What is in common between all the following?
- surgeries
involving multiple complications (and hence multiple specialists),
- sophisticated
aircrafts,
- building
skyscrapers, and
- disease
control in slums exposed to multiple sources of infection.
Complexity.
Atul Gawande is renowned surgeon.
However, his reputation as a surgeon has gradually been eclipsed by that of him
as a celebrity author. In this book, he addresses the challenge of extreme
complexity. Most of the examples for complexity in this book are in his domain
– health care. He also tells us stories involving: a passenger aircraft when
engines inexplicably stalled; the builders of an unusually designed skyscraper
who realize it had a fatal design flaw; surgeries in various operating rooms
around the globe; threats and challenges created by a natural disaster. What is
the single tool that can enhance your chance of success in these diverse
conditions? The humble checklist.
Gawande builds up his case by starting
by describing complexity in the operating room. Conditions that would have been
considered irreversible or fatal a few decades ago are now handled by advances
in medical science. No one person can master all these advances. A team of
medical professionals who specialize in amazingly small niche areas work on a
treating a single patient. But the collection of these amazing talents comes at
a price - complexity. The larger the team, the more tangled the wires of
communication.
This not unlike the builder’s
profession. The master builder of the 18th century Europe could design and a
building and coordinate the work of various specialists to get it built. Modern
skyscrapers far exceed the capacity of the single individual to mastermind
their construction. You need more than a smart master builder to coordinate the
work of architects, designers, plumbers and electricians to build constructs
that would have been considered impossible two hundred years ago. The scale of
what is possible has grown considerably; and so has the price that we have to
pay, should things go wrong.
There was a pivotal event that
resulted in this book. Gawande receives a phone call from Geneva, from someone
who works for the World Health Organization. Would he agree to host a forum to
improve the surgical safety in the operating rooms worldwide? After some
persuasion, he agrees to convene a meeting to start looking for answers. The
benefit of working for WHO is access to all the data. Professionals from around
the world meet, share their stories, and launch a pilot program to observe and
improve the surgical conditions round the world.
The progress of the program is
interwoven with more stories of complexity and what works and what doesn’t. The
stories are well chosen and well told. The common thread is commitment to
checklists, customization of the checklist to local conditions, and
communication among participants.
He shares the results of the program
that spans various continents, cultures and economic conditions. The results
are nothing short of miraculous. The checklist works!
I expected the book to end with a
story of heroism where Gawande turns a hopeless situation around using his new
weapon, the checklist. He surprises us with a story of his mistake that almost
turns fatal. A nurse saves the day due to her diligence. It was the checklist
and a nurse that are given credit for the final win. Gawande surprises you
again, with his humility.
I find the book a timely refresher for
people like me in software development, when everyone in the industry is
preoccupied with technical advancements. When your development engineers have
to work with technical specialists, user experience engineers, dev-ops
engineers, vendors and infrastructure providers, in addition to managing an already
complex schedule, and unforgiving SLA agreements, what can you do to minimize
the chances of messing up? Does it get any worse if the people involved are
geographically spread out? How negotiable are the rules when the local
conditions vary? I believe Atul Gawande has provided the answers.
I highly recommend this book.
(Originally published in LinkedIn, February 2019 by Anand Kannan)
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