In the introduction of Taking the Medicine, Druin Burch writes that, "Doctors, for most of history, have killed their patients far more often than they have saved them." When we think about shoddy medical practices, we think about bloodletting and leeches. But as recently as the 20th century, medical professionals have claimed that amphetamines helped student concentrate, antidepressants caused people to commit suicide, and "pregnant women should drink Guinness." What can people in business learn from medicine?
Recent medical progress is not only the story of better drugs, more effective treatments, and seamless surgeries. In the last four or five decades, medicine has made several intellectual leaps, and not just technological and pharmaceutical gains. Medical researchers understand the value of experimentation, control groups, and double blind experiments. Hospital administrators study hospitals from a systems perspective to reduce misdiagnoses, lower costs, and improve patient wait times. Instead of blindly accepting the status quo--bloodletting and leeches were considered useful remedies for over a thousand years--we're using reason, and not superstition, to search for what works and abandon what doesn't.
When we look for business wisdom, we typically start in the business aisle. Medicine is a much more lively, though sometimes morbid, illustration of why effective management, smart experimentation, and clear thinking matter. Below are three business insights gleaned from three books found in the medical aisle: Atul Gawande's The Checklist Manifesto, David Wootton's Bad Medicine, and the previously mentioned Taking the Medicine, by Druin Burch.
1. To improve performance, change the environment and not the individual.
Why do doctors make mistakes?
In The Checklist Manifesto Atul Gawande distinguishes between errors of ignorance (screwing up because we don't know what to do) and errors of ineptitude--the mistakes we make because we don't use what we already know. Drawing from the aviation industry, Gawande suggests that surgical teams adopt checklists. Checklists are not instructional but designed to prevent trivial mistakes by reducing cognitive load. Instead of remembering dozens of small tasks such as hand washing, the checklist outsources memory. And because nurses manage the checklist, fewer errors result from command and control style management.
It works. Gawande reports that in 2012, eight hospitals that adopted checklists saw complication rates fall 35 percent and death rates 47 percent. We tend to think that medical errors result from lazy thinking or incompetence, but they are often circumstantial.
When Steve Jobs strategically placed the bathroom in the center of the Pixar headquarters, he was nudging employees to collaborate. Mayor Michael Bloomberg famously used an open office "bullpen" to encourage accessibility. The controversial "Six Sigma" dramatically reduced product defects for big companies like GE. Commentators debate how effective these initiatives are but the general insight is correct. If you want to improve performance, change the environment instead of obsessing over the individual.
2. Embrace experimentation and tinkering; hope for serendipity.
The story of medical progress goes something like this: an inventor (Alexander Fleming) investigates what he knows (the properties of stapholycocci) and uncovers something else (penicillin), which changes the world. James Lind unknowingly discovered a cure for scurvy--nearly two hundred years before the properties of Vitamin C were known--by tinkering with remedies that included sulfuric acid and vinegar, but also fruit.
Burch discusses other examples in Taking the Medicine. In 1847, Ignaz Semmelweis noticed that women in a ward run by doctors were dying at a rate nine times higher than women in a ward run by midwives. He reasoned that since midwives did not perform autopsies, doctors must be transferring puerperal fever (or childbed fever) from the corpses to the mothers. Semmelweis was right, and the solution was simple: hand washing. (Unfortunately, the use of antiseptics would come many years later with the help of Joseph Lister and Louis Pasteur.)
Business is filled with similar serendipitous moments, from the Post-It note to Gmail. Regular business readers might be familiar with 3M's 15 percent time and its imitators, such as Google's 20 percent time. These initiatives encourage employees to spend a certain percentage of their work hours experimenting with personal projects. The idea is to allow smart people to tinker with small projects that are intrinsically motivating. There's a place for top-down innovation, but it should never snuff out bottom-up experimentation.
3. Don't conflate what you can't see with what doesn't exist.
Too many times a drug (Thalidomide), habit (smoking), food (trans fat) or procedure (Lobotomy) was deemed safe--even beneficial--and then ultimately harmful. It takes years to overturn accepted but dubious medical beliefs. And when someone questions the status quo, he is confronted with this response: "Yeah, but do you have any evidence that the status quo is bad?"
Conflating evidence of no harm ("nothing suggests that trans fat is bad") with no evidence of harm ("therefore trans fat is good") is a common mistake in medicine. For example, in the 1910s, before cigarettes were mass produced, it would have been difficult to link smoking to lung cancer, yet it would have been impossible to rule out the possibility that smoking does not cause lung cancer. Tragically, that's precisely what thousands of doctors and pharmacologists did.
This oversight echoes an idea embraced by several innovators, including Henry Ford, who knew to ignore customers who demanded faster horses, and Steve Jobs, who observed that "people don't know what they want until you show it to them." In other words, Ford and Jobs did not conflate what the market said, with what actually existed.