Cowboys and Pit Crews
Instructions: 1) Read the article “Cowboys and Pit Crews” – AtulGawande commencement speech at Harvard Med School in 2011 reprinted in the New Yorker
2) Discuss the following three questions.
• Do you agree with AtulGawande’s perspective re the practice of medicine should be more like that of a “pit crew” or a “cowboy”? Why or why not?
• If you agree, what elements from the quality gurus (Walter Shewhart, Edward Deming, Joseph Juran, Donald Berwick) are relevant to moving medicine towards a “pit crew” approach? Why? (select elements from at least 3 gurus).
• If you disagree, what elements form the quality gurus are the most beneficial to improving quality and patient safety in health care in its current state in the U.S.? (select elements from at least 3 gurus)
Cowboys and Pit Crews
I agree with Atul that medicine should be practiced like a ‘pit crew’ instead of taking a ‘cowboy’ approach. Several reasons exist for this point of view I have chosen:
Medicine has grown in leaps and bounds in the space of a couple of generations. Today, we have cures for the majority of diagnoses that afflict us as human beings. Everyone looks up to medical practitioners in the belief that they know what is best since they are certified, but doctors don’t always perform to expectations. Health professionals have a duty to the rest of society especially now that people are struggling to get medical attention. The manner in which healthcare is practiced and organized is borrowed from an era when doctors held all patient information in their heads while managing everything by themselves.
Medical practitioners are trained to be autonomous, independent and self-sufficient while conducting a broad range of diagnoses and treatments. However, today it is not possible for one doctor to carry out all activities alone since they are diverse and more complex than before. One person cannot run the immunoassay, the protocol the MRI, conduct the physical therapy, and direct the treatment of an emergent cancer. More specialists are required today, per person, than in the 1970s when two practitioners were sufficient (Gawande, 2011). According to Atul, two million patients are likely to pick up infections in American hospitals merely because someone failed to adhere to the antiseptic precautions. Clinicians are more educated than ever before and have access to state of the art equipment and technology, but all these elements are not in sync with each other. Therefore, all these specialists must operate as a team rather than autonomously to give the best care possible.
Medical practitioners should encourage a pit crew mentality so as to arrest the unsustainable in healthcare costs. The medical performance follows a bell curve with a huge gap separating the best and worst results for a particular condition depending on where people receive their care. Costs follow a bell curve too with variations of thirty to fifty percent for similar patients. Interestingly, the curves do not match, and the places that are least expensive are the ones that get the best results (Gawande, 2011). The most expensive often receive the worst results hence we should strive to ensure that clinicians provide what is most necessary to society, better care at a lower cost. Places that operate systematically, like a pit crew, are more likely to be successful.
Joseph Juran stressed the need for extensive quality training in creating sustainable management practices. It goes without saying that training is a critical component of medical practitioners in every field. Sufficient training enables caregivers to come up with solutions to the problems that are unconcerned by data and experience. Apart from focusing on medical expertise alone, they should understand other complimentary skills like Information Technology.
Edward Deming, in one of his many points, suggested that we should be consistent in our efforts to improve product and service so as to be competitive and remain in business. Caregivers must strive to be at their best and offer significant help to patients. One sure way to improve the services provided by caregivers is by ensuring they cooperate and work together instead of being autonomous.
Walter Shewhart is a well-known
crusader of total quality management just like Juran. Every staff member must
make sure that they are committed to offering high standards in every aspect of
their work. When caregivers adopt the pit crew mentality, they are going to be
in a position to provide wholesome care.
Gawande, a. (2011). Cowboys and pit crews. New Yorker.