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Gawande's No brainer, Know-how and Know-why? (#21)


The screengrab above shows that, this blog and LinkedIn to one side, I also peddle my thoughts on twitter in a more relaxed fashion. In reality a good 30% of my twitter output is nonsense and the rest is tangentially related to lean. Occasionally, I'll post or retweet something of use. 


Atul Gawande, on the other hand, will draw his terminal breath knowing that he made a practical difference poised to echo through the generations. Gawande has written extensively but his gift to us lean-leaning people is an exploration of the simple checklist with an enviable thoroughness. His book "The Checklist Manifesto" reached the primary conclusion that checklists save lives in surgery situations EVERYWHERE in the world and cost peanuts to implement.


If dictionary control were in my hands, under the entry for "no-brainer" would be a reference to this book, and yet 6 years later it appears to remain a tough sell for those trying to improve medical outcomes. This may, collectively, be our fault as a lean community. Our fault because we quite rightly celebrate Shokunin (master craftsmen) both within and outside of lean. I'm guilty of it myself having previously posted gushingly about both Jiro Ono (sushi) and Ryan Neil (bonsai) without thinking of the unintended consequence.


Gawande is very honest about his failures and has talked about how he failed initially to 'sell' the checklist idea to surgeons. (A warning here that, although I have been under the knife of a surgeon with reassuring small hands, I know nothing about performing surgery)


What I do know is that the surgeons Gawande was trying to convince, quite naturally, interpreted pre-surgery checklist introduction as an amateurishly reductive attempt to deskill their trade. Surgeons, are to be sure, extremely skilled people, but the unintended consequence of creating a mystique around this skill is the resistance it creates to any kind of standardisation; even when it's helpful.


The problem was in the sell, as it often is with us lean people. Shingo reminded us years ago that any argument has a logical and an emotional side to it. Logic isn't enough unless you're among Vulcans. There has to be a WIIFM (What's In It For Me). Gawande, if memory serves, had more luck when he presented the checklist in a "look, you're a highly skilled surgeon, grappling with very complex life or death problems and making split second decisions. Let us unburden you of the tedious stuff before, during and after surgery so that you can focus on deploying your considerable skill to best effect" My words not Atul Gawande's, so apologies if I misrepresent.


Either way, this week's message is that:


1) Just asking someone to do their job differently (because you said so) is rarely enough...


2) ...but telling them why is more likely to work. The best chance of success, however, comes when this is paired with...


3) ...an answer to the magic question; "What's in it for me?"


It's the transition from Know-how to Know-why, and that's how we reach the holy grail of sustainable business improvement through Kaizen; develop good people to make good parts (Monozukuri wa hito zukuri for the Japanese amongst you)


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