working on improving myself both physically and emotionally. I’m also
eager for the NFL playoffs and seeing how my favorite team, the New
England Patriots, fares under the leadership of Coach Bill Belichick and
quarterback Tom Brady. Doctors and health care can learn much from
Over the past decade, the New England Patriots have been dominant
appearing in 40 percent of the Super Bowls played and winning 3 out of
4. Nothing prior to 2000, would have suggested this superior performance
with playoff appearances only six times from 1985 to 2000 and two Super
Bowl appears, both losses. Their new head coach Bill Belichick hired
in 2000 had a losing record in his prior stint at Cleveland. Their
current quarterback Tom Brady was drafted in the second to last round.
So what was their secret for success? Nothing
particularly earth-shattering. It was and still is a relentless focus on
continuous improvement by practicing deliberately and explicitly. This
is an important learning for the US healthcare system which consistently
lags that of other industrialized countries when measured on quality
In general, doctors don’t focus on how medical
care is delivered. We don’t focus on our own continuous improvement,
which is a far different philosophy than individual athletes in
professional sports. In our profession and in our training, we also
typically don’t focus on ensuring that the care we provide is
consistently reliable over a period of time with our diverse medical
Yet, success in the NFL is based on whether a group
of individuals, which composition may differ annually, can execute the
plan well every time.
For the team to do well, it first
relies on the individual player to do well. Take the Patriots’
quarterback Tom Brady. He is currently among the best quarterbacks in
the NFL playing today. Some argue he may be the best ever to play the
position. Was he destined for greatness early in his career?
No. In fact, Brady doubted his abilities early on
while at Michigan. Change started to occur when he adopted a different
mindset presented by one of his mentors, Michigan associate athletic
director Greg Harden. It
isn’t about just talent that will result in success, but in fact a
focus on improving one’s skills which allow the possibility to be the
best. Though he did succeed at Michigan, Brady was drafted in 199th by the Patriots in 2000.
did he do? The future hall of famer simply did what he learned at
Michigan – learn the position better than anyone else and be deliberate
about his practice. His NFL rookie year was unremarkable. In the
following year, as a second year quarterback, he started off slowly. He
steadily improved to the point that when the Patriots were in the Super
Bowl, he led the team to a final winning drive. Brady became the
youngest quarterback ever to win a Super Bowl.
reaching the pinnacle of a football career in January 2002, he hasn’t
stopped improving his skills. When asked recently to impart some wisdom to NFL quarterback rookie and Heisman trophy winner Cam Newton, Brady said this –
always realize that you can always be better. You can always be a
better friend, a better player, a better teammate, and always try to
find ways to improve. I go out there and be the best teammate I can be;
because the goal in life is to win.
Yet how often do
doctors work specifically on themselves and improve what they truly
control, that is their own individual skills and talents? How often do
we each work hard on improving our clinical acumen, communication
skills, surgical techniques, or diagnostic skills? As doctors after we
have finished our advanced training via a residency or fellowship
program, we don’t seek opportunities to improve skills we believe we
have mastered. In fact, we bristle at continuous improvement as New
Yorker writer and surgeon Dr. Atul Gawande notes in his article Personal Best.
every élite tennis player in the world [has a coach]. Professional
athletes use coaches to make sure they are as good as they can be.
doctors don’t. I’d paid to have a kid just out of college look at my
serve. So why did I find it inconceivable to pay someone to come into my
operating room and coach me on my surgical technique?
tries an experiment and convinces a mentor, who he respects highly, to
observe him in the operating room. Gawade reflected that in the
debriefing with his mentor
That one twenty-minute discussion gave me more to consider and work on
than I’d had in the past five years. It had been strange and more than a
little awkward having to explain to the surgical team why Osteen was
spending the morning with us. “He’s here to coach me,” I’d said. Yet the
stranger thing, it occurred to me, was that no senior colleague had
come to observe me in the eight years since I’d established my surgical
practice. Like most work, medical practice is largely unseen by anyone
who might raise one’s sights. I’d had no outside ears and eyes.
Gawande observes that in health care
capabilities of doctors matter every bit as much as the technology.
This is true of all professions. What ultimately makes the difference is
how well people use technology. We have devoted disastrously little
attention to fostering those abilities.
individually, each doctor can and should focus on improving his
individual abilities and to know his position the best, to be a doctor’s
But there is more. Health care isn’t just
about one position, one profession, or one doctor. Providing complex
medical care is like leading a football team of 53 players of which only
11 are on the field at any given time to play offense, defense, or
special teams. For success, each individual must do his job consistently
and reliably every time. Anything short of that is incredibly obvious.
Failings unfold weekly to tens of thousands of fans in the stadium and
millions watching via instant replay, the internet, and ESPN. Success
and failure is dictated by a win-loss record until the season ends and
the cycle repeats itself.
Patriots have been exceptional in the past decade not only because of
having Tom Brady but also for the many other individual players who are
focused not only on making their own skills better but to do so for the
benefit of the team. Previous “troublemakers” and prima donna wide
receivers Randy Moss and Chad Ochocinco, when joining the Patriots have
been quiet, humble, hard-working, and focused on improving and
contributing to the team. This team focus comes directly from the top
with head coach Bill
Belichick. Profiled recently by NFL films, note how he leads and
prepares his team deliberately to think ahead, anticipate problems, and
execute the plan consistently in practice. Though each player is a
paid professional and should know the game instinctively, Belichick
takes no chances. He says the following to players in practice –
I want to call out the situation, pay attention.
I don’t care whether you are part of it or not.
First and ten, plus 50, alert for what.
Ok, they have no time outs. The ball is on the one yard line. Tell me what is going to happen here.
We got 40 seconds and need a field goal, two minutes.
We good on every thing fellas? No questions? We’re good?
to his son) – Those situations are just as good for the coaches as they
are for the players. Makes everybody think about what I might want to
Like [Tom] Brady he’s thinking one thing,
Billy (Patriots’ quarterback coach) is thinking something. We want them
both thinking the same thing you know.
record as well as playoff appearances, conference championships, and
Super Bowl wins are consistent with high performance outcomes.
Impressive considering that every other team in the NFL has players and
coaches each driven to excel. What might healthcare learn from the
Patriots head coach?
Can doctors and staff work together
and regularly drill on scenarios both likely and rare? Can we use
checklists and protocols and modify accordingly much the same way a
coach changes the playbook? In medicine, we assume that that everyone
knows his task when it comes to code blues and emergency surgeries. We
also assume that everyone knows his task when it comes to mundane stuff
like drawing up medications or discontinuing orders in the hospital. We
are then stunned when adult heparin is given to babies in the ICU and the blood
thinner coumadin isn’t stopped when a resident doctors is interrupted
with a text message with significant consequences to the patient.
We often blame the individual rather than ask can it be about something else that increases likelihood for success?
We don’t fully appreciate the discipline or the
processes needed to create a highly reliable organization. What we don’t
have are physician leaders who can take the care we provide to the next
level. Note the comments from Dr. Thomas Lee, network president of
Partners HealthCare System and professor of medicine at Harvard Medical
School in a podcast regarding his article in Harvard Business Review – Turning Doctors Into Leaders.
[Doctors are] taught to rely solely upon themselves. They don’t
necessarily work well in teams. They don’t think about the bigger
picture, because they’ve been taught to focus just on the patient in
front of them.
…to respond to the pressures created by all this [medical
progress which causes rising costs, quality challenges, and chaos that
patients experience] is for providers to get more organized and adopt
systems that will bring order to the chaos. But that takes leadership.
It takes the kind of leadership where you can persuade clinicians to
work together in teams, as in almost every successful business, they
For the US healthcare system to improve and succeed in providing
highly reliable and safe care to everyone, it will require individual
doctors to be like Tom Brady and ask – is there something I can do even
better? It will require some doctors to be like Bill Belichick and ask –
is there a process and discipline I can provide to allow the team that I
Doctors can and must lead the changes that
everyone in the country wants from our health care system. There is no
other group best suited to the task.
The question is – are doctors ready to step up?