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The first and biggest reason is also the hardest to change – doctors, with decades of education and experience under their belts, have trouble admitting weakness, and to them the idea of a checklist means they are not perfect.
Transcription Outsourcing, LLC is a Denver, Colorado-based medical transcription company that provides fast, accurate and reliable transcription services for hospitals, clinics, facilities and individual practices of all sizes. In a recent issue of The New Yorker, surgeon and Harvard Medical School professor Atul Gawande offers some hope by outlining a future vision of healthcare delivery that's modeled after the rigorous process deployed by The Cheesecake Factory. Gawande's perspective strongly matches the one expressed in The Innovator's Prescription, Innosight co-founder Clayton Christensen's 2009 book on healthcare innovation. For example, as a patient, are you willing to give up being seen by a provider with an "M.D." behind her name in return for the assurance that you would never wait more than five minutes and would have all your questions answered every visit?A  Or a bit further along the disruptive spectrum, how about forgoing clinic visits altogether if you can connect with an expert via FaceTime whenever you wish and have every preventative test scheduled in your home or workplace at your convenience?
Some patients and physicians will surely find a standardized, disruptive innovation-heavy approach to healthcare anathema, especially relative to the idealized image of the Norman Rockwell doctor carefully crafting treatment plans to each patient's unique circumstances.A  Indeed, we would all prefer Le Bernardin at Cheesecake Factory prices. The good news is that several major healthcare companies that Innosight has worked with have demonstrated that transformative innovations can be incubated and scaled successfully despite the many pitfalls that exist. Secondly, healthcare leaders will need to realize that it is critical to keep truly disruptive efforts largely separate from ongoing operations. Finally, it will be essential to apply a "test and learn" mindset and approach to innovative efforts rather that moving directly "from idea to launch."A  Truly transformative innovation is often elusive at first.
Whether or not Gawande's Cheesecake Factory vision ultimately comes to fruition, it is clear that a systems-approach to innovation in healthcare delivery is badly needed.A  Healthcare leaders should start by identifying those innovations that make the right trade-offs. Tim Gustafson is a principal at Innosight who has worked with companies in all sectors of healthcare.
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Atul Gawande, a surgeon and author of The Checklist Manifesto: How to Get Things Right, has for years been saying that doctors need to use checklists to help them prevent errors, infections, complications – even death. Doctors have said checklists “dumb down” medicine, that it removes the “art” of their work. There are a million case studies out there where doctors who have used them have proven their effectiveness time and time again. Christensen and his physician co-authors argue that the answer to the healthcare crisis will come from adopting innovative approaches that make unconventional trade-offsa€”the type of innovation Christensen termed "disruptive" over a decade beforea€”and then standardizing the business model that delivers these innovations wherever possible.A  While a substantial improvement over typical "family restaurants," The Cheesecake Factory is arguably a disruptive innovation to traditional fine-dining establishments. Indeed, Gawande posits that this nascent trend will inevitably take over large swaths of the system.
As a physician, are you okay giving up most of your decision-making autonomy for your routine patients if you're invited to spend as much time as it takes to crack your most complex cases?A  How about not seeing the vast majority of your patients at all if you can gain complete confidence that "the system," with its integrated technology and powerful data processing engines, will provide them with higher quality and significantly cheaper care than you could ever hope to offer on your own? But the question we have to ask is what are we willing to give up in order to obtain the quality and experience we need at the prices we can pay? When the right time comes, you can carefully consider how to integrate the two streams of activity.
The typical entrepreneur changes his game-plan four to five times before meeting with success.
Only then can they apply the best practices of leading innovators to ensure potentially transformative innovations are given every chance of success.
And yet, is their work really art, or is it a mixture of instinct, science and plain-old consistency?
Gawande gives the real-life example in his book of an experienced pilot who had years of flight experience, yet crashed due to pilot error on a plane that was far more complicated than previous models.

Yet, as Gawande observes, it's able to change its 300-plus item menu every quarter while adhering to a standard of quality, efficiency, and customer satisfaction that our health system finds unattainable. In the future world of large and standardized healthcare juggernauts that Gawande describes, the patients and the physicians who are employed by them will be forced to make trade-offs by asking which dimensions of performance they are willing to give up to achieve the outcomes, experiences, and prices that everyone seems to want.
That's why you should adopt a systematic approach to identifying the individual assumptions that must be true for new innovations to be successful. One newspaper even printed that it was “too much airplane for one man to fly.” And yet, because of that accident and the more complicated newer planes, the aviation industry adapted and came up with pilot takeoff and landing checklists. We are inconsistent and unreliable because of the complexity of care.” But when he tested using checklists with surgeons in eight hospitals, “we caught basic mistakes and some of that stupid stuff… we get better results.” So why are some doctors resistant to using them, even when shown proof that they work?
They are human beings that have been trusted with another human’s life, and they need to utilize every tool they can to prevent tragedies, especially if one has been proven to save lives. In doing so, healthcare leaders can "de-risk" the efforts and allow the ideas to evolve as learning occurs.
Yet doctors still need the years of training, the education, and the know-how to follow even a simple checklist – a person off the street couldn’t do it. You can have all the training and experience in the world, yet caring for another human being and managing every potential complication is too complicated not use similar check-and-balance methods.
But once they’ve mastered the steps, they just need a little reminder push to ensure they aren’t forgetting anything.

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