The power of marginal gains

So what does Cycling have to do with health care – and you?

What can health care – and you – learn from the British Cycling experience? More important, how can you apply it to your health care practice?

Sir Dave Brailsford is a former professional cyclist who also holds a Master of Business Administration (MBA) – an interesting combination! While working on his MBA, he’d been fascinated by “kaizen” – a Japanese word meaning “improvement.” It’s a process improvement technique based on the idea that small, ongoing positive changes (“marginal gains”) can add up to major improvements. Sir Dave thought the techniques could be applied to cycling. He gambled that if the team analyzed everything that goes into competing on a bike and then improved each element by 1%, they would achieve a significant increase in overall performance.

Their consistent stunning record in the past ten years speaks to the success of that calculated gamble.

#healthcare #ems #paramedicine #nursing #doctors

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Recognizing cues – Solving the challenges of diagnostic mastery

Part 2:  Solving the challenges of diagnostic mastery

Four of the challenges to mastery learning for health practitioners (if you’re a health practitioner you’ve almost certainly experienced them) are…

  1. Multiple Cues. Within each area of initial patient assessment, there are multiple cues related to Airway, Breathing, Circulation, Disabilities, and Exposure (A-B-C-D-E). In classroom, simulation or practicum experiences, or in professional practice, you could go months or years and not encounter some of the possible cues. To become a master of identifying cues and recognizing patterns could take decades.

  2. Multiple sub-actions. Within each skill set involved in assessment and diagnosis, there are many sub-actions. Even during training, you may have few opportunities to practice sub-sets of skills, again and again, to become so proficient you can perform each action expertly and automatically, almost without thinking.

  3. No opportunity to slow it down. During training, whether in classrooms, simulation settings or practicum placements, the entire Observe, Orient, Decide, Act process often unfolds quickly without the opportunity for you to slow it down and look at each cue and its potential meaning or each component of each skill within a larger process. In the real world of practice, of course, “slowing it down” is even less possible than during training.

  4. Limited opportunity for immediate feedback. Though trainers, colleagues, and supervisors to provide feedback to students and practitioners, mastery learning requires immediate feedback about each aspect of your performance. That is simply not possible even during training, and certainly not once you are registered as a certified professional.

#healthcare #EMS #medicine

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Recognizing cues – In life and in health care

Features with deeper meaning

The low fuel light in your car.

The half-open lid of your mailbox.

The sound of your front door opening.

These are all features of our environment that have meaning for us. They all signify something deeper than what you see or hear. We need to get gas, the mail arrived, our significant other is home.

Features that signify deeper meaning – called cues – are all around us. Knowing the meaning of cues is a key element of going about our daily lives. Cues are also key to making accurate decisions quickly in situations when making accurate decisions is important.

#healthcare #ems #paramedicine #nursing #doctors

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Error-proofing: part 2

Part 2: It’s not magic, it’s mastery learning using Recognize

In health care and in other fields, the science of peak performance enables practitioners to operate at optimum levels in the face of external challenges, even in moments when they are not at their personal best.

You may have had some of those moments yourself, when you surprised yourself by what you were able to do under adverse conditions. You may have observed the best people in your profession operating at that super-level. As a dedicated professional, you probably want to reach that level of consistent mastery yourself.

It’s not magic. There is a specific, science-based, research-proven, systematic step-by-step method of learning that can take you to that level of peak performance. It’s called mastery learning and it’s within your reach.


#healthcare #medicine #paramedicine

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Error-proofing: Part 1

Most everybody recognizes that health care providers – nurses, paramedics, physicians, and other practitioners – ought to be in top form when they’re on the job.

But here’s a fact of life most everybody also knows. Human beings cannot always be in top form.

Unlike most other professions, in health care practice the stakes are so high that tolerance for error is zero. That’s even though, as a health care provider, you must make quick assessments and decisions in high-pressure environments, and even though no human being can be at an optimum level all the time.

#Medicine #Paramedicine #healthcare #nursing #doctors #ems

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Enhancing healthcare practitioners cue recognition: Part 2

Deliberate practice and mastery learning

Mere practice (repeating an activity) does not necessarily improve performance. In fact, practice by itself, without external guidance, may even result in reinforcing poor performance!

Deliberate practice is an evidence-based method “grounded in information processing and behavioural theories of skill acquisition and maintenance” developed by learning psychologist K. Anders Ericsson, an icon of peak performance.

#Medicine #Paramedicine #healthcare #nursing #doctors #ems


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Enhancing healthcare practitioner cue recognition: Part 1

Improving assessment and diagnosis in a high-stress environment: pattern recognition

The risk of medical error begins within the first few minutes of patient contact: assessment and diagnosis in a high-stress environment. The most common type of medical error is an error of diagnosis.

We know about factors that contribute to error (chaotic environments, high mental workload, distraction, fear, time constraints, etc.) – but what do we know about factors that contribute to expert diagnostic performance?

#medicine #paramedicine #healthcare #nursing #doctors #ems

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