TED2017
Atul Gawande: Want to get great at something? Get a coach
阿图 · 葛文德: 想要成为行业精英？去找个教练吧。
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我们该如何提高自己应对复杂局面的能力？阿图 · 葛文德凭借外科医生的精准度研究了这个问题。他分享了自己的收获：一个好的教练能提供真实的情况，帮助自己培养积极的思维模式，并打破错误的习惯，协助我们建立新的习惯。“真正重要的，不是现在的你有多优秀，而是未来的你将多精彩。”葛文德说。
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. Full bio
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 as an expert.
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今天我并非以一个
专家的身份来这里演讲，
专家的身份来这里演讲，
我是为了那些一直非常想要
00:14
I come to you as someone
who has been really interested
who has been really interested
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00:17
in how I get better at what I do
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在自己的领域成为行家的人
00:20
and how we all do.
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而来。
00:23
I think it's not just
how good you are now,
how good you are now,
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我想，重要的不是现在你有多优秀，
而是未来你将多精彩。
00:25
I think it's how good you're going to be
that really matters.
that really matters.
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00:29
I was visiting this birth center
in the north of India.
in the north of India.
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我曾经到访印度北边的
这个生育中心。
这个生育中心。
00:32
I was watching the birth attendants,
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我看着这些产护人员，
发现她们正在与复杂的局面
00:34
and I realized I was witnessing in them
an extreme form of this very struggle,
an extreme form of this very struggle,
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00:39
which is how people improve
in the face of complexity --
in the face of complexity --
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进行艰苦的斗争——
当然，也许是我多虑了。
00:43
or don't.
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00:46
The women here are delivering in a region
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但在当地生育中心
00:48
where the typical birth center
has a one-in-20 death rate for the babies,
has a one-in-20 death rate for the babies,
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出生的婴儿，死亡率高达5%，
00:54
and the moms are dying at a rate
ten times higher than they do elsewhere.
ten times higher than they do elsewhere.
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孕妇的死亡率也是其他地区的十倍。
00:59
Now, we've known the critical practices
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现在，我们已经知道降低几十年来
01:02
that stop the big killers
in birth for decades,
in birth for decades,
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新生儿死亡率居高不下的关键举措，
01:05
and the thing about it is
that even in this place --
that even in this place --
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以及造成这一现象的原因——
01:09
in this place especially,
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像这种地方，
01:11
the simplest things are not simple.
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稀松小事也可以举步维艰。
01:13
We know for example you should wash hands
and put on clean gloves,
and put on clean gloves,
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众所周知，产护人员应该
洗手后戴上干净的手套，
洗手后戴上干净的手套，
01:18
but here,
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然而在这里，
01:19
the tap is in another room,
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手术室没有水龙头
01:22
and they don't have clean gloves.
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产护人员也没有干净的手套。
01:25
To reuse their gloves,
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为了重复利用手套
01:26
they wash them in this basin
of dilute bleach,
of dilute bleach,
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她们用稀释的漂白水清洗手套，
01:30
but you can see there's still blood
on the gloves from the last delivery.
on the gloves from the last delivery.
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但手套上仍有之前使用留下的血迹。
01:39
Ten percent of babies are born
with difficulty breathing everywhere.
with difficulty breathing everywhere.
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世界上10%的孩子出生时就
伴有呼吸困难的症状。
伴有呼吸困难的症状。
01:43
We know what to do.
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人们知道如何解决这一问题。
01:44
You dry the baby with a clean cloth
to stimulate them to breathe.
to stimulate them to breathe.
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用干净的毛巾轻抚婴儿
以刺激他们呼吸。
以刺激他们呼吸。
01:48
If they don't start to breathe,
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如果没有作用，
01:50
you suction out their airways.
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应疏通他们的呼吸道。
01:52
And if that doesn't work,
you give them breaths with the baby mask.
you give them breaths with the baby mask.
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如果效果仍然不明显，
应该给他们戴上婴儿（氧气）面罩。
应该给他们戴上婴儿（氧气）面罩。
01:57
But these are skills that they've learned
mostly from textbooks,
mostly from textbooks,
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这些是学校教授的方法，
02:01
and that baby mask is broken.
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然而在这儿，婴儿面罩
根本无法使用。
根本无法使用。
02:09
In this one disturbing image for me
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这一幕给我留下了深刻的印象，
02:12
is a picture that brings home
just how dire the situation is.
just how dire the situation is.
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不断提醒着我，情况实在太糟糕了。
02:17
This is a baby 10 minutes after birth,
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这是一个刚出生10分钟的婴儿，
02:19
and he's alive,
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他还活着，
02:22
but only just.
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但是仅仅活着。
02:24
No clean cloth,
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不仅没有干净的绵毯，
02:25
has not been dried,
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也没有干燥的毛巾，
02:27
not warming skin to skin,
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它感受不到任何温暖，
02:31
an unsterile clamp across the cord.
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只有一个未经消毒的夹子夹着脐带。
02:34
He's an infection waiting to happen,
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他即将被感染，
02:35
and he's losing
his temperature by the minute.
his temperature by the minute.
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正面临着体温下降的危险。
02:41
Successful child delivery
requires a successful team of people.
requires a successful team of people.
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每一个婴儿的顺利出生，
背后都少不了一个出色的团队。
背后都少不了一个出色的团队。
02:45
A whole team has to be
skilled and coordinated;
skilled and coordinated;
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由技艺高超且配合默契的
成员组成的团队，
成员组成的团队，
02:47
the nurses who do the deliveries
in a place like this,
in a place like this,
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产护人员在团队的相互配合下工作，
02:50
the doctor who backs them up,
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有医生的支持，
02:52
the supply clerk who's responsible
for 22 critical drugs and supplies
for 22 critical drugs and supplies
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供应员会在床边和仓库里
02:56
being in stock and at the bedside,
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准备充足的药品和所需的用具，
02:59
the medical officer in charge,
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医疗主管负责
03:00
responsible for the quality
of the whole facility.
of the whole facility.
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医疗设备的质量。
03:05
The thing is they are all
experienced professionals.
experienced professionals.
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他们都是熟练的专业人士。
03:09
I didn't meet anybody who hadn't been
part of thousands of deliveries.
part of thousands of deliveries.
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每个人都参与过上千次的接生。
03:15
But against the complexities
that they face,
that they face,
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但当他们面对这种复杂的局面时，
03:18
they seem to be at their limits.
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却变得束手无策。
03:21
They were not getting better anymore.
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他们已经尽力做到最好了。
03:25
It's how good you're going to be
that really matters.
that really matters.
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但关键在于，未来
他们能否改变这一现状。
他们能否改变这一现状。
03:32
It presses on a fundamental question.
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由此延伸出一个基本的问题。
03:35
How do professionals
get better at what they do?
get better at what they do?
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行家是怎么做到精益求精的？
03:39
How do they get great?
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他们怎么变得杰出？
03:41
And there are two views about this.
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关于此问题有两类观点。
一类是传统的教学观点。
03:42
One is the traditional pedagogical view.
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03:45
That is that you go to school,
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去学校学习，
上课，做功课，考试，毕业，
03:47
you study, you practice,
you learn, you graduate,
you learn, you graduate,
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03:50
and then you go out into the world
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然后走向社会，
03:52
and you make your way on your own.
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独自前行。
成为一个能自我管理，
不断进步的专家。
不断进步的专家。
03:54
A professional is someone who is capable
of managing their own improvement.
of managing their own improvement.
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03:59
That is the approach that virtually
all professionals have learned by.
all professionals have learned by.
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这几乎是所有专业人士学习的方法。
04:04
That's how doctors learn,
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是医生学习的方法，
是律师学习的方法，
04:05
that's how lawyers do,
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04:07
scientists ...
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是科学家学习的方法，
04:09
musicians.
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也是音乐家学习的方法.....
04:12
And the thing is, it works.
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并且这个方法效果显著。
04:15
Consider for example legendary
Juilliard violin instructor Dorothy DeLay.
Juilliard violin instructor Dorothy DeLay.
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比如朱利亚音乐学院的
传奇教师多萝西·迪蕾（Dorothy DeLay）。
传奇教师多萝西·迪蕾（Dorothy DeLay）。
04:20
She trained an amazing roster
of violin virtuosos:
of violin virtuosos:
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她培养了一大批杰出的小提琴演奏家：
04:24
Midori, Sarah Chang, Itzhak Perlman.
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美岛莉， 张莎拉，伊扎克·帕尔曼等。
04:26
Each of them came to her as young talents,
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他们拜入她门下时都已锋芒毕露，
04:30
and they worked with her over years.
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经历数年的练习后，
最终达到了很高的水准。
最终达到了很高的水准。
04:32
What she worked on most, she said,
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她说，她最大的贡献是
04:34
was inculcating in them
habits of thinking and of learning
habits of thinking and of learning
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培养了他们思考和学习的习惯，
04:38
so that they could make their way
in the world without her
in the world without her
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当他们毕业后
04:41
when they were done.
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可以独自走好以后的路。
04:45
Now, the contrasting view
comes out of sports.
comes out of sports.
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另一类观点来自运动项目。
04:50
And they say "You are never done,
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教练往往说：“你们还差的远呢！”
04:52
everybody needs a coach."
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每个运动员都需要一个教练。
04:54
Everyone.
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是的，每一个。
04:56
The greatest in the world needs a coach.
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即使是世界上最杰出的运动员。
05:01
So I tried to think
about this as a surgeon.
about this as a surgeon.
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我试着用一名外科医生的
思维来考虑这一观点。
思维来考虑这一观点。
05:05
Pay someone to come
into my operating room,
into my operating room,
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请一个人来手术室，
05:10
observe me and critique me.
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对我进行观察及评判。
05:14
That seems absurd.
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这听起来很可笑。
05:16
Expertise means not needing to be coached.
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因为专业技能意味着
不需要再被训练。
不需要再被训练。
05:20
So then which view is right?
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那么，哪一个观点是正确的呢？
05:25
I learned that coaching came into sports
as a very American idea.
as a very American idea.
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我了解到，教练模式源于美国。
05:30
In 1875,
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1875年，
05:32
Harvard and Yale played one of the very
first American-rules football games.
first American-rules football games.
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哈佛和耶鲁之间举行了
美国历史上早期的橄榄球比赛。
美国历史上早期的橄榄球比赛。
耶鲁聘请了一位主教练。
05:36
Yale hired a head coach;
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05:39
Harvard did not.
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然而哈佛没有这样做。
05:41
The results?
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至于结果？
在之后30年的比赛里，
05:42
Over the next three decades,
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05:44
Harvard won just four times.
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哈佛只赢了四场。
05:47
Harvard hired a coach.
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后来哈佛不得不也聘请教练。
05:50
(Laughter)
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（笑声）
05:52
And it became the way that sports works.
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之后聘请教练成了体育界的标配。
但教练真的这么有用吗？
05:56
But is it necessary then?
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05:57
Does it transfer into other fields?
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这一模式有没有进入其它领域？
06:01
I decided to ask, of all people,
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我决定请教一下他人，
06:03
Itzhak Perlman.
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伊扎克·帕尔曼。
06:05
He had trained the Dorothy DeLay way
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他按照多萝西·迪蕾的方式练习，
06:08
and became arguably the greatest
violinist of his generation.
violinist of his generation.
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成为了同时代最杰出的小提琴家。
06:12
One of the beautiful things about
getting to write for "The New Yorker"
getting to write for "The New Yorker"
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为《纽约客》写文章的
一个美妙之处在于，
一个美妙之处在于，
我给人们打电话，他们都会回我电话。
06:16
is I call people up,
and they return my phone calls.
and they return my phone calls.
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（笑声）
06:19
(Laughter)
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伊扎克·帕尔曼回了我的电话。
06:20
And Perlman returned my phone call.
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06:23
So we ended up having
an almost two-hour conversation
an almost two-hour conversation
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围绕着他如何取得如此成就，
06:25
about how he got
to where he got in his career.
to where he got in his career.
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我们进行了两个小时的长谈。
06:30
And I asked him, I said,
"Why don't violinists have coaches?"
"Why don't violinists have coaches?"
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我问他：为什么小提琴家没有教练？
06:34
And he said, "I don't know,
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他回道：我不知道别人有没有，
06:37
but I always had a coach."
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但是我一直都有。”
06:39
"You always had a coach?"
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“你有教练？”
06:41
"Oh yeah, my wife, Toby."
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“对，就是我的爱人托比。”
06:45
They had graduated
together from Juilliard,
together from Juilliard,
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他们一起从朱丽亚音乐学院毕业，
06:48
and she had given up her job
as a concert violinist
as a concert violinist
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为了当他的教练，
她放弃了担任乐团小提琴手的工作，
06:52
to be his coach,
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06:53
sitting in the audience,
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在观众席中
06:55
observing him and giving him feedback.
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对他进行观察，并给予反馈。
“伊扎克，中间那部分
06:57
"Itzhak, in that middle section,
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07:00
you know you sounded
a little bit mechanical.
a little bit mechanical.
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听起来没有灵气。
07:03
What can you differently next time?"
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下次你会进行不同的处理吗？”
07:06
It was crucial to everything
he became, he said.
he became, he said.
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这对他如今取得的成就
至关重要，他说。
至关重要，他说。
07:10
Turns out there are numerous problems
in making it on your own.
in making it on your own.
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当你独自一人时，会面对很多问题。
07:15
You don't recognize the issues
that are standing in your way
that are standing in your way
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你意识不到自身的问题，
07:18
or if you do,
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即使你意识到了，
也可能不知道怎么改正。
07:19
you don't necessarily
know how to fix them.
know how to fix them.
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07:21
And the result is
that somewhere along the way,
that somewhere along the way,
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一路走来，你所面临的就是
自己的能力开始停滞不前了。
07:24
you stop improving.
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07:28
And I thought about that,
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这使我陷入沉思，
07:30
and I realized that was exactly
what had happened to me as a surgeon.
what had happened to me as a surgeon.
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意识到这正是出现在我身上的问题。
07:34
I'd entered practice in 2003,
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我从03年开始从医，
07:37
and for the first several years,
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在最初的若干年中，
我的学习曲线在稳步改善。
07:38
it was just this steady, upward
improvement in my learning curve.
improvement in my learning curve.
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07:43
I watched my complication rates drop
from one year to the next.
from one year to the next.
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术后并发症逐年下降。
07:47
And after about five years,
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之后五年，
这一数字不再变化了。
07:48
they leveled out.
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07:51
And a few more years after that,
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再往后几年，
我基本上是在原地踏步。
07:52
I realized I wasn't getting
any better anymore.
any better anymore.
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07:56
And I thought: "Is this
as good as I'm going to get?"
as good as I'm going to get?"
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我不禁暗想：“难道
我的能力已经达到顶峰了吗？”
我的能力已经达到顶峰了吗？”
08:00
So I thought a little more and I said ...
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再次忖度后，自言自语地说，
08:03
"OK,
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“好吧，
08:05
I'll try a coach."
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我要需要一个教练。”
08:07
So I asked a former professor
of mine who had retired,
of mine who had retired,
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于是我邀请了教过我的
已退休教授，
已退休教授，
08:11
his name is Bob Osteen,
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鲍勃 · 欧斯丁，
08:13
and he agreed to come to my operating room
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他答应了我的请求，
08:16
and observe me.
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到手术室来观察我。
08:19
The case --
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那次手术——
我清晰地记得，
08:20
I remember that first case.
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手术堪称完美。
08:21
It went beautifully.
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08:23
I didn't think there would be
anything much he'd have to say
anything much he'd have to say
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手术结束后，
我以为他没什么好说的。
08:26
when we were done.
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08:27
Instead, he had a whole page
dense with notes.
dense with notes.
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结果，他写了满满一页的笔记。
08:31
(Laughter)
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（笑声）
08:33
"Just small things," he said.
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“都是些小问题，”他说。
08:34
(Laughter)
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（笑声）
08:35
But it's the small things that matter.
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但是细节决定成败。
08:39
"Did you notice that the light
had swung out of the wound
had swung out of the wound
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“在手术中，你注意到
光源没有很好地
光源没有很好地
对着伤口了吗？
08:42
during the case?
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08:43
You spent about half an hour
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这半个小时的手术
08:45
just operating off the light
from reflected surfaces."
from reflected surfaces."
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都是在光照不足的情况下进行的。”
08:49
"Another thing I noticed," he said,
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“另一件事是，”他说，
你会不时地抬起你的手肘。
08:51
"Your elbow goes up in the air
every once in a while.
every once in a while.
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08:54
That means you're not in full control.
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这说明你有些地方不受控制。
08:57
A surgeon's elbows should be down
at their sides resting comfortably.
at their sides resting comfortably.
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手术时手肘应该自然的下垂。
09:01
So that means if you feel
your elbow going in the air,
your elbow going in the air,
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以后你感觉手肘抬起时，
应该换一个更称手的器械，
或者调整一下站姿。”
或者调整一下站姿。”
09:04
you should get a different instrument,
or just move your feet."
or just move your feet."
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09:09
It was a whole other level of awareness.
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这席话让我醍醐灌顶。
09:14
And I had to think,
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我不得不思考，
09:17
you know, there was something
fundamentally profound about this.
fundamentally profound about this.
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这背后一定有着更深的意义。
09:21
He was describing what great coaches do,
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他不愧为一个出色的教练，
09:24
and what they do is they are
your external eyes and ears,
your external eyes and ears,
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因为出色的教练就是
充当你的第三只眼睛和耳朵，
充当你的第三只眼睛和耳朵，
09:27
providing a more accurate
picture of your reality.
picture of your reality.
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为你的状态提供一个更真实的描述。
09:31
They're recognizing the fundamentals.
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他们更注重细节。
09:33
They're breaking your actions down
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他们会细致地剖析你的行为，
09:36
and then helping you
build them back up again.
build them back up again.
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并帮你建立正确的习惯。
09:38
After two months of coaching,
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经历两个月的训练后，
09:40
I felt myself getting better again.
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我犹如脱胎换骨。
09:43
And after a year,
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一年之后，
我发现术后的并发症
进一步减少了。
进一步减少了。
09:44
I saw my complications
drop down even further.
drop down even further.
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09:49
It was painful.
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这一过程是非常煎熬的。
09:51
I didn't like being observed,
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我不喜欢被监督，
09:54
and at times I didn't want
to have to work on things.
to have to work on things.
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有时候也厌倦工作。
09:57
I also felt there were periods where
I would get worse before I got better.
I would get worse before I got better.
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在达到最佳状态之前，
我也经历过低谷。
我也经历过低谷。
10:01
But it made me realize
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但这使我意识到
10:02
that the coaches were onto something
profoundly important.
profoundly important.
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教练扮演着极其重要的角色。
10:09
In my other work,
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除了本职工作，
10:10
I lead a health systems innovation center
called Ariadne Labs,
called Ariadne Labs,
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我还领导着一个叫阿里阿德涅实验室
（Ariadne Labs）的医疗系统创新中心，
（Ariadne Labs）的医疗系统创新中心，
10:14
where we work on problems
in the delivery of health care,
in the delivery of health care,
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致力于提供医疗保健服务，
包括全球生育。
10:18
including global childbirth.
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10:20
As part of it,
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同世界卫生组织合作，
我们共同设计出了
一个安全可行的生育检查表，
一个安全可行的生育检查表，
10:21
we had worked with
the World Health Organization
the World Health Organization
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这也是该项目的内容之一。
10:24
to devise a safe childbirth checklist.
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10:26
It lays out the fundamentals.
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这张表列出了基本要求，
10:28
It breaks down the fundamentals --
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并细化了这些要求——
强调了一个团队
必须遵守的行为规范，
必须遵守的行为规范，
10:30
the critical actions
a team needs to go through
a team needs to go through
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比如一个孕妇进入产房时，
10:33
when a woman comes in in labor,
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她准备用力时，
10:35
when she's ready to push,
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婴儿出来之后，
10:37
when the baby is out,
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母亲跟孩子准备回家时，
他们应该分别采取怎样的行动。
他们应该分别采取怎样的行动。
10:39
and then when the mom and baby
are ready to go home.
are ready to go home.
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10:42
And we knew
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我们知道
仅仅制定出检查表，
效果并不会有太大的改观，
效果并不会有太大的改观，
10:43
that just handing out a checklist
wasn't going to change very much,
wasn't going to change very much,
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甚至在学校里着重强调这些内容，
10:46
and even just teaching it in the classroom
wasn't necessarily going to be enough
wasn't necessarily going to be enough
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10:51
to get people to make the changes
that you needed to bring it alive.
that you needed to bring it alive.
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也不一定能有多少效果。
10:55
And I thought on my experience and said,
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于是，我又想到了自己的经历，
“我们尝试一下教练模式如何？
10:57
"What if we tried coaching?
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11:00
What if we tried coaching
at a massive scale?"
at a massive scale?"
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在大规模范围内进行试验怎么样？”
11:04
We found some incredible partners,
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我们找了一些出色的合作伙伴，
11:07
including the government of India,
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比如印度政府，
11:10
and we ran a trial there
in 120 birth centers.
in 120 birth centers.
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并在印度最大的邦，北方邦的
120个生育中心
120个生育中心
进行了试验。
11:13
In Uttar Pradesh,
in India's largest state.
in India's largest state.
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我们观察了半数的生育中心，
11:17
Half of the centers
basically we just observed,
basically we just observed,
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11:23
but the other half
got visits from coaches.
got visits from coaches.
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但另一半即使没有被监督，
也有教练进行指点。
也有教练进行指点。
11:25
We trained an army
of doctors and nurses like this one
of doctors and nurses like this one
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我们训练了一组
医疗人员充当教练队伍，
医疗人员充当教练队伍，
11:29
who learned to observe the care
and also the managers
and also the managers
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学着观察护理过程还有管理人员，
11:34
and then help them
build on their strengths
build on their strengths
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然后帮助他们发挥长处，
11:36
and address their weaknesses.
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弥补不足的地方。
11:38
One of the skills for example
they had to work on with people --
they had to work on with people --
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比如，他们要学着与他人打交道——
为日后能进行高效的交流
11:41
turned out to be
fundamentally important --
fundamentally important --
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打下坚定的基础。
11:44
was communication.
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当婴儿面罩坏掉，手套没有库存，
11:45
Getting the nurses to practice speaking up
when the baby mask is broken
when the baby mask is broken
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11:49
or the gloves are not in stock
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或者有人没有洗手，
11:51
or someone's not washing their hands.
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护士们应学着去指出这些问题。
11:53
And then getting others,
including the managers,
including the managers,
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而其他人，包括管理人员，
应该学会倾听。
11:55
to practice listening.
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11:57
This small army of coaches
ended up coaching 400 nurses
ended up coaching 400 nurses
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这支教练队伍已经
培训了400个产护人员
培训了400个产护人员
和一些助理，
12:02
and other birth attendants,
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还有100个医生和管理人员。
12:04
and 100 physicians and managers.
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12:07
We tracked the results
across 160,000 births.
across 160,000 births.
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我们追踪了16万个出生案例。
12:13
The results ...
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至于结果——
12:15
in the control group you had --
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在对照组，
12:17
and these are the ones
who did not get coaching --
who did not get coaching --
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也就是没有接受培训的结果——
12:19
they delivered on only one-third
of 18 basic practices
of 18 basic practices
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我们要考察的18个基本要求中，
12:23
that we were measuring.
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他们只做到了1/3。
12:25
And most important was
over the course of the years of study,
over the course of the years of study,
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最重要的是，经过数年的跟踪，
对照组的表现没有任何改善。
12:28
we saw no improvement over time.
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12:30
The other folks
got four months of coaching
got four months of coaching
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而实验组的人经过4个月的训练，
12:33
and then it tapered off over eight months,
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死亡率连续八个月都有所下降，
12:35
and we saw them increase
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我们看到了他们的进步，
12:37
to greater than two-thirds
of the practices being delivered.
of the practices being delivered.
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成功分娩的婴儿数量
比以前足足多了2/3。
比以前足足多了2/3。
12:42
It works.
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教练模式起作用了。
我们发现很多生育中心
12:43
We could see the improvement in quality,
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12:47
and you could see it happen
across a whole range of centers
across a whole range of centers
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都发生了质的改善，
12:50
that suggested that coaching
could be a whole line of way
could be a whole line of way
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这意味着整个过程有教练的参与，
12:53
that we bring value to what we do.
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可以为我们的工作带来更多价值。
12:56
You can imagine the whole job category
that could reach out in the world
that could reach out in the world
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想象一下，如果世界上
所有的工作都有教练的加入，
所有的工作都有教练的加入，
13:00
and that millions of people could fulfill.
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无数的人就可以从中获益。
13:04
We were clearly
at the beginning of it, though,
at the beginning of it, though,
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尽管在起初，我们成效显著，
13:06
because there was still a distance to go.
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但我们还有很长的路要走。
13:08
You have to put
all of the checklist together
all of the checklist together
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我们需要整合所有的检查表，
13:10
to achieve the substantial
reductions in mortality.
reductions in mortality.
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3376
以在降低死亡率方面
实现实质性的进展。
实现实质性的进展。
13:14
But we began seeing the first places
that were getting there,
that were getting there,
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最早实施这一项目的地方
已取得了一些进展，
已取得了一些进展，
这个生育中心就是其中之一，
13:17
and this center was one of them
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1936
13:19
because coaching helped them
learn to execute on the fundamentals.
learn to execute on the fundamentals.
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因为教练模式帮助他们
学会了解决根本问题。
学会了解决根本问题。
13:24
And you could see it here.
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你们可以看到这一过程。
13:27
This is a 23-year-old woman
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这个23岁的产妇
13:30
who had come in by ambulance,
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是被救护车送来的，
13:32
in labor with her third child.
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她即将迎来第三个孩子。
13:35
She broke her water in the triage area,
267
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5776
她的羊水在分流区破裂，
13:41
so they brought her directly
to the labor and delivery room,
to the labor and delivery room,
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3376
因此医护人员直接
给她安排了产房接生，
给她安排了产房接生，
并且着手检查。
13:44
and then they ran through their checks.
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我为这些照片加了时间标记，
13:46
I put the time stamp on here
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13:48
so you could see
how quickly all of this happens
how quickly all of this happens
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大家可以看到，
这一切都发生得如此迅速，
这一切都发生得如此迅速，
13:51
and how much more complicated
that makes things.
that makes things.
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大大增加了整个过程的复杂程度。
13:54
Within four minutes,
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在四分钟以内，
13:55
they had taken the blood pressure,
measured her pulse
measured her pulse
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她们测量了产妇的血压，脉搏，
13:59
and also measured
the heart rate of the baby.
the heart rate of the baby.
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还有婴儿的心率。
14:02
That meant that the blood pressure cuff
and the fetal Doppler monitor,
and the fetal Doppler monitor,
276
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3336
这意味着血压袖带和
胎儿多普勒监视器都在现场，
胎儿多普勒监视器都在现场，
14:05
they were all there,
and the nurse knew how to use them.
and the nurse knew how to use them.
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并且产护人员知道怎么操作。
14:08
The team was skilled and coordinated.
278
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团队技术娴熟，配合默契。
14:11
The mom was doing great,
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这位妈妈状态良好，
14:12
the baby's heart rate was 143,
which is normal.
which is normal.
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婴儿的心率是143，属正常范围。
14:16
Eight minutes later, the intensity
of the contractions picked up,
of the contractions picked up,
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八分钟后，子宫收缩的
强度开始增加，
强度开始增加，
14:20
so the nurse washed her hands,
282
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2136
产护人员将手清洗后，
14:22
put on clean gloves,
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带上干净的手套给她做检查，
14:23
examined her and found
that her cervix was fully dilated.
that her cervix was fully dilated.
284
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3416
发现她的子宫颈完全张开。
14:27
The baby was ready to come.
285
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婴儿即将出生。
14:29
She then went straight over
to do her next set of checks.
to do her next set of checks.
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3456
产护人员立即进行剩余的检查项目。
14:33
All of the equipment,
she worked her way through
she worked her way through
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2256
她对各项逐一进行检查，
确保需要的所有设备都已就绪。
14:35
and made sure she had everything
she needed at the bedside.
she needed at the bedside.
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婴儿面罩，无菌毛巾
14:38
The baby mask was there,
the sterile towel,
the sterile towel,
289
866400
2056
14:40
the sterile equipment that you needed.
290
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和需要的无菌设备，全部就位。
14:42
And then three minutes later,
one push and that baby was out.
one push and that baby was out.
291
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5536
三分钟后，产妇开始用力，
婴儿出来了。
婴儿出来了。
14:48
(Applause)
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（掌声）
14:52
I was watching this delivery,
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当时我正在注视着产房，
14:54
and suddenly I realized that the mood
in that room had changed.
in that room had changed.
294
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3840
突然发现产房里的气氛变了。
15:00
The nurse was looking
at the community health worker
at the community health worker
295
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产护人员正看着护送产妇进来的
社区保健人员，
15:02
who had come in with the woman
296
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1456
因为那个婴儿似乎状态不妙。
15:04
because that baby
did not seem to be alive.
did not seem to be alive.
297
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2680
15:08
She was blue and floppy and not breathing.
298
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3600
她全身发紫，皮肤松弛
并且没有呼吸。
并且没有呼吸。
15:12
She would be one of that one-in-20.
299
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她似乎就是被死神选中的那一个。
15:16
But the nurse kept going
with her checkpoints.
with her checkpoints.
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3016
但是产护人员按部就班地
行动了起来。
行动了起来。
她用一个干净的毛巾擦拭婴儿。
15:19
She dried that baby with a clean towel.
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15:22
And after a minute,
when that didn't stimulate that baby,
when that didn't stimulate that baby,
302
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但一分钟后，婴儿还是毫无反应，
15:25
she ran to get the baby mask
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她立刻跑去拿婴儿面罩，
15:28
and the other one went to get the suction.
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另一个产护人员拿来了吸管。
15:31
She didn't have a mechanical suction
because you could count on electricity,
because you could count on electricity,
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因为没有可靠的电力供应，
她没有用电动吸管，而是用口用吸管
她没有用电动吸管，而是用口用吸管
清理小女孩的呼吸道，
15:35
so she used a mouth suction,
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在20秒内，
15:36
and within 20 seconds,
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异物被一点点吸了出来。
15:37
she was clearing out
that little girl's airways.
that little girl's airways.
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15:40
And she got back a green, thick liquid,
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在一分钟内，
15:42
and within a minute
of being able to do that
of being able to do that
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她不间断地重复着，
最终吸出了粘稠的异物，
15:44
and suctioning out over and over,
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婴儿开始了呼吸。
15:46
that baby started to breathe.
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（掌声）
15:47
(Applause)
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15:53
Another minute and that baby was crying.
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孩子的哭声紧随而至。
15:57
And five minutes after that,
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5分钟后，
15:59
she was pink and warming
on her mother's chest,
on her mother's chest,
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她的肤色变得正常，
被母亲抱在了怀里，
被母亲抱在了怀里，
那位母亲激动地
握住的产护人员的手，
握住的产护人员的手，
16:02
and that mother reached out
to grab that nurse's hand,
to grab that nurse's hand,
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那一刻，大家都松了一口气。
16:05
and they could all breathe.
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16:09
I saw a team transformed
because of coaching.
because of coaching.
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我目睹了一个在教练模式下
发生华丽转变的团队。
发生华丽转变的团队。
16:13
And I saw at least one life
saved because of it.
saved because of it.
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目睹了无数生命因此获救。
16:17
We followed up with that mother
a few months later.
a few months later.
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数月之后，我们拜访了那个母亲。
16:20
Mom and baby were doing great.
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母女健康平安。
16:23
The baby's name is Anshika.
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女婴名叫安西卡，
16:27
It means "beautiful."
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意为“美丽”。
16:30
And she is what's possible
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她的存活证明了，
16:31
when we really understand
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当我们真正明白
16:33
how people get better at what they do.
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如何更出色地做好本职工作时，
一切皆有可能。
一切皆有可能。
16:36
Thank you.
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谢谢。
（掌声）
16:37
(Applause)
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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