Keep calm and carry on

22 Feb

“Jesica’s Story” is heartbreaking. This U.S. News World Report expose from 7/28/2003 by Avery Comarow, subtitled “One mistake didn’t kill her — the organ donor system was fatally flawed,” tells the story of the death of Jesica Santillan, a 17-year-old with a failing heart. The story details a series of mistakes which ended fatally for Jesica: the transplant surgeon didn’t bring home his printout with patient data, an organ procurement coordinator didn’t challenge why Jesica’s name was not included on a match list, the pediatric nurse coordinator failed to flag an important detail for cross check on her medical information. Jesica received her heart transplant — of a heart pumping Type A blood, when she was in fact Type O. While it’s possible she might have been able to survive this with anti-rejection drugs, she didn’t. Worst of all, this was perhaps a failure caused in part by people caring too much. I think the transplant surgeon, James Jaggers, wanted so much to give Jesica a new heart that he failed to verify this important Med School-101 detail. Others involved in the mix-up — organ procurement coordinators, other surgeons, nurses — may have suffered the same heartfelt blindness, for one simple reason: It’s very difficult to find a heart suitable for transplantation in a child. When it looked like they had one that would work for Jesica, hope of a good outcome got the better of them, exacerbated by the incredibly tight timeframes for successful transplants. This speaks to the need for well-defined methods and processes, and a certain cool detachment necessary. Obviously, every possible detail involved in a heart transplant should be codified, although a lot of it was in Jesica’s case and the error still occurred. Perhaps someone with a medical background and no direct interest in the case (i.e. not the surgeon, not an employee of the transplant hospital, not a coordinator for the organ procurement organization) should perform an additional peer review prior to this type surgery as a final cross-check.

Although these two stories would seem to have nothing in common, a similar element also comes into play in “Two Football Coaches Have a Lot to Teach Screaming Managers” by Carol Hymowitz, which ran in The Wall Street Journal Jan. 29, 2007. The two coaches profiled, Tony Dungy of the Indianapolis Colts and Lovie Smith of the Chicago Bears, are all about rational judgment versus out-of-control emotion. Rather than screaming at their players as a lot of coaches do, Dungy and Smith give directives calmly and treat players with respect. Funny, when you don’t yell at people and rile up their emotions, they can focus better on the task at hand. Keep a cool head, or as a now wildly popular reissued British propaganda poster from World War II says, “Keep Calm and Carry On.”

Keeping calm also has a lot to do with another story, “Get Healthy–or Else,”  Business Week’s 2/26/2007 cover story by Michelle Conlin. Jim Hagedorn, the CEO of Scotts Miracle-Gro Co., has carried out an “all-out attack on medical costs.” Hagedorn had an epiphany about employee health care, and started his crusade by calling his HR director at 11 p.m. to get the ball rolling. While there’s nothing wrong with calling your staff occasionally at odd hours, this and other telling details in the story point up a little recklessness on Hagedorn’s part. He has part of the solution, no doubt, and there’s no question his company’s health-care bill was ballooning, or rather careening, out of control, with costs surging at a double-digit rate annually. However, his solution seems both hasty and Draconian. Perhaps a calmer, less emotional approach and more consultation with the affected employees might produce more sustainable long-term results.


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