Preparing For Disaster

Atul Gawande, in his commencement speech at Williams College, gives a useful anecdote about what makes the difference between good patient outcomes and bad ones:

But there continue to be huge differences between hospitals in the outcomes of their care. Some places still have far higher death rates than others. And an interesting line of research has opened up asking why. Researchers at the University of Michigan discovered the answer recently, and it has a twist I didn’t expect. I thought that the best places simply did a better job at controlling and minimizing risks—that they did a better job of preventing things from going wrong. But, to my surprise, they didn’t. Their complication rates after surgery were almost the same as others. Instead, what they proved to be really great at was rescuing people when they had a complication, preventing failures from becoming a catastrophe. Scientists have given a new name to the deaths that occur in surgery after something goes wrong—whether it is an infection or some bizarre twist of the stomach. They call them a “failure to rescue.” More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more. This may in fact be the real story of human and societal improvement. We talk a lot about “risk management”—a nice hygienic phrase. But in the end, risk is necessary. Things can and will go wrong. Yet some have a better capacity to prepare for the possibility, to limit the damage, and to sometimes even retrieve success from failure.

In a somewhat related way, my current work involves a struggling manufacturing business.  We've got a lot of preventable problems to work out.  However, when something bad does happen, the guys on the shop floor are really good at running parts "on the fly" to fix it.  This gives me hope that if we can work out some of these problems, and the guys are left to do what they do best on a more consistent basis, we'll be able to get ahead of things.  It is some comfort that they seem to be able to rescue more.