I recently watched Dr. Atul Gawande on video describe how what American healthcare needs is pit crews and not cowboys. This sentiment is also memorialized in his thought-provoking writings for the New Yorker.
Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing. A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements in pediatric anesthesia handoffs. His observations were astounding and really highlighted how the culture of medicine is different from Formula 1. In Formula 1, pit crews have a ‘fanatical’ approach to training that relies on repitition. In healthcare, the first time we often do something is “on the fly”. Moreover, on-the-job training usually means ‘checking the box’ by attending an annual patient safety lecture. Perhaps the most important was the role of the “lollipop man” in pit crews. And yes, even thought it’s a funny name, it’s a critical job. As shown in the video, the Lollipop man is responsible for signaling and coordinating to the driver the major steps of the pit stop. When it is safe to step on the gas, the Lollipop man will signal to the driver. Sounds like a thing so perhaps it can be automated. Wrong. When Ferrari tried replacing the Lollipop man with a stop light that signaled the driver, the confusion created (does amber mean stop or go?) led to a driver leaving the pit with his gas still connected. Quickly after this incident, Ferrari announced it would go back to the tried and trusted Lollipop “hu”man.
So, who are the Lollipop men (or women) in healthcare? Turns out that Dr. Catchpole and his team observed that it was often unclear who was leading the handoff process that they were observing in healthcare. With team training and system reengineering, Dr. Catchpole’s team was able to reorganize the pediatric handover so there was a Lollipop man (anesthesiologist) at the helm.
While these handoffs represent a critical element of healthcare communication in a focused area, it is symbolic of a larger problem in healthcare – we are still missing “Lollipop men” to coordinate healthcare for patients across multiple sites and specialties. This is even more critical on the 2-year anniversary of healthcare reform and this month’s match results. At a time when we need to cultivate and train more “Lollipop men” to coordinate care for patients, we have had stable numbers of students who enter primary care fields. And like the lessons from the Ferrari team, it is doubtful that a computer (even Watson who is now working in medicine apparently) will be able to do the job of a Lollipop man.
So, how can we recruit more Lollipop men? While it is tempting to blame the rise or fall of various specialties and market forces, it is important to recognize that being this is a difficult job to do when the Lollipop is broken or even nonexistent. Without the tools to execute the critical coordination that Lollipop men rely on, they cannot do their job. So, the first order of business to ensure that the Lollipop, or an infrastructure to coordinate care for patients through their race that is their healthcare journey, exists. As the Supreme Court debates the future of the Accountable Care Act, there is no greater time to highlight the importance of the Lollipop.
–Vineet Arora MD
Recently, I was asked to speak about innovations in inpatient medical education for leaders in general internal medicine. Knowing that I would be last in a distinguished lineup of speakers and that my charge was to discuss novel ways to teach in the inpatient setting, I thought it would be important to review how its been done for a long time — so long that it is embodied in one of my favorite fairy tales…
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