COMPLICATIONS IN SURGERY AND THE ART OF PREMORTEM
In a brilliant talk by Atul Gawande – an American Surgeon – at the New Yorker festival in 2014, he gave an exposition on what it meant to rescue success from failure. Gawande started off by explaining the history of complications in surgery and how things have improved dramatically over the years. Still, increased death rate are being witnessed in some hospitals.
A supposition that comes to mind is that the best hospitals (the hospitals with lower death rate) are doing a better job minimizing the risk of complications from surgeries. However, a study conducted indicated otherwise: the hospital with lower death rates did not minimize risk of complications, they just did a better job at rescuing the failure. That is, prevent deaths from complications. There are two major line of action to be noted here – preventing risk of complications and preventing deaths from complications.
He went further by positing that institutions/people who fail to rescue success from failure usually have at least one of three things in common. One, no plan at all. Two, the wrong plan. Three, an inadequate plan. My intuition suggests that the no-plan-at-all is far more common. Not just with institutions, but also on a personal level as we live our daily lives.
In essence, you have to prepare for failure. (Depending on how miserable you will be if you lose)
His talked reminded me of a strategy I read about in Daniel Kahneman’s Thinking Fast and Slow. It’s often used in companies to increase the success rate of projects. But I don’t see why we shouldn’t employ it on personal level.
This is how it works:
After the planning for a particular project has been congealed, the (say CEO) then ask of the members of the group to carry out a pre-mortem, attributed to Gary Klein (as opposed to the post-mortem carried out on cadavers in hospitals).
In a pre-mortem, you go into the future and assume the project has failed. Your job, now is to give a detailed exposition into how the failure could have possibly happened (sort of working backwards).
By doing this you will most likely restructure your plans to prevent a failure or prepare adequate contingency plan to accommodate such failures when it occur. And the beautiful thing about the pre-mortem is that because there is no sunk cost (yet), you will be able extricate any sunk cost fallacy (i.e you will see clearer)
I will argue that the hospital with the lower death rate from Gawande’s talk have got some knack for the premortem.
(Video Credit: The New Yorker)