Why surgeon and author Atul Gawande says risk is necessary

Smart thinker

Atul Gawande is using his years of experience in the medical field to address problems in the world, and he challenges others to do the same.

Who is he?

Gawande is a Harvard-trained surgeon, Rhodes scholar, World Health Organization program leader and New Yorker writer who specialises in process improvement and decision-making.

What makes him a business thinker?

His knack for drawing connections between the complex problems of surgery and problems in the wider world has made him a favourite with business readers. In one article for The New Yorker, he explored why a fast-food chain called The Cheesecake Factory was able to deliver higher consistency of results than hospitals did, while still controlling costs.

Gawande’s book, The Checklist Manifesto: How to Get Things Right, made the case for everyone, even experts, to tick off essential items in complex projects – not just surgical procedures but jobs like construction.

Summary: If 30-year flight veterans all use checklists before take-off, you should try doing the same for your critical tasks.

“The difference between triumph and defeat, you’ll find, isn’t about willingness to take risks. It’s about mastery of rescue.” Atul Gawande

Who recommends him?

Former US treasury secretary Timothy Geithner praised Gawande’s book Complications as a guide to crisis management.

“It’s about making life-or-death decisions in a fog of uncertainty, dealing with the constant risk of catastrophic failure,” Geithner told interviewer Jon Stewart.

What’s that about M&Ms?

The Checklist Manifesto explains why rock band Van Halen’s concert contracts used to specify that their dressing room contain a bowl of M&Ms, with all the brown ones removed. It was a test: the band wanted to determine how carefully each venue manager was reading the band’s detailed requirements for accommodating its complex, heavy and potentially dangerous arena set-ups.

Gawande on lowering errors by boosting teamwork, in a talk at the Sydney Opera House:

“[Our surgical checklist] was a two-minute, 19-item checklist, mostly about teamwork, a scripted huddle, like in an American football game. And we tested in eight cities, and in every city you had a reduction in complications. The average reduction in complications and deaths was 47 per cent.”

On judgment, in surgery and beyond, speaking at the Williams College commencement, 2012:

“[New research on differences in hospital death rates] has a twist I didn’t expect. I thought that the best places simply did a better job at controlling and minimising risks – that they did a better job of preventing things from going wrong. But to my surprise, they didn’t. Their complication rates after surgery were almost the same as others.

Instead, what they proved to be really great at was rescuing people when they had a complication, preventing failures from becoming a catastrophe.

“Scientists have given a new name to the deaths that occur in surgery after something goes wrong – whether it is an infection or some bizarre twist of the stomach. They call them a ‘Failure to Rescue’. More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more.

“This, in fact, may be the real story of human and societal improvement. Risk is necessary. Things can and will go wrong. But some have better capacity to prepare for the possibility, to limit the damage, and to sometimes even retrieve success from failure.”

This article is from the August issue of INTHEBLACK

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August 2015
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