Atul Gawande: Want to get great at something? Get a coach
アトゥール・ガワンデ: 上達する為に、医療チームにもコーチをつけよう
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching. Full bio
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who has been really interested
ということに
how good you are now,
優れているかだけでなく
that really matters.
ということなのだと考えています
in the north of India.
an extreme form of this very struggle,
in the face of complexity --
という究極の例を
has a one-in-20 death rate for the babies,
ten times higher than they do elsewhere.
in birth for decades,
何十年も前から知っていましたが
that even in this place --
難しいということです
and put on clean gloves,
清潔な手術用手袋を装着したり
of dilute bleach,
on the gloves from the last delivery.
with difficulty breathing everywhere.
生まれた時 呼吸がうまくできません
to stimulate them to breathe.
呼吸を誘発しますが
you give them breaths with the baby mask.
人工呼吸マスクで呼吸をさせます
mostly from textbooks,
人工呼吸器用マスクが壊れています
just how dire the situation is.
臍の緒を挟んだまま
言わんばかりです
his temperature by the minute.
requires a successful team of people.
それを助けるチームとしての成功が必要です
skilled and coordinated;
上手く連携していなければいけません
in a place like this,
for 22 critical drugs and supplies
of the whole facility.
スキルと連携が必要なのです
experienced professionals.
part of thousands of deliveries.
立ち会ってきたスタッフばかりでしたが
that they face,
that really matters.
どこまで精通しているかです
get better at what they do?
高めていくのでしょう?
you learn, you graduate,
学び終えたら卒業します
of managing their own improvement.
プロということになります
all professionals have learned by.
Juilliard violin instructor Dorothy DeLay.
ドロシー・ディレイはどうでしょう
of violin virtuosos:
イツァーク・パールマン
habits of thinking and of learning
in the world without her
世界で活躍できるようにすることでした
comes out of sports.
と言いますね
about this as a surgeon.
外科医として考えてみました
into my operating room,
手術室で私を
コーチが必要無いという事ですから
as a very American idea.
スポーツに取り入れられたと知りました
first American-rules football games.
最初のアメリカ式ルールのフットボールで戦い
イツァーク・パールマンに
violinist of his generation.
バイオリニストに育ちました
getting to write for "The New Yorker"
得た特権とは
and they return my phone calls.
折り返し連絡がもらえる事です
an almost two-hour conversation
to where he got in his career.
語り合いました
"Why don't violinists have coaches?"
コーチをつけないんです?」
together from Juilliard,
as a concert violinist
a little bit mechanical.
he became, he said.
重要だったと彼は言いました
in making it on your own.
数々の問題があったんです
that are standing in your way
障害となっている課題に気付かない
know how to fix them.
that somewhere along the way,
ある時 あなたの成長は
what had happened to me as a surgeon.
まさにそれだと気付いたのです
improvement in my learning curve.
from one year to the next.
any better anymore.
気付きました
as good as I'm going to get?"
「これが自分の限界か?」
of mine who had retired,
私の恩師で
anything much he'd have to say
ほとんど指摘されることもないだろうと
dense with notes.
走り書きで埋まっていました
had swung out of the wound
from reflected surfaces."
every once in a while.
at their sides resting comfortably.
your elbow going in the air,
or just move your feet."
足の位置を変えた方がいい」
fundamentally profound about this.
私の挙動を描写していました
your external eyes and ears,
目や耳となり
picture of your reality.
build them back up again.
drop down even further.
更に減ったのに気付きました
to have to work on things.
嫌になる時もありました
I would get worse before I got better.
更に腕が落ちたと感じた時期がありました
profoundly important.
核心に迫っているのだと
called Ariadne Labs,
医療提供における課題に取り組む
in the delivery of health care,
運営していたのですが
the World Health Organization
a team needs to go through
重要な手順です
are ready to go home.
wasn't going to change very much,
殆ど何も変わらないと
wasn't necessarily going to be enough
that you needed to bring it alive.
十分ではないと知っていました
こう言いました
at a massive scale?"
in 120 birth centers.
ウッタル・プラデーシュの
in India's largest state.
basically we just observed,
観察しただけでしたが
got visits from coaches.
of doctors and nurses like this one
and also the managers
観察手法を学んでもらい
build on their strengths
they had to work on with people --
fundamentally important --
when the baby mask is broken
手術用手袋が欠品していたり
including the managers,
ended up coaching 400 nurses
400名の看護師たちと
コーチしました
across 160,000 births.
who did not get coaching --
of 18 basic practices
over the course of the years of study,
何年にもわたるこの研究中に
got four months of coaching
of the practices being delivered.
改善したことが観察されました
across a whole range of centers
改善が見られて
could be a whole line of way
that could reach out in the world
色々な仕事が想像できますね
at the beginning of it, though,
all of the checklist together
reductions in mortality.
統合しなければなりませんでした
that were getting there,
learn to execute on the fundamentals.
習熟を助けたからです
to the labor and delivery room,
how quickly all of this happens
そのせいで
that makes things.
わかるでしょう
measured her pulse
the heart rate of the baby.
and the fetal Doppler monitor,
胎児超音波心音モニターが準備されていて
and the nurse knew how to use them.
分かっていたということです
連携が取れていました
which is normal.
of the contractions picked up,
that her cervix was fully dilated.
完全に開いているのを確認しました
おかしくありません
to do her next set of checks.
she worked her way through
she needed at the bedside.
全て揃っているのを確認しました
the sterile towel,
殺菌済みのタオルがあり
one push and that baby was out.
赤ちゃんが生まれました
in that room had changed.
一変したのにすぐに気づきました
at the community health worker
did not seem to be alive.
見つめていました
息をしていませんでした
with her checkpoints.
チェック項目をたどり続けました
when that didn't stimulate that baby,
なっていないと分かると
吸引器を取りに行きました
because you could count on electricity,
機械式吸引機はありませんでした
that little girl's airways.
of being able to do that
赤ちゃんは泣き始めました
on her mother's chest,
母親の胸で温められていました
to grab that nurse's hand,
because of coaching.
生まれ変わった所を目にしました
saved because of it.
救われるのを目にしました
a few months later.
ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovatorSurgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching.
Why you should listen
Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect Science, Better: A Surgeon's Notes on Performance, Being Mortal: Medicine and What Matters in the End and The Checklist Manifesto.
He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation and chair of Lifebox, a nonprofit organization making surgery safer globally.
In June 2018, Gawande was chosen to lead the new healthcare company set up by Amazon, JPMorgan and Berkshire Hathaway.
Photo: Aubrey Calo
Atul Gawande | Speaker | TED.com