“Dead or alive? Dead or alive? That’s all that matters!” we would often chant at our anatomy table. It is hard to express this inside joke to anyone who was not there, and especially in writing, without cadence or tone of voice. However, we would often chant this mantra when we were stressed, usually before our weekly oral quizzes. “It didn’t matter if we knew the answer,” we would say coyly, “it only matters if the patient is dead or alive!” Quite frankly, I don’t even remember the origins of this inside joke, but I do recall that it had something to do with making fun of bottom-line, outcomes-focused physicians.
I reflected on this a lot today during the Teeter Totter game, in which we pretended the seesaw was a ward, and we had to enter and leave the ward as a team without cracking the eggs, our metaphorical patients, who were resting beneath the ends of the plank. I was on was the team that not only cracked the egg-patient before all 7 of our teammates were on the seesaw, but also didn’t realize that we could save the other, and subsequently cracked the other egg as we were giving up. One team succeeded to put all 7 of their teammates onto the seesaw and off without cracking the egg-patients; two of the other teams failed as well, though both made it farther than we did in the process. My teammates and I congratulated each other on the successes we made, and admired the other failing teams who had made it farther, however I found myself feeling like pride was an inappropriate emotion. At the end of the day it didn’t really matter how well we had done, we still failed. On the seesaw, our failure cracked our egg-patients; in the allegorical world, our failure killed our real patients.
This conference has done a wonderful job of underscoring the importance of just culture, collaboration, communication, teamwork, strong systems, and root-cause analysis. Our team relentlessly analyzed the other groups, and had a pretty strong PDSA-style debrief. We identified several factors that could have led to our seesaw becoming suddenly off balance, despite the fact that we had been doing so well. However, none of this changes the fact that we still killed two of our egg-patients. The team that was perfect until the last person still killed one of its egg-patients. The team who saved two of its eggs after it cracked the other two still killed the other two. “Dead or alive?” In the end of the game, this really is the only question.
Outcomes matter. However, what I have realized is that this mentality is not necessarily a bad thing. We want to strive for high outcomes. Where bottom-line organizations often get critiqued is when their goals conflict with the interests of the people involved. As I continue to learn, there are tangible ways to approach process improvement holistically and justly. Although “Dead or alive?” may be the primary question, “Why and how?” are equally as important.