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Cowboys, Pit Crews, and PLCs

June 1, 2011

Atul Guwande, author of Better and the Checklist Manifesto, just delivered a wonderful commencement address to the graduates of Harvard Medical School. You should read it in its entirety:

Cowboys and Pit Crews

The talk discusses how doctors in modern hospitals focused on the best patient outcomes need to start to operate less like cowboys, and more like pit crews.

Guwande starts by describing medicine as it used to be—the country doctor with the limited set of options, and how it exists today—the medical team with an inexhaustible set of tests and treatments.

The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves.

But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.

He describes the solution to this problem (and the ever growning costs of health care) as finding ways for doctors from many different backgrounds to work together as “pit crews.” And he lays out three important skills that these teams must have:

  1. An ability to distinguish success from failure, driven by fascination with gathering, refining and analyzing data.
  2. Devising solutions for systematic problems uncovered by data.
  3. The ability to scale, and get colleagues at all levels to join in.

After reading this, I think Guwande’s analysis could apply equally well to the world of education. In the past, it was entirely possible to be a “cowboy” teacher: perfect your curriculum, close your door, and have little concern for anything else that takes place outside your classroom—new discoveries in your field, new educational techniques, or even the next class students are headed to. Today, this is less and less possible. The advancement of many of our fields and technological tools at least call into question whether it’s enough to simply give students a grounding in 19th century physics, when Wolfram Alpha can solve most of those problems for you. Advances in education and brain research temp us with the possibility that there are other ways of teaching beyond how we were taught that might be more effective. And as our students are pulled in more and more directions, we begin to sense that if we really are to get our students to achieve the outcomes we want, we need to begin to engage them beyond the narrow confines of our classroom.

It also occurs to me that I think many of my colleagues would say that the education equivalent of the pit crew is the PLC (professional learning community), a group of teachers who share a common focus on determining 1) what they want students to understand, 2) how they will teach that understanding 3) how they will measure whether students understand that idea, and 4) what they will do with students who go beyond or cannot reach that understanding. Next year, my department has decided to invest 2 hours each week to meet as a PLC, and I’m really looking forward to trying to help us approach this opportunity with a pit crew mentality.

In the end, Guwande even shows that the idea of the cowboy as a loner doesn’t really exist anymore. He says:

I met an actual cowboy. He described to me how cowboys do their job today, herding thousands of cattle. They have tightly organized teams, with everyone assigned specific positions and communicating with each other constantly. They have protocols and checklists for bad weather, emergencies, the inoculations they must dispense. Even the cowboys, it turns out, function like pit crews now. It may be time for us to join them.

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