Wednesday, February 29, 2012
Each year, there are amazing technology demonstrations at TED. Jack Choi of Anatomage blew us away with this demonstration. (When I first typed that name, I made a typo and typed Anatomagic. That might be a more appropriate name.)
Atul Gawande is a rock star. From the moment I started to read his book The Checklist Manifesto until the last word, I was spellbound. Gawande writes fluidly, simply, and with great insight about issues in healthcare. He speaks as engagingly as he writes.
Checklists have worked in other industries, like aviation and major construction, to reduce errors. The Checklist Manifesto is about importing those ideas into medicine. And Gawande showed how it worked. As a result of this work in his own hospital, Gawande was commissioned by WHO to devise a surgical checklist that could be implemented around the world.
Here's the checklist:
The checklist was piloted in eight hospitals around the world, ranging from a rural hospital in Tanzania to world-class teaching hospitals in Toronto and Seattle. There's a knack to making such a good checklist - it had to be general enough to be applicable anywhere, it had to cover the most crucial items, and it couldn't be so long that no one would use it. The result was a 19-item, 2-minute check list with 3 pause points. You can see how obvious some of the steps are on the list above. It's standard that antibiotics are given before an operation to reduce the probability of infection. Really, now, would people forget such a simple step? Introducing yourself to everyone on the team? Give me a break. Surely that would be obvious, especially in a situation where unambiguous communication might be life-or-death in an emergency that could arise. Apparently these things are not that obvious: introduction of this checklist reduced complications by 35% and deaths by a whopping 47%. 47% reduction in deaths!! Not by fancy new technology, but by systematizing what everyone already knew was the right thing to do.
In today's TED talk, Gawande talked a bit about check lists, but mostly he talked about the culture and philosophy of medicine. Medical culture was established back in the days when medical knowledge was sparse, specialists were few, and doctors practiced heroic medicine. There were few treatments that had been proved effective, and doctors were often heading into uncharted waters and you had to be bold to try a procedure that might help.
Today, the medical environment is completely different. There are known treatments for most diagnoses - over 4,000 proven medical and surgical procedures and 6,000 drugs. No one professional can know everything, and medical practitioners are now deeply segregated into their specialities. It's all about working as a team, within a known, systematic framework. But that's not how doctors have been trained. Our system has trained cowboys. What we need are pit crews! We need to focus, not on individual heroics, but on values like team work, discipline and humility.
Sitting on a hospital board, and thinking a lot about how innovation could take place in healthcare, it seems clear that individual components of the healthcare system can work very well, but the system overall is a mess. Our hospital delivers fantastic care as a rehab hospital, but it is at the transition points between acute care and our hospital, and between our hospital and the home that the cracks in the system appear. Ironically, as I've observed in businesses, fixing a broken system yields efficiency, effectiveness, customer satisfaction and cost savings.
Yet, because of cultural issues, Gawande says that adoption of the surgical check list has been slow and has had to struggle against the resistance of the autonomous, lone-hero vision of medicine. Yet this simple change would save both lives and money. The cost of adoption - namely training and engagement of staff - should be small compared to buying another sophisticated piece of medical technology.
Gawande's talk was totally inspiring to me, and I leapt to my feet in a standing ovation. I was somewhat surprised that only about 40% of the audience joined me. I guess this kind of system thinking is not as sexy as some of the other talks we're hearing.
Tuesday, February 28, 2012
Yet the world does not sufficiently value introverts. Teachers rate extroverts more highly. Extroverts have an edge in promotions in the workplace. And the world is becomingly increasingly hostile to introverts.
Education systems have a singleminded emphasis on group work. Even classroom arrangements that have shifted from individual desks to group pods mark a transition to an environment that is difficult for an introvert who wants to think things out alone. This is particularly true in the MBA schools where I teach. There is an enormous premium placed on the skills of oral presentation and relatively little on the value of writing cogently. This is reasonable, given that we know success in business is linked to this presentation skill. After an interesting exchange with a very capable and introverted student this year, it got me thinking whether the B-School establishment was perpetuating this tendency. So Cain's talk really struck a nerve today.
Many great transformational leaders have been introverts, and their strength has often come from a time of contemplation alone 'in the wilderness'. But today, we are tending more and more to be led only by extroverts - and the ones who talk loudest at that.
Cain offers three Calls to Action:
- Stop the madness for group work. Provide introverts and extroverts with an environment that brings out their best work.
- Go to the wilderness. Give yourself time to think alone and unadulterated by the voices of others.
- Do the self-examination to figure out which style brings out the best in yourself, and try to find an environment that suits your style.
TED is known for putting together an eclectic program that features ideas from all different disciplines, leaving the attendees to make the linkages among the talks. Today, we had back-to-back talks on the same topic, presenting oppposite views.
First up was Paul Gilding. Former global CEO of Greenpeace, and author of The Great Disruption, Paul's message was clear: the earth is full. We need 1.5 earths to maintain our current economy. This growth will therefore have to come to a stop, because of the laws of physics, chemistry and economics. Since this crisis is inevitable, the only thing left for us to do is to choose how we will react and how early we will react. The earlier we react, the less the cost will be and the gentler the landing. However, if we don't prepare for such enormous disruption, it will be truly ugly.
Paul was frank in saying his purpose was to instil sufficient fear to overcome complacency, change people's behaviour and drive an urgent commitment to change.
The next talk was by Peter Diamandes. Peter runs the X Prize and is a co-founder of the Singularity University, with Ray Kurzweil. He is a disciple of the Kurzweil doctrine that we all underestimate the pace of technological innovation: such innovation always advances exponentially, whereas our expectations tend to be linear.
Because of mankind's ingenuity and the relentless laws of change (think Moore's Law which says computing power doubles about every 18 months), challenges that look insurmountable today will certainly be overcome by technological improvements tomorrow. The earth is nowhere near full. There isn't any real scarcity, just accessibility problems. There's lots of solar energy to support us - we just have to harness it. There's lots of water; we just have to harness the oceans. In essence, Peter was saying, "Don't worry about it. We got it."
Chris Anderson asked for a show of hands supporting Peter or Paul. The vote was almost even, with a slight edge for Peter's optimism. That was an interesting result in a crowd that has been accused of unreasoning Silicon Valley optimism.
To me, there was huge irony in the question. If you really believed Paul's message of doom and took action, then Peter's prediction is likely to come true. If you sat back comfortably, believing Peter's optimistic message, then perhaps Paul's prediction would come true. Is that self-unfulfilling prophecy?
Monday, February 27, 2012
Music was a big part of this pre-day at TED and I loved it all!
The block party tonight featured the band Red Baraat. This brass and percussion band played rollicking, energetic music that had people really bouncing on the dance floor. In preparing for this post, I did a bit of research, and that drum the leader plays at both ends is called a dohl, and the music is derived from Indian wedding music. Listen to this video of their performance at the Montreal Jazz Festival, and see if it makes you want to go to an Indian wedding, the way I do!
Earlier in the afternoon, I was captivated by the lovely voice of Meklit Hadero. She's from Ethiopia and lives in San Francisco and her music shows the influence of both places. Here's a link to hear her.
The always ebullient Robert Gupta was back to treat us to some Bach. I can't get enough of Robert Gupta. In fact, in curating the TEDxIBYork conference, the first TED talk video I elected to include was Gupta's. Do watch it; it will pull at your heart strings. Amazing again today.
Another great experience today was listening to Abigail Washburn on the banjo. She was delightful.
Equally fascinating was her back story. With a passion for changing the world through justice systems, and fluency in Chinese, Washburn was on her way to China to study law. However, she stopped at a Kentucky Blue Grass Festival with her newly-acquired banjo. She was invited to jam with a few musicians and all of a sudden, she was offered a recording contract in Nashville. So off she went to build a career in music and to charm audiences around the world with her banjo and songs - in English and Chinese! Washburn is still committed to bettering the world, and her TED Fellow descriptor lists her as a singer + banjo player + cultural activist. But, as she says, US-China relations didn't need another lawyer.
Catch some video of her singing in Chinese here.
The TED Fellows program is designed to bring together young world-changers and trailblazers who have shown unusual accomplishment and exceptional courage. The program targets individuals from the Asia/Pacific region, Africa, the Caribbean, Latin America and the Middle East, though anyone from anywhere in the world, age 18 and over, is welcome to apply. This is the description of the TED Fellows program on the web site.
Today there were two sessions featuring TED Fellows and what a remarkable and diverse group they were.
My favourite talk was by Myshkin Ingawale, an exuberant young man, who is the founder of a medical device company, BioSense.
The first product of BioSense is ToucHB, which does cheap, on-the-spot prick-free blood testing for anemia.
As with so many who tell their stories on the TED stage, Myshkin was motivated to develop this device after a visit to a village in India with a doctor friend. A woman and infant had just died due to hemorrhaging after childbirth because of the mother's anemia. Yet anemia is so easy to diagnose, and so cheap to treat. But not easy to diagnose in an Indian village far from the nearest healthcare clinic to have the $10,000 machine that could do the diagnosis.
Myshkin's device looks very much like the device that might go over your finger in a western hospital to monitor the oxygen level in your blood. It works by analyzing three wavelengths of light passing through the tissues. ToucHB measures the oxygen level, but adds the crucial data about anemia.
Myshkin ended with a map of the incidence of deaths from anemia after childbirth in the world today, with hot spots in parts of Asia and South America. He has the modest goal of wiping all those hot spots off the map through his device, which brings healthcare to the people, instead of people having to go long distances to a clinic.An inspiring young man.
Both the developed and the developing world have major healthcare problems, although they are very different. Through my study of the power of disruptive innovation, and my work on a hospital board, I am convinced that the only way to solve these healthcare problems is to put the right tools for diagnosis and treatment into the hands of less skilled people, and ultimately each of us individually. Myshkin's on the right path.
It's that magical time of year. The balloon is up. Literally. There's a big TED balloon floating over the Long Beach Performing Arts Centre. The lamp posts are festooned with TED banners. The exhibits are open. The first talks have been delivered. I'm excited.
Today I joined the eclectic group of people who've put on TEDx conferences around the world. Most of them are at TED Active, the sister conference in Palm Springs that gets a live feed from Long Beach, and purportedly has a lot more fun than we do! We had a tour of the many exhibits around the venue. That was a real treat, because I find there's just never enough time to absorb all the great ideas sprinkled around these exhibits. It was a tough choice between that and a two-hour master class in Improv, but I think I made the right decision.
TEDx is a fantastic story of innovation, of people starting out with modest ambitions to allow people to host their own TEDx conferences around the world. They sought the right balance between protecting the brand with rules and guidance, and freedom to let the idea flourish. Well, it worked beyond their wildest imagination. In three years:
- 3,500 TEDx conferences - quantity
- 1,000 cities in 128 countries - diversity
- more TEDx talks than from any one TED conference, 10% of TED.com and growing - quality
There's a little green dog tag on our name badges for TEDx organizers, and I must say I'm proud to wear it.