By Alexander Laufer and Jeff Russell
In our current blog we will use metaphors from hospital life
to highlight two different approaches for dealing with problems. The first is a
story told by Terry Little:
Life in the E.R.1
Contrary to what my wife would
say, I don't watch much television. I do, however, regularly watch one show on
the Learning Channel—the reality series Trauma: Life in the E.R.
While watching the last episode,
I recognized parallels between what was going on in the emergency room, with
its host of accident and gunshot wound victims, and what goes on in successful
project management.
First, there was a sense of
urgency, but not haste. As an ambulance or helicopter brought in patients, the
physicians, nurses and technicians did some quick planning, anticipating the
likely condition and needs of the patient. They moved to get the necessary
tools and equipment in place before the patient arrived.
Once the victim appeared, there
was no wasted motion. With time as the chief resource, no one did anything that
didn't directly address the ultimate objective—saving the victim. The medical
team shared a clear set of priorities: deal with life threatening issues first,
possible long-term consequences second and ignore everything else.
Each person in the room had an
active role. No one was in the emergency room as an observer or overseer.
Someone was clearly in charge, but typically no one waited to be told what to
do. Interestingly enough, no one ever seemed paralyzed by fear of doing the
wrong thing. Through training and experience the entire team operated in
harmony. When there wasn't enough information to make a decision about a course
of treatment, the staff moved quickly to get more information using x-rays,
magnetic resonance imaging and similar diagnostics. People spent little time
debating or pondering what to do next. They decided on what to do and got on
with it.
Sometimes the unexpected happened
and a situation that seemed to be in control suddenly went out-of-control. In
those cases, there was no hand wringing or fault finding—just a measured,
adapted response to the new situation. Sometimes there were mistakes; mostly
they were acts of omission rather than commission. There was concern and open
discussion about the mistakes, but learning was the chief consequence.
I also noted that there was a
general acceptance that not everything affecting the patient was totally within
the control of those in the emergency room. The staff spent their time dealing
with what was in their control and not complaining about what wasn't.
The second lifesaving story is an abridged version of a
bizarre episode taken from the novel Doctors,2 as it
appeared in Breaking the Code of Project Management.3
It was to be a
routine removal of a gallbladder. However, some problems were anticipated since
the patient, Mr. A, had a somewhat complex medical history and was allergic to
almost everything one could imagine.
It was my first
week as an intern on Surgery. I was eager and proud to be in the operating room
with the chief surgeon, Dr. Aubrey, and the anesthesiologist, Dr. Nagy, who
were considered to be the top specialists in their fields.
Everything
seemed to be going smoothly until Dr. Nagy started reporting some problems.
From then on, it seems that things deteriorated faster than lightning. One
moment the blood pressure was dropping and the next, the ECG was going crazy.
In spite of all their emergency procedures, within a few minutes the ECG was
flat and Dr. Nagy pronounced the patient dead.
Suddenly there
was silence. No one dared speak until Dr. Aubrey decided on a course of action.
He ordered Dr. Nagy to continue aerating the lungs. I wondered what was going
on. After all, the poor man was dead! Then, with growing disbelief, I watched
as Dr. Aubrey took over from his assistant and carefully started suturing and
closing the opening. When the last suture was in place, Dr. Aubrey quietly
ordered, “Take him to the recovery room. I’ll be there in a few moments.”
I was stunned.
Only after I recovered my speech did I dare ask Dr. Aubrey’s assistant why they
continued pumping air into the dead man’s lungs. He seemed to think the answer
was obvious: “That way, Mr. A will be pronounced dead after the operation by
somebody in the recovery room. This explains why no patient of Dr. Aubrey’s
ever dies on his operating table….”
The intern in
the Doctors story explained that another reason for Dr. Aubrey’s
aberrant practice was to avoid the massive paperwork required by the hospital
and the insurance companies. Thus, in addition to maintaining his perfect
operating record, the surgeon was able to pass a time-consuming bureaucratic
job on to the recovery room staff.
The two lifesaving cases were affected by their unique
contexts and the operating assumptions of their relevant leaders. In the ER
series the assumption was that they operated in a “living order” environment,
thus problems were expected and were addressed swiftly which was followed by an
effort to learn from them. On the other hand, in Doctors, the
environment was assumed to be in “geometric order”: major problems were not
expected, and if unfortunately did occur they were quickly buried.
1Life in the E.R. appears in an article that was written
by Terry Little and published in the NASA Magazine, Academy Sharing Knowledge, under the
title: “Project Management: The Television Show.” http://appel.nasa.gov/2003/06/01/project-management-the-television-show/
Terry
Little served as a project manager in the US Air Force where he was regarded as
one of the most successful project managers. He then served as the executive
director of the Missile Defense Agency, the senior civilian in an organization
of approximately 8,000 employees. Earlier, he was the first director of the Air
Force Acquisition Center of Excellence. Currently, Terry is a member of a research team at the
Consortium for Project Leadership at the University of Wisconsin.
2E. Segal. 1988. Doctors. New York, NY: Bantam Books, 303-6.
3A. Laufer. 1999. Breaking
the Code of Project Management. New York, NY: Palgrave, 189-190.
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