12 healthcare books for Yuletide — No. 4
Reading suggestions for the healthcare nerd in your life
Let me ask you a question.
If I gave you two free, first class return tickets to somewhere exotic with the prospect of two weeks enjoying some excellent beaches and some five-star service somewhere luxurious … would you want to go?
I’m guessing - on balance - the answer would be yes.
Let me be more specific.
Would stepping onto the airplane and turning left cause you a flicker of fear?
No?
That’s sensible. You are really not doing to die on the airplane. Later, swimming in the pool trying to balance your pina colada on your lilo … maybe. But not on the plane.
How do I know? Because the chances of dying in an jet plane was roughly 1 in 5.8 million take-offs in 2022.
To realise why that is to all extents the same as ‘zero’, work out how long it would take - flying to your exotic destination of choice and back again every day, repeatedly - before you had enjoyed 5.8 million take-offs.
A couple of years? A decade? A lifetime? Several hundred years maybe?
No.
It’s eight thousand years. At least a couple of millennia longer than recorded human civilisation.
Of course, that’s reassuring for us when we go on holiday.
So let us contrast that with the chances of being the subject of an adverse event while an inpatient in a hospital. Not any hospital. Your hospital. A good sized, well stocked western hospital. With eager, well qualified doctors and nurses.
The answer? Around 1 in 10 patients suffer an adverse event - half of which are preventable..
It’s not a good look.
Does this matter? Well, about 3.6% of hospitals deaths are considered avoidable, and half of us die in hospital so, as they say in the US: “Go figure”. Or perhaps “Do the math”.
We clearly need to do both.
Yesterday I left you nursing a sore head from an academic book that you should read, (but probably won’t). It urged us using significant doses of well-argued prose, to think differently about patient safety, bringing systems thinking to bear on the problems that occur (and recur) in healthcare.
Sadly, the hangover is going to linger as you read this next book. But it does explain what needs to be done.
Title: Black Box Thinking
Author: Matthew Syed
Date of Publication: 2015
Amazon rating: 657 in Psychological Training & Coaching
Why you should read it
Because at some point you need realise how bad healthcare is at learning.
Synopsis
The black box of the title is that Black Box Recorder that makes the news on the rare occasions that a jet hits the ground. This black box is a near indestructible record of all the data gathered by that plane. It includes the cockpit recordings, as well as many of the readings from the equipment and instrumentation.
And when a plane goes down, this record is studied in exhaustive detail to help explain exactly what went wrong. When its secrets are revealed, the conclusions provide the basis for the changes that the airline industry agrees - as a whole - to ensure it should never happen again.
As a result of this approach - this thinking - we get near-zero fatal incidents in aviation.
What Syed does in an easily readable journalistic style is to show how the examination of failure, this obsession with data and this single-minded determination to eliminate error all underpin successes in other areas.
He discusses James Dyson’s 5,000 failed attempts to create a bagless vacuum cleaner. He interviews the Mercedes F1 racing team, and shows how British cycling achieved world-bearing status by concentrating on ‘1% improvements’ in every part of the racing process.
He also highlights how the education system stigmatises failure rather than nurtures its lessons. He shows how the criminal justice system fails to learn from miscarriages of justice.
But healthcare - at least in my reading - stands out for its abject failure to learn from error. Maybe I’m sensitised, but I found it depressing.
I felt particularly ashamed that the prevalence of individualism, hierarchy, and a focus on ‘being right all the time’ makes the medical profession in particular a large reason why we fail to improve.
Syed says:
“The problem is not a small group of crazy, homicidal, incompetent doctors going around causing havoc. Medical errors follow a normal bell-shaped distribution. They occur most often not when clinicians get bored or lazy or malign, but when they are going about their business with the diligence and concern you would expect from the medical profession.
We find it too hard to change - almost exclusively because we don’t have the systems to help us do so.
Let me leave you with an anecdote that illustrates how far we have to go. In 2015, German Wings Flight 9525 was deliberately crashed into a mountain because a suicidal pilot was left in the cockpit alone - behind the “9/11” reinforced door - when his co-pilot went to the bathroom. Within a few weeks the evidence was made public. And within a further three days, the European Aviation Safety Agency issued guidance that ensured that no pilots should be left alone in the cockpit.
That change of behaviour, based on that guidance was implemented in full, by all airlines, the very same day.
Next time you hear of a serious incident in healthcare, ask yourself this: what would it take to ensure that ‘black-box thinking’ could prevent it happening again?
My rating
Readability: 8 / 10 (Syed is a well-versed journalist. He was also an olympic table-tennis player)
Applicability: 4 / 10 (its not diminution of its power to say this book is not a practical guide)
Giftability: 8 /10 (no one should regret reading this)