A different future, Part V – What can the healthcare system learn from a racing team?

If you are a fan of auto racing, you probably have a favorite race or event. NASCAR has been particularly popular in the United States in recent years but for my money, the most difficult test of cars and their drivers and crews is the 24 hours of Le Mans. From 3 PM on the second Saturday in June until 3 PM the following day, cars will be driven the distance from New York to Los Angeles over an eight and one-half mile circuit which is largely constructed from public roads. Rain or shine, the cars run.  During the first decade of the 21^st century one racing team dominated the 24 hours of Le Mans. In 2000 Audi brought its new R8 to Le Mans and won. It won again in 2001, 2002, 2004, and 2005. Then, in 2006 Audi came to Le Mans with the truly innovative R 10 diesel and won again. In 2007 Audi won yet again. But in 2008, a challenger arose. The French automaker Peugeot entered a diesel car of its own and in the races leading up to Le Mans it was faster than the R10; faster by a considerable margin.  Yet, after the flag fell on Sunday afternoon, the drivers from Audi’s number two car, Tom Kristensen, Allan McNish, and Dindo Capello  stood at the top of the podium; winners again. Their victory and what they did to achieve it is emblematic of what it takes to create a high performing healthcare system and of what we need to do if we want to maximize quality and minimize costs. These are what I consider to be the lessons from the 2008 Le Mans.

1. It’s the pits – The Peugeot car was faster than the R 10 by about three seconds every lap at Le Mans (cars travel the eight and one-half miles in a little over three minutes). In the world of auto racing, three seconds is a long time but it pales in comparison to the time that can be lost in the pits. Certainly, efficient pit stops are not as sexy as building a faster engine but they are absolutely fundamental to victory. Team Audi arrived at Le Mans before any other team and they used that time to practice their pit stops. They practiced tire changes, driver changes, repairs to the cars, and every other scenario they could imagine. They timed themselves and then they worked to better their times. Working on these basics allowed team Audi to make the most of their time in the pits and to make fewer pit stops. Those of us in healthcare can take a page from their playbook. Focusing on fundamentals is more likely to help us build a safer, better healthcare system than relying solely on advances in technology. In most cases and for most patients, attention to the basics; to doing the right things again and again is going to win the day.
2. Even the Lone Ranger has a team – Our vision of heroes in healthcare needs to change. We Americans seem to have a fascination with the lone hero who is bucking the system. TV doctors are maverick smart-alecks and larger-than-life figures doing battle against stuffy administrators and venial colleagues. At Le Mans, Audi’s victory belonged to a team. It took three drivers, several engineers, mechanics, and other crew members to win the race. At critical moments in the race, various team members assumed leadership. In fact, one of the engineers overrode the preference of the driver and insisted on changing the tires for a set designed for wet weather. When rain drenched the course and competitors’ vehicles equipped with dry weather slick tires were sliding around like they were driving on ice, the surefooted Audi gained even more time on the field.  In order to deliver optimal healthcare, it takes a team. Communication and coordination are far more important than playing hunches and lone-wolf tactics. A well-functioning team provides the right care, at the right time, and by the right personnel. In the future, successful healthcare organizations will be composed of teams.
3. Technology has an important role – All of the above might suggest that I am “anti-technology”. Trust me; I am far from being a Luddite. At Le Mans Audi and every other team was dependent upon good technology as an adjunct to their people. Engineers receive data from the cars, weather radar gives the teams advanced warning of rain. And, of course, the cars themselves are technological marvels. In healthcare, we too need technological adjuncts. Human beings have limited cognitive capacity. Our brains are really built as problem solving machines. They do not do a good job when we ask them to repetitively complete rote tasks but computers handle such tasks beautifully. Therefore, it makes sense to build systems of care that allow humans to do what they do best and use machines to support humans.

In a couple of months, Audi, ever the innovators will be back at Le Mans with experienced drivers and a brand new car, the R-15 but they won’t rely on the car to win; they’ll do the things they have done for the last decade; stick to fundamentals, work as a team, and rely on technology to help them. Of course there is no guarantee that they’ll win the 2010 race but I wouldn’t bet against them. We can learn a lot from their success.

For more on Team Audi see the amazing film “Truth in 24″ ;availble free on i Tunes