similar to Challenger. (emphasis added). There’s ways you could probably survive it, but politically we weren’t allowed to discuss that for years, which to me is total hogwash. There are still many people that don’t understand that the crew of the Challenger didn’t die until they hit the water. They were all strapped into their seats in a basically intact crew module; their hearts were still beating when they hit the water. People think they were blown to smithereens, but that’s not what happened. And the problem with that is the same one we were talking about with regard to medicine: if you don’t learn what you can from a tragedy, you can’t mitigate that risk in the future.

The entire interview, without ever mentioning Atul Gawande’s The Checklist Manifesto, is an argument for such checklists – for multiple checks throughout the system – to reduce mistakes.

Studying what went wrong is truly worth the time…

“We Don’t Know It” & “We Blow It” – Two Paths to Potential Disaster

I mentioned to a group this week that I think The Checklist Manifesto by Atul Gawande is the most important book I have ever presented.  Not necessarily the best book – but the most important book.  I think about its principles, such as that our age is an age of great complexity, with nearly every news story I read.  I have blogged about it so often that my readers must be thinking, “Oh no – not another Gawande blog post…”

But today, as I was going thorugh the concepts  of the book yet again, these two simple phrases flew out of my mouth.

“We don’t know it”
and
We blow it.”

All mistakes that we make flow from one of these.  Here are the relevant quotes from Gawande’s book (emphasis added):

We have just two reasons that we may fail.
The first is ignorance – we may err because science has given us only a partial understanding of the world and how it works.  There are skyscrapers we do not yet know how to build, snowstorms we cannot predict, heart attacks we still haven’t learned how to stop. The second type of failure the philosophers call ineptitude – because in these instances the knowledge exists, yet we fail to apply it correctly  This is the skyscraper that is built wrong and collapses, the snowstorm whose signs the meteorologist just plain missed, the stab wound from a weapon the doctors forgot to ask about.
For nearly all of history, people’s lives have been governed primarily by ignorance.

Failures of ignorance we can forgive.  If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort.  But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.

In other words:
“We don’t know it” (our problem with ignorance)
and
“We blow it.” (our problem with ineptitude).

We don’t know it.
We blow it.

Solve these two, and we will have a much less troublesome world.

———–

To purchase my synopsis of The Checklist Manifesto, with handout + audio, go to our companion web site, 15minutebusinessbooks.com.