ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovator
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.

Why you should listen

Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect ScienceBetter: 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

More profile about the speaker
Atul Gawande | Speaker | TED.com
TED2017

Atul Gawande: Want to get great at something? Get a coach

葛文德: 想要精益求精?找個教練

Filmed:
3,174,731 views

面對複雜的事情,我們要怎麼才能進步?葛文德以外科醫師的觀點研究這個課題。他分享了他所發現的關鍵:找一個教練,幫助我們更準確地看出現實作法的盲點,逐步灌輸正向的思考習慣,分解我們的動作,然後再幫我們將之重組。葛文德說:「關鍵不是你現在有多好,而是你會變得多好,那才是重點。」
- Surgeon, writer, public health innovator
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

Double-click the English transcript below to play the video.

00:12
I don't come to you today今天 as an expert專家.
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我今天不是以專家的身分來,
00:14
I come to you as someone有人
who has been really interested有興趣
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我來是因為我一直很想知道
00:17
in how I get better at what I do
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要怎麼讓自己做得更好,
00:20
and how we all do.
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我們要怎麼做得更好。
00:23
I think it's not just
how good you are now,
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這件事不只關於你現在多好,
00:25
I think it's how good you're going to be
that really matters事項.
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你會變得多好才是重點。
00:29
I was visiting訪問 this birth分娩 center中央
in the north of India印度.
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我之前在北印度一間婦產中心
00:32
I was watching觀看 the birth分娩 attendants服務員,
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觀察接生人員,
00:34
and I realized實現 I was witnessing見證 in them
an extreme極端 form形成 of this very struggle鬥爭,
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我意識到自己目睹他們
用一種很極端的方式使勁掙扎,
00:39
which哪一個 is how people improve提高
in the face面對 of complexity複雜 --
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就是人在面對複雜情況的時候
進步的那個樣子,
00:43
or don't.
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或沒進步的樣子。
00:46
The women婦女 here are delivering交付 in a region地區
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女性在這區一般產房生產
00:48
where the typical典型 birth分娩 center中央
has a one-in-一對一20 death死亡 rate for the babies嬰兒,
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要面對二十分之一的嬰兒死亡率,
00:54
and the moms媽媽 are dying垂死 at a rate
ten times higher更高 than they do elsewhere別處.
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母親的死亡率比其他地方高出十倍。
00:59
Now, we've我們已經 known已知 the critical危急 practices做法
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現在我們已經知道
數十年來讓嬰兒活產的關鍵措施。
01:02
that stop the big killers殺手
in birth分娩 for decades幾十年,
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01:05
and the thing about it is
that even in this place地點 --
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但問題是即使在這裡,
01:09
in this place地點 especially特別,
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尤其是這裡,
01:11
the simplest簡單 things are not simple簡單.
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最簡單的事情都辦不到。
01:13
We know for example you should wash hands
and put on clean清潔 gloves手套,
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例如我們應該要洗手、戴乾淨手套,
01:18
but here,
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但是這裡,
01:19
the tap龍頭 is in another另一個 room房間,
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水龍頭在別的房間,
01:22
and they don't have clean清潔 gloves手套.
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而且他們沒有乾淨的手套。
01:25
To reuse重用 their gloves手套,
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為了重覆使用手套,
01:26
they wash them in this basin盆地
of dilute bleach漂白,
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他們用這盆稀釋的漂白水洗,
01:30
but you can see there's still blood血液
on the gloves手套 from the last delivery交貨.
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但是大家可以看到,
手套上還有之前接生的血漬。
01:39
Ten percent百分 of babies嬰兒 are born天生
with difficulty困難 breathing呼吸 everywhere到處.
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10% 的嬰兒出生時會呼吸困難,
不管在哪都一樣。
01:43
We know what to do.
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我們知道怎麼應對。
01:44
You dry the baby寶寶 with a clean清潔 cloth
to stimulate刺激 them to breathe呼吸.
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用一塊乾淨的布擦乾嬰兒,
刺激他們呼吸,
01:48
If they don't start開始 to breathe呼吸,
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如果他們還沒開始呼吸,
01:50
you suction吸力 out their airways航空公司.
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就抽吸他們的呼吸道。
01:52
And if that doesn't work,
you give them breaths呼吸 with the baby寶寶 mask面具.
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如果還不行,
就給他們戴嬰兒氧氣罩。
01:57
But these are skills技能 that they've他們已經 learned學到了
mostly大多 from textbooks教科書,
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這些方法他們幾乎都在課本上學過,
02:01
and that baby寶寶 mask面具 is broken破碎.
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但是嬰兒氧氣罩壞了。
02:09
In this one disturbing煩擾的 image圖片 for me
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這個畫面讓我很難受,
02:12
is a picture圖片 that brings帶來 home
just how dire可怕的 the situation情況 is.
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完全顯示出情況有多慘。
02:17
This is a baby寶寶 10 minutes分鐘 after birth分娩,
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這個小孩剛出生十分鐘,
02:19
and he's alive,
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他還活著,
但只剩一絲殘息。
02:22
but only just.
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02:24
No clean清潔 cloth,
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沒有乾淨的布,
02:25
has not been dried,
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沒有被擦乾,
02:27
not warming變暖 skin皮膚 to skin皮膚,
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身體還沒完全變暖,
02:31
an unsterileunsterile clamp across橫過 the cord.
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未殺菌的鉗子剪斷臍帶。
02:34
He's an infection感染 waiting等候 to happen發生,
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他可能快被感染,
02:35
and he's losing失去
his temperature溫度 by the minute分鐘.
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每分鐘都在失溫。
02:41
Successful成功 child兒童 delivery交貨
requires要求 a successful成功 team球隊 of people.
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成功接生需要一組成功團隊。
02:45
A whole整個 team球隊 has to be
skilled技能的 and coordinated協調;
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每個人都應該技巧熟練、合作無間,
02:47
the nurses護士 who do the deliveries交付
in a place地點 like this,
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要有能在這種地方接生的護理師,
02:50
the doctor醫生 who backs them up,
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要有能夠支援的醫生,
02:52
the supply供應 clerk書記 who's誰是 responsible主管
for 22 critical危急 drugs毒品 and supplies耗材
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要有負責打點 22 種重要藥物
和醫療用品的補給員,
02:56
being存在 in stock股票 and at the bedside床頭,
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確保有現貨放在床邊,
02:59
the medical officer in charge收費,
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要有醫務官負責
03:00
responsible主管 for the quality質量
of the whole整個 facility設施.
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所有設備的品質。
03:05
The thing is they are all
experienced有經驗的 professionals專業人士.
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重點是他們全都是
有經驗的專業人員。
03:09
I didn't meet遇到 anybody任何人 who hadn't有沒有 been
part部分 of thousands數千 of deliveries交付.
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我碰過的每一個都接生過好幾千次。
03:15
But against反對 the complexities複雜性
that they face面對,
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但是面對這複雜的情況,
03:18
they seem似乎 to be at their limits範圍.
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他們就像已經做到極限,
03:21
They were not getting得到 better anymore.
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沒辦法做得更好。
03:25
It's how good you're going to be
that really matters事項.
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你能做得多好,才是重點。
03:32
It presses印刷機 on a fundamental基本的 question.
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這又涉及一個基本的問題。
03:35
How do professionals專業人士
get better at what they do?
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專業人員要怎麼做得更好?
03:39
How do they get great?
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要怎麼做到最好?
03:41
And there are two views意見 about this.
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關於這個有兩種觀點。
03:42
One is the traditional傳統 pedagogical教學 view視圖.
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第一種是傳統教學的觀點。
03:45
That is that you go to school學校,
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就是你上學、
03:47
you study研究, you practice實踐,
you learn學習, you graduate畢業,
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研讀、練習、學習、畢業,
03:50
and then you go out into the world世界
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然後出校園進入世界,
03:52
and you make your way on your own擁有.
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用自己的方式走自己的路。
03:54
A professional專業的 is someone有人 who is capable
of managing管理的 their own擁有 improvement起色.
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專業人員有能力讓自己進步。
03:59
That is the approach途徑 that virtually實質上
all professionals專業人士 have learned學到了 by.
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各行各業都學過怎麼做。
04:04
That's how doctors醫生 learn學習,
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醫生就是這麼學的,
04:05
that's how lawyers律師 do,
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還有律師也是,
04:07
scientists科學家們 ...
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科學家……
04:09
musicians音樂家.
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音樂家。
04:12
And the thing is, it works作品.
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重點是,這些方法有用。
04:15
Consider考慮 for example legendary傳奇的
Juilliard茱莉亞音樂學院 violin小提琴 instructor講師 Dorothy多蘿西 DeLay延遲.
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例如茱莉亞學院的小提琴
傳奇教師桃樂絲.狄蕾。
04:20
She trained熟練 an amazing驚人 roster名冊
of violin小提琴 virtuosos藝術大師:
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她訓練過的小提琴大師
名單熠熠生輝:
04:24
Midori, Sarah莎拉 Chang, Itzhak伊紮克 Perlman帕爾曼.
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五嶋綠、張永宙、伊扎克.帕爾曼。
04:26
Each of them came來了 to her as young年輕 talents人才,
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每個好手在年輕時就拜師學藝,
04:30
and they worked工作 with her over years年份.
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跟著她很多年。
04:32
What she worked工作 on most, she said,
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她說,自己做最多的是
04:34
was inculcating灌輸 in them
habits習慣 of thinking思維 and of learning學習
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灌輸他們思考和學習的習慣,
04:38
so that they could make their way
in the world世界 without her
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如此一來他們學成後,
無需她隨侍在側,
04:41
when they were doneDONE.
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就可以自己闖蕩世界。
04:45
Now, the contrasting對比 view視圖
comes out of sports體育.
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體育界持相反觀點。
04:50
And they say "You are never doneDONE,
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他們說:「永遠學不完,
04:52
everybody每個人 needs需求 a coach教練."
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每個人都要教練。」
04:54
Everyone大家.
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無一例外。
04:56
The greatest最大 in the world世界 needs需求 a coach教練.
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世界上最厲害的運動員也需要教練。
05:01
So I tried試著 to think
about this as a surgeon外科醫生.
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我把這件事套在外科上思考。
05:05
Pay工資 someone有人 to come
into my operating操作 room房間,
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付錢請人到我的開刀房,
05:10
observe me and critique批判 me.
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觀察我、評論我,
05:14
That seems似乎 absurd荒誕.
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好像有點奇怪。
05:16
Expertise專門知識 means手段 not needing需要 to be coached執教.
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專家意謂著不需再受教。
05:20
So then which哪一個 view視圖 is right?
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哪個觀點正確?
05:25
I learned學到了 that coaching教練 came來了 into sports體育
as a very American美國 idea理念.
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我發現運動界開始提倡找教練
是很美式的做法。
05:30
In 1875,
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1875 年的時候,
05:32
Harvard哈佛 and Yale耶魯 played發揮 one of the very
first American-rules美國-規則 football足球 games遊戲.
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哈佛和耶魯對打
當時少見的橄欖球賽。
05:36
Yale耶魯 hired僱用 a head coach教練;
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耶魯聘了一位總教練;
05:39
Harvard哈佛 did not.
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哈佛沒有。
05:41
The results結果?
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結果呢?
05:42
Over the next下一個 three decades幾十年,
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之後三十年
05:44
Harvard哈佛 won韓元 just four times.
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哈佛只贏了四次。
05:47
Harvard哈佛 hired僱用 a coach教練.
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哈佛之後也請了教練。
05:50
(Laughter笑聲)
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(笑聲)
05:52
And it became成為 the way that sports體育 works作品.
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這件事就變成體育界常態。
05:56
But is it necessary必要 then?
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但是真的有必要嗎?
05:57
Does it transfer轉讓 into other fields領域?
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其它領域也適用嗎?
06:01
I decided決定 to ask, of all people,
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我決定去問
06:03
Itzhak伊紮克 Perlman帕爾曼.
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伊扎克.帕爾曼。
06:05
He had trained熟練 the Dorothy多蘿西 DeLay延遲 way
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他在桃樂絲.狄蕾門下受訓,
06:08
and became成為 arguably按理說 the greatest最大
violinist小提琴手 of his generation.
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成為他那一代
可說是最成功的小提琴家。
06:12
One of the beautiful美麗 things about
getting得到 to write for "The New Yorker紐約客"
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幫《紐約客》寫文章
最棒的一件事情是
我打給電話找人,他們會回電。
06:16
is I call people up,
and they return返回 my phone電話 calls電話.
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06:19
(Laughter笑聲)
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(笑聲)
06:20
And Perlman帕爾曼 returned my phone電話 call.
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帕爾曼先生回了我電話。
06:23
So we ended結束 up having
an almost幾乎 two-hour兩小時 conversation會話
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結果我們談了將近兩小時,
06:25
about how he got
to where he got in his career事業.
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他告訴我他怎麼達到現在的境界。
06:30
And I asked him, I said,
"Why don't violinists小提琴家 have coaches教練?"
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我問他:
「為什麼小提琴家不請教練?」
06:34
And he said, "I don't know,
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他說:「我也不知道,
06:37
but I always had a coach教練."
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但我以前都有教練。」
06:39
"You always had a coach教練?"
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「你以前都有教練?」
06:41
"Oh yeah, my wife妻子, Toby托比."
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「對啊,是我老婆,桃比。」
06:45
They had graduated畢業
together一起 from Juilliard茱莉亞音樂學院,
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他們一起從茱莉亞學院畢業,
06:48
and she had given特定 up her job工作
as a concert音樂會 violinist小提琴手
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她放棄當小提琴演奏家,
06:52
to be his coach教練,
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改當他的教練,
06:53
sitting坐在 in the audience聽眾,
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坐在觀眾席,
06:55
observing觀察 him and giving him feedback反饋.
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觀察他、給他意見。
06:57
"Itzhak伊紮克, in that middle中間 section部分,
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「伊扎克,中間那段,
07:00
you know you sounded滿面
a little bit mechanical機械.
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聽起來有點生硬。
07:03
What can you differently不同 next下一個 time?"
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下次你可以怎麼改?」
07:06
It was crucial關鍵 to everything
he became成為, he said.
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他說這件事對他的成就功不可沒。
07:10
Turns out there are numerous眾多 problems問題
in making製造 it on your own擁有.
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事實證明,自己追求進步
會有很多問題。
07:15
You don't recognize認識 the issues問題
that are standing常設 in your way
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你不會意識到卡住你的問題,
07:18
or if you do,
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即使你知道問題,
07:19
you don't necessarily一定
know how to fix固定 them.
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也不見得知道該怎麼改善。
07:21
And the result結果 is
that somewhere某處 along沿 the way,
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結果就是成長路上的某一刻
07:24
you stop improving提高.
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你不再進步。
07:28
And I thought about that,
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我思考了這一點,
07:30
and I realized實現 that was exactly究竟
what had happened發生 to me as a surgeon外科醫生.
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了解到那就是我身為外科醫師
所碰到的問題。
07:34
I'd entered進入 practice實踐 in 2003,
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我 2003 年開始行醫,
07:37
and for the first several一些 years年份,
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頭幾年
07:38
it was just this steady穩定, upward向上
improvement起色 in my learning學習 curve曲線.
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我在學習中一直穩定成長。
07:43
I watched看著 my complication並發症 rates利率 drop下降
from one year to the next下一個.
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我看著我病人的併發率年年下降,
07:47
And after about five years年份,
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大概五年後
07:48
they leveled夷為平地 out.
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就停在那邊。
07:51
And a few少數 more years年份 after that,
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之後又過了幾年,
07:52
I realized實現 I wasn't getting得到
any better anymore.
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我知道自己沒有再進步了。
07:56
And I thought: "Is this
as good as I'm going to get?"
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我心想:「這就是我的能耐了嗎?」
08:00
So I thought a little more and I said ...
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我再想了一下之後決定:
08:03
"OK,
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「好,
08:05
I'll try a coach教練."
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我要找教練。」
08:07
So I asked a former前任的 professor教授
of mine who had retired退休,
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所以我問了我之前的教授,
他退休了,
08:11
his name名稱 is Bob短發 Osteen歐斯丁,
153
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叫做鮑伯.歐斯汀,
08:13
and he agreed約定 to come to my operating操作 room房間
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他答應我到我的手術房
08:16
and observe me.
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觀察我。
08:19
The case案件 --
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第一個病例,
08:20
I remember記得 that first case案件.
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我記得很清楚,
08:21
It went beautifully精美.
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那個手術開得很漂亮。
08:23
I didn't think there would be
anything much he'd他會 have to say
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結束後,我覺得他不會有什麼好說的。
08:26
when we were doneDONE.
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08:27
Instead代替, he had a whole整個 page
dense稠密 with notes筆記.
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但是他寫了一整張密密麻麻的筆記。
08:31
(Laughter笑聲)
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(笑聲)
08:33
"Just small things," he said.
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「一些小事而已,」他說。
08:34
(Laughter笑聲)
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(笑聲)
08:35
But it's the small things that matter.
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但魔鬼藏在細節裡。
08:39
"Did you notice注意 that the light
had swung揮動 out of the wound傷口
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「你有發現開刀的時候,
08:42
during the case案件?
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燈沒有對著傷口照嗎?
08:43
You spent花費 about half an hour小時
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你有半小時
08:45
just operating操作 off the light
from reflected反射的 surfaces."
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用反射光動手術。」
08:49
"Another另一個 thing I noticed注意到," he said,
170
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「我還注意到一件事,」他說,
08:51
"Your elbow彎頭 goes up in the air空氣
every一切 once一旦 in a while.
171
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「你的手肘三不五時會往上提。
08:54
That means手段 you're not in full充分 control控制.
172
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表示你沒有完全控制自己。
08:57
A surgeon's外科醫生 elbows肘部 should be down
at their sides雙方 resting休息 comfortably舒服.
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外科醫生的手肘應該要自然下垂。
09:01
So that means手段 if you feel
your elbow彎頭 going in the air空氣,
174
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如果你覺得手肘往上提,
就應該要換器具,
或是移動一下腳步。」
09:04
you should get a different不同 instrument儀器,
or just move移動 your feet."
175
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09:09
It was a whole整個 other level水平 of awareness意識.
176
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這是完全不同程度的體認。
09:14
And I had to think,
177
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我當時想,
09:17
you know, there was something
fundamentally從根本上 profound深刻 about this.
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這件事從根本來看意義深遠。
09:21
He was describing說明 what great coaches教練 do,
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他說的話就是好教練做的事,
09:24
and what they do is they are
your external外部 eyes眼睛 and ears耳朵,
180
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他們當你身外的眼睛和耳朵,
09:27
providing提供 a more accurate準確
picture圖片 of your reality現實.
181
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提供你更精確的現實。
09:31
They're recognizing認識 the fundamentals基本面.
182
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1960
他們看出根本原因。
09:33
They're breaking破壞 your actions行動 down
183
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他們分解你的動作,
09:36
and then helping幫助 you
build建立 them back up again.
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再幫你重新組合起來。
09:38
After two months個月 of coaching教練,
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兩個月的訓練後,
09:40
I felt myself getting得到 better again.
186
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我發現自己又進步了。
09:43
And after a year,
187
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一年之後,
09:44
I saw my complications並發症
drop下降 down even further進一步.
188
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我病人的併發症案例降更低了。
09:49
It was painful痛苦.
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1200
過程很痛苦。
09:51
I didn't like being存在 observed觀察到的,
190
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我不喜歡被觀察,
09:54
and at times I didn't want
to have to work on things.
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有時候我不想被逼著改掉習慣。
09:57
I also felt there were periods where
I would get worse更差 before I got better.
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我也覺得在我進步之前,
有段時間在退步。
10:01
But it made製作 me realize實現
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但這件事讓我了解
10:02
that the coaches教練 were onto something
profoundly深深 important重要.
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這些指導影響深遠,意義重大。
10:09
In my other work,
195
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我的另一份工作是
10:10
I lead a health健康 systems系統 innovation革新 center中央
called Ariadne阿里阿德涅 Labs實驗室,
196
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主持阿里亞尼醫藥創新中心,
10:14
where we work on problems問題
in the delivery交貨 of health健康 care關心,
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我們處理產房裡碰到的問題,
10:18
including包含 global全球 childbirth分娩.
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包含全球嬰兒出生率。
10:20
As part部分 of it,
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其中,
10:21
we had worked工作 with
the World世界 Health健康 Organization組織
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我們和世界衛生組織合作
10:24
to devise設計 a safe安全 childbirth分娩 checklist清單.
201
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設計出一套安全生產清單。
10:26
It lays樂事 out the fundamentals基本面.
202
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清單上列出所有基本要件,
10:28
It breaks休息 down the fundamentals基本面 --
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瓦解基本要件──
10:30
the critical危急 actions行動
a team球隊 needs需求 to go through通過
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一連串團隊必須做的動作──
10:33
when a woman女人 comes in in labor勞動,
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從產婦進產房來分娩、
10:35
when she's ready準備 to push,
206
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1936
她準備好用力推,
10:37
when the baby寶寶 is out,
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到嬰兒出生,
10:39
and then when the mom媽媽 and baby寶寶
are ready準備 to go home.
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最後母子準備回家。
10:42
And we knew知道
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我們知道,
10:43
that just handing移交 out a checklist清單
wasn't going to change更改 very much,
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一張清單不會改變太多,
10:46
and even just teaching教學 it in the classroom課堂
wasn't necessarily一定 going to be enough足夠
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即使是在教室裡教都不見得能
10:51
to get people to make the changes變化
that you needed需要 to bring帶來 it alive.
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讓人做出可以讓嬰兒活下來的改變。
10:55
And I thought on my experience經驗 and said,
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我考量了我的經驗後說:
10:57
"What if we tried試著 coaching教練?
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「要不要試看看找教練?
11:00
What if we tried試著 coaching教練
at a massive大規模的 scale規模?"
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要不要試看看大規模找教練來做?」
11:04
We found發現 some incredible難以置信 partners夥伴,
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我們找到一些很棒的夥伴,
11:07
including包含 the government政府 of India印度,
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包含印度政府,
11:10
and we ran a trial審訊 there
in 120 birth分娩 centers中心.
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我們在當地 120 間產婦中心測試。
11:13
In Uttar北方邦 Pradesh,
in India's印度 largest最大 state.
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在印度最大的行政區北方邦,
11:17
Half of the centers中心
basically基本上 we just observed觀察到的,
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有一半的診所,我們單純觀察,
11:23
but the other half
got visits訪問 from coaches教練.
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另一半會有教練過去。
11:25
We trained熟練 an army軍隊
of doctors醫生 and nurses護士 like this one
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我們訓練一批醫師和護理師,像她,
11:29
who learned學到了 to observe the care關心
and also the managers經理
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他們學習觀察產房的護理
和管理階層,
11:34
and then help them
build建立 on their strengths優勢
224
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然後幫他們加強能力,
11:36
and address地址 their weaknesses弱點.
225
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指出他們的弱點。
11:38
One of the skills技能 for example
they had to work on with people --
226
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舉例來說,他們和人工作
必須有的一項技巧,
事後證明這很重要,
11:41
turned轉身 out to be
fundamentally從根本上 important重要 --
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就是溝通。
11:44
was communication通訊.
228
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讓護理師練習勇於發言,
比如說,嬰兒氧氣罩壞掉、
11:45
Getting入門 the nurses護士 to practice實踐 speaking請講 up
when the baby寶寶 mask面具 is broken破碎
229
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11:49
or the gloves手套 are not in stock股票
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手套庫存量不夠、
11:51
or someone's誰家 not washing洗滌 their hands.
231
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有人沒洗手。
11:53
And then getting得到 others其他,
including包含 the managers經理,
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然後讓其他人,包含管理階層,
11:55
to practice實踐 listening.
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練習傾聽。
11:57
This small army軍隊 of coaches教練
ended結束 up coaching教練 400 nurses護士
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這一小批教練最後
訓練了四百位護理師、
12:02
and other birth分娩 attendants服務員,
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接生員、
12:04
and 100 physicians醫師 and managers經理.
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一百名外科醫生和管理人員。
12:07
We tracked追踪 the results結果
across橫過 160,000 births出生.
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我們追蹤 16 萬名新生兒,
12:13
The results結果 ...
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結果……
12:15
in the control控制 group you had --
239
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在控制組的是
12:17
and these are the ones那些
who did not get coaching教練 --
240
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沒有受訓的人,
12:19
they delivered交付 on only one-third三分之一
of 18 basic基本 practices做法
241
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我們測量的 18 個基本要件當中,
他們只做到三分之一。
12:23
that we were measuring測量.
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12:25
And most important重要 was
over the course課程 of the years年份 of study研究,
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最重要的是經過多年研究,
12:28
we saw no improvement起色 over time.
244
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我們在過程中沒看到進步。
12:30
The other folks鄉親
got four months個月 of coaching教練
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其他接受四個月訓練的人,
12:33
and then it tapered off over eight months個月,
246
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接下來的八個月訓練逐漸變少,
12:35
and we saw them increase增加
247
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我們看見他們進步到
12:37
to greater更大 than two-thirds三分之二
of the practices做法 being存在 delivered交付.
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做到超過三分之二的基本要件。
12:42
It works作品.
249
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結果奏效。
12:43
We could see the improvement起色 in quality質量,
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我們可以看到品質進步,
12:47
and you could see it happen發生
across橫過 a whole整個 range範圍 of centers中心
251
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2816
你可以看到許多診所都有成效,
12:50
that suggested建議 that coaching教練
could be a whole整個 line of way
252
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3216
這表示訓練可能是一條路,
12:53
that we bring帶來 value to what we do.
253
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彰顯我們專業的價值。
12:56
You can imagine想像 the whole整個 job工作 category類別
that could reach達到 out in the world世界
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你可以想見這能延續到世界上各行各業
13:00
and that millions百萬 of people could fulfill履行.
255
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能滿足上百萬人。
13:04
We were clearly明確地
at the beginning開始 of it, though雖然,
256
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2216
不過我們顯然才剛起步,
13:06
because there was still a distance距離 to go.
257
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2096
還有一段路要走。
13:08
You have to put
all of the checklist清單 together一起
258
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2216
要把所有確認事項放在一起,
13:10
to achieve實現 the substantial大量的
reductions減少 in mortality死亡.
259
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3376
才能真的減少死亡率。
13:14
But we began開始 seeing眼看 the first places地方
that were getting得到 there,
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但我們開始看到第一批產房進步,
13:17
and this center中央 was one of them
261
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這是其中一間,
13:19
because coaching教練 helped幫助 them
learn學習 to execute執行 on the fundamentals基本面.
262
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3400
因為訓練幫他們學習從根本做起。
13:24
And you could see it here.
263
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在這邊可以看到成果。
13:27
This is a 23-year-old-歲 woman女人
264
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2896
這位婦女 23 歲,
13:30
who had come in by ambulance救護車,
265
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2096
她被救護車送來,
13:32
in labor勞動 with her third第三 child兒童.
266
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準備生她的第三胎。
13:35
She broke打破 her water in the triage分流 area,
267
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5776
她在檢傷分類區的時候羊水破了,
13:41
so they brought her directly
to the labor勞動 and delivery交貨 room房間,
268
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3376
所以直接被送到產房,
13:44
and then they ran through通過 their checks檢查.
269
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1896
然後醫護人員逐項確認清單。
13:46
I put the time stamp郵票 on here
270
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我在照片上標了時間,
13:48
so you could see
how quickly很快 all of this happens發生
271
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2896
你們就能看到這些事發生有多快,
13:51
and how much more complicated複雜
that makes品牌 things.
272
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還有事情變得多複雜。
13:54
Within four minutes分鐘,
273
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不過幾分鐘,
13:55
they had taken採取 the blood血液 pressure壓力,
measured測量 her pulse脈衝
274
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3176
他們已經幫她量血壓、測脈博
13:59
and also measured測量
the heart rate of the baby寶寶.
275
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和小孩的心跳。
14:02
That meant意味著 that the blood血液 pressure壓力 cuff袖口
and the fetal Doppler多普勒 monitor監控,
276
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3336
這表示血壓計和胎心儀都在這邊,
14:05
they were all there,
and the nurse護士 knew知道 how to use them.
277
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而且護理師知道要怎麼操作。
14:08
The team球隊 was skilled技能的 and coordinated協調.
278
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1960
這組團隊訓練有素、合作無間。
14:11
The mom媽媽 was doing great,
279
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1256
媽媽的狀況很好,
14:12
the baby's寶寶 heart rate was 143,
which哪一個 is normal正常.
280
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嬰兒心跳 143 下,很正常。
14:16
Eight minutes分鐘 later後來, the intensity強度
of the contractions宮縮 picked採摘的 up,
281
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3896
八分鐘後,宮縮變強,
14:20
so the nurse護士 washed her hands,
282
848000
2136
所以護理師洗手、
14:22
put on clean清潔 gloves手套,
283
850160
1616
戴上乾淨的手套,
14:23
examined檢查 her and found發現
that her cervix宮頸 was fully充分 dilated擴張.
284
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3416
檢查產婦,發現她子宮頸完全張開,
14:27
The baby寶寶 was ready準備 to come.
285
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1680
嬰兒準備好要出生了。
14:29
She then went straight直行 over
to do her next下一個 set of checks檢查.
286
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3456
所以她直接確認下一套清單。
14:33
All of the equipment設備,
she worked工作 her way through通過
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她一一確認所有儀器
14:35
and made製作 sure she had everything
she needed需要 at the bedside床頭.
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和所需物品都在床邊。
14:38
The baby寶寶 mask面具 was there,
the sterile無菌 towel毛巾,
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嬰兒氧氣罩、無菌布,
14:40
the sterile無菌 equipment設備 that you needed需要.
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所有你需要的無菌用品都在。
14:42
And then three minutes分鐘 later後來,
one push and that baby寶寶 was out.
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三分鐘後,推一下寶寶就出來了。
14:48
(Applause掌聲)
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(掌聲)
14:52
I was watching觀看 this delivery交貨,
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我看這個生產過程的時候,
14:54
and suddenly突然 I realized實現 that the mood心情
in that room房間 had changed.
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突然意識到房裡的氣氛變了。
15:00
The nurse護士 was looking
at the community社區 health健康 worker工人
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護理師看著社區保健員
15:02
who had come in with the woman女人
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和產婦一起進來,
15:04
because that baby寶寶
did not seem似乎 to be alive.
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因為寶寶好像沒有活下來。
15:08
She was blue藍色 and floppy軟盤 and not breathing呼吸.
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她膚色鐵青、全身鬆軟、沒有呼吸。
15:12
She would be one of that one-in-一對一20.
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她可能會是那 20 個之中的一個。
15:16
But the nurse護士 kept不停 going
with her checkpoints檢查站.
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但是護理師繼續確認清單,
15:19
She dried that baby寶寶 with a clean清潔 towel毛巾.
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用乾淨的布擦乾嬰兒。
15:22
And after a minute分鐘,
when that didn't stimulate刺激 that baby寶寶,
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一分鐘後,
嬰兒沒有受刺激開始呼吸,
15:25
she ran to get the baby寶寶 mask面具
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她跑去拿嬰兒氧氣罩,
15:28
and the other one went to get the suction吸力.
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另一位去拿抽吸器。
15:31
She didn't have a mechanical機械 suction吸力
because you could count計數 on electricity電力,
305
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因為電力的問題,
她沒有電動抽吸器,
她用口部抽吸器,
15:35
so she used a mouth suction吸力,
306
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20 秒內,
15:36
and within 20 seconds,
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她開始清小女嬰的呼吸道,
15:37
she was clearing空地 out
that little girl's女孩 airways航空公司.
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15:40
And she got back a green綠色, thick liquid液體,
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清出綠色濃稠的液體,
15:42
and within a minute分鐘
of being存在 able能夠 to do that
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可以開始不斷抽吸後一分鐘內
15:44
and suctioning out over and over,
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15:46
that baby寶寶 started開始 to breathe呼吸.
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1416
寶寶開始呼吸了。
15:47
(Applause掌聲)
313
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(掌聲)
15:53
Another另一個 minute分鐘 and that baby寶寶 was crying哭了.
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下一刻寶寶就哭了。
15:57
And five minutes分鐘 after that,
315
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五分鐘後,
15:59
she was pink and warming變暖
on her mother's母親 chest胸部,
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粉嫩溫暖的她就在母親的懷裡,
16:02
and that mother母親 reached到達 out
to grab that nurse's護士 hand,
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這位媽媽伸手握住護理師的手,
16:05
and they could all breathe呼吸.
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她們都能呼吸了。
16:09
I saw a team球隊 transformed改造
because of coaching教練.
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我看到因為訓練,讓一組團隊改變。
16:13
And I saw at least最小 one life
saved保存 because of it.
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我看到至少因此救了一條人命。
16:17
We followed其次 up with that mother母親
a few少數 months個月 later後來.
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幾個月後我們追蹤這位母親。
16:20
Mom媽媽 and baby寶寶 were doing great.
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她和寶寶都很好。
16:23
The baby's寶寶 name名稱 is AnshikaAnshika.
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寶寶叫安希卡,
16:27
It means手段 "beautiful美麗."
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是「美麗」的意思。
16:30
And she is what's possible可能
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她的存在證實了,
16:31
when we really understand理解
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當我們知道如何精益求精時。
16:33
how people get better at what they do.
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美麗成果就有可能實現。
16:36
Thank you.
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謝謝。
16:37
(Applause掌聲)
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(掌聲)
Translated by Marssi Draw
Reviewed by Adrienne Lin

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ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovator
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.

Why you should listen

Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect ScienceBetter: 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

More profile about the speaker
Atul Gawande | Speaker | TED.com

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