One of the things I love about conferences is listening to “fringe” talks – those which don’t necessarily cover a review of a clinical topic but encourage us to look at our overall practice in a different way.
At the London Trauma Conference back in December 2014 I caught up with Dr Tom Evens – Tom is a post-CCT EM doc who has been working with the British Olympic rowing team as a coach and at the LTC he shared not only his experiences coaching in elite sport but also about the lessons he’s been able to translate from those experiences into clinical practice and specifically trauma care.
In the podcast we talk briefly about whether trauma can be regarded an elite sport and how we can be high performance (rather than world class) in looking after our trauma patients. Tom defines high performance as a process  and an organisational culture in which we value “doing every small thing as well as it possibly can be done and making the best choices in every circumstance”.
We talk about how athletes use mental modelling, visualising and understanding the performance they are aspiring to and how we can use a greater understanding of metacognition (with references to great resources from Cliff Reid and Scott Weingart) and simulation to prepare ourselves for our “performance time” in the resuscitation room.
We also touched on marginal gains in Emergency Medicine and Tom’s experiences of learning from successes and failures as well as the cost of improving our performance through coaching.
Have a listen to the podcast here:
You might also want to check out the previous LTC podcasts
vb
Nat
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Great Podcast. Tom makes a comment about the difference in marginal gains in elite systems versus other systems that are not yet at 99% performance.
I disagree with Tom on this, although it’s really an issue of semantics. See out previous post on this here http://www.stemlynsblog.org/ed-need-matt-parker-st-emlyns/
In a system that is already at 99% the ONLY THING LEFT is marginal gains. Therefore it becomes really important and the major thing to focus on.
In less than perfect systems then there is still nothing wrong with looking for changes big and small. They all add up in the end 🙂
S
I think that a lot of the 99% is about consistency. For most ED systems, the biggest gain comes from doing the basic things in a consistently excellent way.
Still, there is lots of scope for innovating the way we do the basics: rapid assessment, care bundles, improving investigations are all examples where a small improvement repeated over thousands of patients adds up to a big change.
My problem with the marginal gains paradigm is that people think that the British Cyclists were successful because the team manager made them bring their own pillows on training camp, or had heated pants on race day – but these small things sit on on top of a great big thing: excellent and committed training.
Useful reference here: http://www.cyclingcartoons.com/marginal-gains/
I sometimes talk to athletes about the “aggregation of good decisions”. Their race performance will represent the sum of all the good decisions they made along the way. Perhaps this is a useful paradigm for all of us still learning the craft!
From a health economics and population-needs basis, I would argue that elitism is counterproductive if it means diverting resources from other important but neglected areas of medicine. Once you are reach a certain level of functioning, the law of diminishing returns means you achieve less for increasing amounts of investment.
For instance, I have been trying to increase sepsis awareness in my institution with the simple message of administering prompt antibiotics. Yet our response times consistently fall way below more ‘sexy’ metrics such as emergency cath-lab activation times and Code Stroke calls.
But from both absolute and relative differences I would argue that getting sepsis right (in both the ED and across the hospital) saves more lives than the other two combined. And that the solution to the former actually consumes far less physical resources.
The argument is further extended to the many regional and remote centres in Australia that serves large portions of the population, yet little government is attention in provisioning them for the basics of trauma care.
By all means improve your processes but don’t rob attention from Peter just to give to Paul.
Agreed. Ironically in a more complex world, I find the emphasis on the basics to be of utmost import and yield.
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