Thursday, March 8, 2012

Part II - What Doctors and Healthcare Can Learn from the New England Patriots

Although my team, the New England Patriots lost Super Bowl XLVI to the New York Giants in one of the most exciting and tense games in recent memory, reviewing both the pre and post game coverage provided even more learning for doctors and healthcare than my prior post. One can demand excellence and still fall short. When one fails to achieve the intended goals, the learnings can be as important if not more so than when one is successful. In the latter, you assume that you understand the reason for success. In the former, you must investigate to determine problems. It is the approach that matters.

CEO of the Patriots, Robert Kraft noted in a post Super Bowl conference that statistically every NFL team has a 6 percent chance of reaching the Super Bowl and consequently a 3 percent chance of winning. Over the past decade, the Patriots have been in half of them. An impressive statistic considering other teams have equally dedicated players and coaches who also are focused on success. So what makes the Patriots so successful?

One learning is the true meaning of teamwork. Sure football is a team sport, but are the players and coaches truly a tight knit team on the same page for excellence?  Prior to the 2002 Super Bowl, players were introduced onto the field individually by name. Hearing your name called out and then running out onto the field to a crowd of screaming fans undoubtedly is a thrill for every player, particularly when it is the Super Bowl. Yet for the Patriots that year, this was not the case. Earlier that season at an away game, a mix-up in the team introductions had the team unprepared. Instead of the usual player introductions, the team instead raced onto the field as a team rather than individually.

Then 9/11 happened. For the remainder of the season, the Patriots found it fitting to continue dash onto to the field as a team as the nation came to grips of an unspeakable assault on our country.

Hours before 2002 Super Bowl kick off, head coach Bill Belichick notified his team that the NFL and television network required that the team be introduced as individual players. To come out as a team would be in violation of policy.

What did the team want to do?

They ran out as a team. The first time ever that has occurred. As noted on ESPN by former 49er quarterback and football analyst Steve Young, that tradition has continued to present day and shifted the focus back from the individual to the team, the right thing for football.

And perhaps this is the right thing for doctors and the health care system. How often do hospitals and health care organize themselves around having the "best" doctor? How often do people ask, who is the "best" surgeon, internist, oncologist, cardiologist. Is medical care really about one person or is it about having the right team? Dr. Atul Gawande, author, New Yorker writer, and surgeon, noted in his commencement speech titled, Cowboys and Pit Crews, at the Harvard Medical School in 2011 that today.

“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves... But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”

“...We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.”

It really should be about the team and not the individual. This is particularly true when it comes to medical errors. When a wrong site surgery occurs or a medication is administered at a dosage that exceeds safe usage, the question in health care is - "Who is responsible?" As noted safety expert and UCSF professor Dr. Robert Wachter notes in a 2004 interview when a medical error occurs at a hospital -

"...people invariably point fingers at that place and person and lose sight of the systems failures that are really responsible. Look at it this way -- ask anyone if they've seen a medical error and they'll immediately tell you a story about one. Could it possibly be that all doctors and nurses are careless and stupid? Or, perhaps, does the ubiquity of the problem indicate that something deeper and far more interesting is going on?"

So in the true meaning of teamwork, should something happen, the team is accountable not necessarily the individual. The team owns the problem and does not leave the individual alone, unsupported, or in shame. Even after the most recent Super Bowl loss when many people picked up on individual player errors of dropped passes, including one from wide receiver Wes Welker, one of the most sure handed receivers in the NFL, which likely would have resulted in a Super Bowl win, no one from the team scapegoated him or others. As quarterback Tom Brady put it in the post Super Bowl press conference -

You win as a team and you lose as a team. Certainly it wasn't one play is the reason that we lost today. Everybody feels that we could have done more....

There was some missed opportunities.
When surveyed on the Boston Globe on who should be blamed most for the Super Bowl loss, quarterback Tom Brady, head coach Bill Belichick, the Patriots defense, or the receivers Aaron Hernandez or Wes Walker, the majority of votes distributed the blame evenly across the team. It was not just one person.

Yet in health care, we do a terrible job in supporting others when errors happen. We often assume the individual was at fault rather than a collective fault or system failure. Health care professionals who have dedicated their lives to saving lives are devastated. Some commit suicide after a medical error.

Finally the last learning is leadership, having a vision, and understanding what really matters. All season long as his young defensive unit was getting dogged in the press as being among the worst in giving up total yards to other teams, Belichick calmly noted that it wasn't about that statistic which mattered, but what was the win - loss column. Hard to argue with that as this team did make the Super Bowl.

Belichick is known to resist the status quo. He's a football coach, not a fashion model, yet was mandated by the NFL to wear Reebok sanctioned clothing on the sidelines to look nice. What did he do? He picked up the ugliest piece of clothing he could find, the hoodie.

There was no way to opt out of that deal so Belichick considered the fashion options laid out in front of him, and selected the most unstylish outfit, a grey hooded sweatshirt. He began wearing it each week. Only not before having the sleeves cut off to make it even less attractive.

“It’s comfortable,” Belichick said in explaining his fashion choice. “I carry my stuff in my pouch.”

What about chopping off the sleeves?

“I have short arms,” Belichick said.

The irony is the “BB hooded sweatshirt” became a hot seller. It was so bad, it was cool. It now comes in all sizes and colors, even women’s versions. They sell for about $80
As a coach and leader, he knows what really matters: putting his players in a position to win. This is what leaders do and what players and analysts noted repeatedly up to the game. Belichick does everything possible for them to succeed. Near the end of the game, Belichick understood that the Giant offense had a high probability of scoring a touchdown and he needed to give his future hall of famer quarterback Tom Brady time to score. So he asked his defense to let the go ahead touchdown to go through to allow maximum time on the clock.

Good move? Well the outcome and the win for the Patriots didn't happen. But, it was the right leadership decision and recognized by Giants quarterback Eli Manning, who "had ordered [Giants running back] Bradshaw to take a knee."

Do we in health care have these leaders who can create environments that allow doctors and other care providers the opportunity to be successful? Do we have leaders who truly have vision and know what really matters?

Even without a Super Bowl win, we can still learn a lot from the New England Patriots. A true culture of teamwork matters and exists when we can still support each other not when things go smoothly, but when things don't. We need to have leaders who not only have vision, but also the discipline to do the right thing and challenge conventional thinking and the status quo.

Only then can health care truly transform and be what Americans want and deserve. 

Though I look forward to next year, there obviously is much unpredictability in which team reaches the Super Bowl. I'm certain the Patriots will have another successful year.

Congratulations to the NY Giants and their team, coaches, and leadership.

Unlike football, where there is next year and they need to perform for a game at a time, for us we need to get a win with every patient everyday at every moment. Our performance can never lapse.


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