News Desk: Cowboys and Pit Crews : The New Yorker

For one, you must acquire an ability to recognize when you’ve succeeded and when you’ve failed for patients. People in effective systems become interested in data. They put effort and resources into collecting them, refining them, understanding what they say about their performance.

Second, you must grow an ability to devise solutions for the system problems that data and experience uncover. When I was in medical school, for instance, one of the last ways I’d have imagined spending time in my future surgical career would have been working on things like checklists. Robots and surgical techniques, sure. Information technology, maybe. But checklists?

They turn out, however, to be among the basic tools of the quality and productivity revolution in aviation, engineering, construction—in virtually every field combining high risk and complexity. Checklists seem lowly and simplistic, but they help fill in for the gaps in our brains and between our brains. They emphasize group precision in execution. And making them in medicine has forced us to define our key aims for our patients and to say exactly what we will do to achieve them. Making teams successful is more difficult than we knew. Even the simplest checklist forces us to grapple with vulnerabilities like handoffs and checklist overload. But designed well, the results can be extraordinary, allowing us to nearly eliminate many hospital infections, to cut deaths in surgery by as much as half globally, and to slash costs, as well.

Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that make it possible. Partly, it is because the work is rooted in different values than the ones we’ve had. They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.

This is Atul Gawande at Harvard Medical School's Commencement, talking about the work that I'll be trying to enable doctors to do, starting in five weeks!

If, If, If

I watched a bit of the Harvard Class Day events online a few days ago, streaming the speeches as I cleaned up my room and tried to figure out what to save and what to recycle. It's odd, in retrospect, to think about what could have happened if I had chosen to go to a big Ivy League school - my future would likely have been changed, and my networks would have been very different. Unlike so many of my friends here, I had no relationship to Williams, no knowledge of the Berkshires or even of the college's general location - when we first sketched out college locations for a road trip, we put Williams next to Boston.

And yet, I chose Williams, or rather, with its declarations of values, Williams chose me, and my life is changed.

Isn't that remarkable?

So many people in this world have so much of their futures written or swayed by the circumstances of their birth and the demographic trends of the countries they inherit. So many people will never travel across oceans, will never read such ancient works, will never have the chances that I have had and, to some extent, squandered. I know now, looking back, that I could have done much more at Williams - could have written the book I sketched out freshman year about the desires and beliefs of the "Obama Generation," could have spent an aggregated 20 hours more editing all of my essays (with a probable .1 GPA bump), could have, could have, could have.

But I'm happy with what I did here, and more importantly, with what I learned here. Williams taught me a huge number of incalculable things, many of which are hard to articulate, but I know that I'll be more effective and harder working at all of my future jobs because of it. I could have gone to another school, yes (assuming my admissions to Williams wasn't a lucky fluke), but I'm well-situated now to have the life that I want - to enjoy my work, to have enough income to live securely, and ultimately to become one of the many citizens that makes this country work.

Leaving my deck

Susie Hopkins House, my incredibly lucky residence, has two upstairs rooms that share access to a private deck (the rest of the house can go through a window as well). I'm feeling a lot of conflicting emotions today, as I begin to walk towards the end of my time at Williams in the form of one more final exam, but my deck is a constant; where the weather is great and the view of trees and grass wonderful (if atypical).

But, given the recent failed rapture, I do feel ironically left behind, in a sense. My deck is only wonderful when I share it with the people I love, whether in rocking under an umbrella while singing, holding each other in the rain, or having one of those long conversations that mark true and lasting friendships. I'm never going to pay so little for such a palatial living situation; I couldn't have asked for a better place to end my time at Williams than Susie Hopkins, alongside my wonderful housemates Chris, Asad, Ayyaz, Ville, Mike, Diego, Rosie, and Will.

But I do have to come inside from the deck, and I do have to get food and take this test. I do need to leave this campus, and take my place in the wider world, whatever that will be. People have told me recently that I'll be fine, or that they expect me to accomplish great things, but I know this: luck, as Randy Pausch said, is preparation times opportunity, and I may well be "unaccomplished" in my life. I might not hold the titles and the offices that others have jokingly and non-jokingly attached to me; all I hope is to have enough to live securely, and to hold the titles of husband and father. It may well happen that more opportunities present themselves, and I will take them, but I will not scheme or devise a master plan to lead to any outcome.

My plan, instead, is to do what feels right, and to make decisions day-to-day that I can live with for the rest of my life. If my time at Williams and before is any indication, that may well be enough, and I have to live with both that possibility and the chance that it won't come to any fruition. But as I ended my last record op-ed: I may never uphold my values perfectly, but there are angels in history and the present time to guide me on my way.