Cowboys, Pit Crews, Doctors and Checklists — A Summary of What We Do

CowboysPitcrewsIn this TED video, Atul Gawande compares cowboys and pit crews as he discusses solutions to broken medical systems. He also, inadvertently, offers a brilliant summary of what we do here at Peregrine every day—we help managers (a) analyze problems, (b) develop systems that help solve those problems, and/or (c) implement the solutions. We make complex systems work better.

I love that Gawande emphasizes the value of checklists. The systems in which we live and work are so complex today, “we can’t know it all, we can’t do it by ourselves.”  Turns out, these days, even cowboys use checklists.

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Excerpts and key points:

  • “You can’t make a recipe for something as complicated as surgery. But, you CAN make a recipe for how to have a team that’s prepared for the unexpected.”
  • There was a time when we functioned as craftsmen. It used to be that “…what was known you could know, you could hold it all in your head, and you could do it all. [For the physician,] if you had a prescription pad, and a nurse, and a hospital… you really could do it all. You set the fracture, you drew the blood, you spun the blood and looked at it under the microscope…. This was a life as a craftsman.”
  • Today, work/life is so complex, “we’ve reached the point where we’ve realized we can’t know it all. We can’t do it all by ourselves.”
  • “We’re all specialists now…. Everyone only has a piece of the [solution].”
  • Rationale for change:
    • “Holding onto the structure we’ve built around daring, independence, and self-sufficiency has become a disaster. We have trained, hired and rewarded [workers] to be cowboys. But what we really need is pit crews.”
  • We need better systems—systems that help us do the following:
    • (a) Recognize success and failure – “When you are a specialist, you can’t see the end result very well. You have to become really interested in data, unsexy as that sounds.”
    • (b) Devise solutions– Sometimes useful solutions include tools as simple as a good checklist.
    • (c) Implement the solution(s) – To get “colleagues across the entire chain to actually do these things.” Often this is “…slow to spread. This is not yet our norm… making checklists.” We’re rather resistant to it. We think we can go it alone.
  • On resistance to checklists:
    • “There’s a deep resistance because using these tools forces us to confront that we’re not a system, forces us to behave with a different set of values. Just using a checklist requires you to embrace different values from the ones we’ve had like humility, discipline, and teamwork. This is the opposite of what we were built on—independence, self-sufficiency, and autonomy.”
  • On adoption of checklists:
    • “I met an actual cowboy. I asked him, what was it like to actually herd a thousand cattle across hundreds of miles? How did you do that? And he said, ‘We have  cowboys stationed at distinct places all around. They communicate electronically constantly, and they have protocols and checklists for how they handle everything.’ Even the cowboys are pit crews now.”

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Come join Joe Halpin and me at the North Bay ATD meeting on Tuesday, 19 Apr 2016 (5:30p), for a fun and insightful discussion on how to build damn good job aids. No cost to first time visitors. Here are the details.

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For professional assistance thinking through your complex workforce performance issues and/or designing and developing performance support tools (e.g., checklists and other job aids), contact Peregrine today.

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Posted in: Analysis, Consulting, Innovation, Job Aids, Manager Tips, Performance, Performance Support, Tools, Training

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