What the Thai Cave Rescue Can Teach Healthcare About Quality and Safety

We have all been overjoyed by the recent rescue[1] of the Thai soccer team, and their coach, after being trapped in an underwater cave for 18 days. The story of their rescue is a drama for the ages, and no doubt Hollywood is clamoring to tell their story. But in my role as a physician executive, I’m more intrigued by the lessons it offers to the U.S. healthcare industry

As international teams of cave diving experts assembled to assist the Thai divers, the group faced multiple challenges. Even if they could successfully navigate the cave’s structure, and battle the threat of flooding and low oxygen levels, each of the 13 young men would have to be taught how to swim and dive in order to get out. Fortunately, with the Thai government pumping water out of the cave, child size harnesses and masks brought in from France, and divers from as far away as Belgium, Denmark and Australia assisting, the rescue was successful. There was luck – the monsoon rains that were predicted to flood the caves held off until the last group of four boys and their coach were out – but what most impressed me was the leadership and teamwork involved. The expertise and skill of each member of the team was recognized and leveraged in the rescue attempt. There was no discussion of ‘well, we’ve always done it this way, so we have to try that first.’

Healthcare hasn’t quite achieved this level of teamwork and trust. So much of medicine is not evidence-based but driven by precedent and a leadership style that rewards adhering to a given protocol because a department head or administrator wanted everyone to follow it.

Dr. Pauline Chen, a surgeon and gifted writer, has written a lot about how pivotal a more open and egalitarian hospital culture can be for improving patient outcomes. She cites[2] the results of research that implemented a “Leadership Saves Lives” strategy that included the formation of a “Guiding Coalition,” or a team of administrators, nurses, clinicians and technicians from a hospital that works to discover ways the institution can improve its culture, and how to work to implement the changes needed. The study looked particularly at heart attack mortality rates. According to Chen:

“The researchers discovered that the degree of an institution’s cultural change was directly linked to how patients did. Hospitals that made more substantial changes in their work culture realized larger and more sustained drops in heart attack mortality rates. Among the four hospitals in the study that experienced less dramatic cultural changes, there were improvements in patient outcomes, but the improvements were not sustained.”

“What is different about this work is that it has proven that cultural change is possible and can save lives,” said Dr. Patrick Geoghegan, professor of mental health and social care at Anglia Ruskin University in Britain, who is spearheading a program based on Leadership Saves Lives in the National Health Service. “You can have all of the best policies, procedures and strategies, but if the hospital’s organizational culture is not receptive, then you will fail.”

In short, without cultural change, hospitals and health systems can’t make any progress to quality and safety. In the 20 years or so since I trained as a physician, I haven’t seen substantial movement to evolve the hospital culture.  But there is some. Intermountain Health, a Utah-based health system, is embracing value-based care at its core, and making great margin on a great mission. Their cultural leadership is inspirational. They are transparent with their doctors about what successful physicians do, what tools they use, and how that impacts cost and quality. Best practices are then implemented across groups to make the best care the norm.  And they are doing it in such a way that the physicians are driving the changes themselves.

Intermountain knows their direction, and they know how to improve.  Continuous improvement is an activity of its own. It relies on good information, but also on learning systems of management and pushing those systems throughout the organization.

Verge Health is in the business of partnering with great health systems to put management systems in the hands of executives that are looking to improve quality, safety, and efficiency.  Our tools help introduce smart management practices that can be implemented across all areas of healthcare delivery.  Our clients include Cleveland Clinic, Atrium Health, RWJBarnabas Health and many others who are leading in terms of innovation in the areas of safety and quality. As a result, they are reducing their risk of adverse events and regulatory intervention.

What Intermountain has pulled together, and what Dr. Chen points to, brings to mind another rescue nearly 50 years ago, when NASA flattened hierarchies and pulled together as a team to bring home the stranded Apollo 13[3] astronauts. Tom Hanks, playing astronaut James Lovell in the Apollo 13 movie, said: “From now on, we live in a world where man has walked on the moon. And it’s not a miracle, we just decided to go.”

Healthcare can move from volume to value, and it doesn’t have to take forever. We just have to decide to do it.

Have you decided to stop handling issues of risk and compliance the old way? Then schedule a demo with us today.

[1] Steve George, James Masters and Kara Fox, “The Thai Cave Rescue Ended in Success. But Only Two Weeks Ago it All Seemed Hopeless,” July 11, 2018, https://www.cnn.com/2018/07/11/asia/thai-cave-rescue-full-story-intl/index.html.

[2] Pauline Chen, “A More Egalitarian Culture is Better for Everyone,” The New York Times ‘Well’ blog, May, 31, 2018, https://www.nytimes.com/2018/05/31/well/live/doctors-patients-hospital-culture-better-health.html.

[3] NASA, “Apollo 13,” July 8, 2009, https://www.nasa.gov/mission_pages/apollo/missions/apollo13.html.