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SoDA Blog Leadership Ideas and Opinions

The end of the line for lone wolves and cowboys

by Sara Williams, Made by Many / November 23, 2011

In May of this year, Atul Gawande delivered the commencement address at Harvard Medical School. Dr. Gawande is a Rhodes Scholar, a surgeon, a New Yorker staff writer and an associate professor at both the Harvard School of Public Health and Harvard Medical School. He’s also on Twitter: @Atul_Gawande.

Dr. Gawande’s commencement address, published in The New Yorker under the title Cowboys and Pit Crews, is about change. I read it Monday night and have been thinking about it ever since. One question in particular keeps running ’round my head:

We humans are doing an amazing job of changing our world… but how are we doing at adapting to the changes we create?

In our industry we talk a lot about disruptive innovation. This has become a bit of a buzz term, but for a reason: the light-speed discovery and advancement that is happening in the world of technology is profoundly affecting the way we live, communicate and advertise. Increasingly, no matter who or where you are, you can’t escape innovation.

We’re at a point where in just about any industry there is so much to know, it’s rare that one person knows or does it all. Lone wolf operations are becoming more rare and less successful. Collaboration – and the systems it entails – isn’t optional. The solo cowboy doing his thing out there on the range? He’s part of a team.

I’ve given some thought to this wave of change as it applies to the realms in which I spend most of my time and energy: communication, journalism, advertising. But I haven’t really looked beyond these areas. Dr. Gawande’s address reminded me that it is affecting *all* aspects of human life, including healthcare:

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… We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly.

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.

You don’t have to work in healthcare for this to resonate. Complexity is everywhere. It’s also really scary.

Dr. Gawande describes a situation where technological advances have led to high-speed and ever-faster innovation, forcing and fragmenting the healthcare landscape to the point that the old ways of working just don’t work anymore:

We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care.

This makes great sense: disruptive innovation changes a space or industry, and then it forces the people who work or live in that space to change the way they work or live. We all seem to have this first part down: we’re making new technologies all the time and those technologies make what used to be impossible, possible. The internet, mobile technology, penicillin, air travel… all game-changing inventions. What we struggle with is adapting our old structures and systems to this new landscape.

It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.

Change is chaotic, there’s no mistaking that. But could a good chunk of the chaos we typically associate with change be attributable to our resisting change and trying to apply old behaviours to new environments? Food for thought.

I strongly recommend Dr. Gawande’s article. It includes some very interesting proposals for new ways of working that are applicable across multiple industries, not just healthcare. Don’t settle for my review – take ten minutes and read the real deal.