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7 Lessons from AHA's Leadership Summit

Cheryl Clark, for HealthLeaders Media, July 21, 2011

"The solution to that was that rather than have the surgeons do the prep, we now have nurses doing the prep, with just a few nurses who are trained in how to do it, all do it the same way every time using the same solution.

"But when it was first rolled out, one of the surgeons came in and said 'What are you talking about? I prep the patient. Why are you trying to do that? Don't do that.'

"It would have been pretty easy for the nurses to say, OK. Got it. You do it. You're the surgeon; you're in charge. But she said, 'No. This is important and this is why we're doing it. I'll get Dr. Vogel and he'll talk to you.' And she did. And he came in and told him...'Sorry you missed the communication this is what it's about.' The surgeon observed, and was on board."

Bergomi added that all too often, the "culture is such that when the surgeon says this is what you're going to do, people unquestioningly go and do it—particularly in the operating room setting. For a nurse to actually stand up and say 'No, you're wrong.' is a testament for us to sustain this over time."

4. Be less like cowboys, more like pit crews

The star of the forum was keynote speaker Atul Gawande, MD, a Brigham and Women's Hospital surgeon, and now well-known healthcare writer.

Gawande's latest catchy phrase, "Cowboys to Pit Crews," describes the dramatic change he sees necessary for healthcare to be more effective. Doctors, he argues, must behave like team players rather than individuals. In the 1970s, Gawande said, only 2.5 full-time equivalent providers were necessary to take care of a sick patient. Today it is 15.

"We're in the midst of trying to make a transition of what I call going from cowboys to pit crews," he said. "We've rewarded, hired, and trained people to be cowboys, but it's pit crews we need. Pit crews for patients. Whether we call them accountable care organizations or medical homes or just getting your staff together to go in the right direction. This is the fundamental cultural battle we're struggling with," he said.

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