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

阿图 · 葛文德: 想要成为行业精英?去找个教练吧。

Filmed:
3,174,731 views

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。
- 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专家.
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今天我并非以一个
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有人
who has been really interested有兴趣
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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,
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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事项.
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00:29
I was visiting访问 this birth分娩 center中央
in the north of India印度.
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我曾经到访印度北边的
这个生育中心。
00:32
I was watching观看 the birth分娩 attendants服务员,
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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实现 I was witnessing见证 in them
an extreme极端 form形成 of this very struggle斗争,
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00:39
which哪一个 is how people improve提高
in the face面对 of complexity复杂 --
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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妇女 here are delivering交付 in a region地区
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但在当地生育中心
00:48
where the typical典型 birth分娩 center中央
has a one-in-一对一20 death死亡 rate for the babies婴儿,
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出生的婴儿,死亡率高达5%,
00:54
and the moms妈妈 are dying垂死 at a rate
ten times higher更高 than they do elsewhere别处.
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孕妇的死亡率也是其他地区的十倍。
00:59
Now, we've我们已经 known已知 the critical危急 practices做法
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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杀手
in birth分娩 for decades几十年,
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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地点 --
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以及造成这一现象的原因——
01:09
in this place地点 especially特别,
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像这种地方,
01:11
the simplest简单 things are not simple简单.
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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清洁 gloves手套,
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众所周知,产护人员应该
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龙头 is in another另一个 room房间,
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手术室没有水龙头
01:22
and they don't have clean清洁 gloves手套.
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产护人员也没有干净的手套。
01:25
To reuse重用 their gloves手套,
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为了重复利用手套
01:26
they wash them in this basin盆地
of dilute bleach漂白,
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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血液
on the gloves手套 from the last delivery交货.
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但手套上仍有之前使用留下的血迹。
01:39
Ten percent百分 of babies婴儿 are born天生
with difficulty困难 breathing呼吸 everywhere到处.
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世界上10%的孩子出生时就
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宝宝 with a clean清洁 cloth
to stimulate刺激 them to breathe呼吸.
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用干净的毛巾轻抚婴儿
以刺激他们呼吸。
01:48
If they don't start开始 to breathe呼吸,
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如果没有作用,
01:50
you suction吸力 out their airways航空公司.
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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呼吸 with the baby宝宝 mask面具.
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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。
01:57
But these are skills技能 that they've他们已经 learned学到了
mostly大多 from textbooks教科书,
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这些是学校教授的方法,
02:01
and that baby宝宝 mask面具 is broken破碎.
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然而在这儿,婴儿面罩
根本无法使用。
02:09
In this one disturbing烦扰的 image图片 for me
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这一幕给我留下了深刻的印象,
02:12
is a picture图片 that brings带来 home
just how dire可怕的 the situation情况 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宝宝 10 minutes分钟 after birth分娩,
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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清洁 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变暖 skin皮肤 to skin皮肤,
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它感受不到任何温暖,
02:31
an unsterileunsterile clamp across横过 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感染 waiting等候 to happen发生,
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他即将被感染,
02:35
and he's losing失去
his temperature温度 by the minute分钟.
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正面临着体温下降的危险。
02:41
Successful成功 child儿童 delivery交货
requires要求 a successful成功 team球队 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。
02:45
A whole整个 team球队 has to be
skilled技能的 and coordinated协调;
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由技艺高超且配合默契的
成员组成的团队,
02:47
the nurses护士 who do the deliveries交付
in a place地点 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医生 who backs them up,
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有医生的支持,
02:52
the supply供应 clerk书记 who's谁是 responsible主管
for 22 critical危急 drugs毒品 and supplies耗材
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供应员会在床边和仓库里
02:56
being存在 in stock股票 and at the bedside床头,
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准备充足的药品和所需的用具,
02:59
the medical officer in charge收费,
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医疗主管负责
03:00
responsible主管 for the quality质量
of the whole整个 facility设施.
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医疗设备的质量。
03:05
The thing is they are all
experienced有经验的 professionals专业人士.
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他们都是熟练的专业人士。
03:09
I didn't meet遇到 anybody任何人 who hadn't有没有 been
part部分 of thousands数千 of deliveries交付.
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每个人都参与过上千次的接生。
03:15
But against反对 the complexities复杂性
that they face面对,
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但当他们面对这种复杂的局面时,
03:18
they seem似乎 to be at their limits范围.
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却变得束手无策。
03:21
They were not getting得到 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事项.
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但关键在于,未来
他们能否改变这一现状。
03:32
It presses印刷机 on a fundamental基本的 question.
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由此延伸出一个基本的问题。
03:35
How do professionals专业人士
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意见 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传统 pedagogical教学 view视图.
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03:45
That is that you go to school学校,
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去学校学习,
上课,做功课,考试,毕业,
03:47
you study研究, you practice实践,
you learn学习, you graduate毕业,
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03:50
and then you go out into the world世界
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然后走向社会,
03:52
and you make your way on your own拥有.
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独自前行。
成为一个能自我管理,
不断进步的专家。
03:54
A professional专业的 is someone有人 who is capable
of managing管理的 their own拥有 improvement起色.
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03:59
That is the approach途径 that virtually实质上
all professionals专业人士 have learned学到了 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医生 learn学习,
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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律师 do,
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04:07
scientists科学家们 ...
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是科学家学习的方法,
04:09
musicians音乐家.
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也是音乐家学习的方法.....
04:12
And the thing is, it works作品.
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并且这个方法效果显著。
04:15
Consider考虑 for example legendary传奇的
Juilliard茱莉亚音乐学院 violin小提琴 instructor讲师 Dorothy多萝西 DeLay延迟.
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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)。
04:20
She trained熟练 an amazing惊人 roster名册
of violin小提琴 virtuosos艺术大师:
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她培养了一大批杰出的小提琴演奏家:
04:24
Midori绿, Sarah莎拉 Chang, Itzhak伊扎克 Perlman帕尔曼.
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美岛莉, 张莎拉,伊扎克·帕尔曼等。
04:26
Each of them came来了 to her as young年轻 talents人才,
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他们拜入她门下时都已锋芒毕露,
04:30
and they worked工作 with her over years年份.
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经历数年的练习后,
最终达到了很高的水准。
04:32
What she worked工作 on most, she said,
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她说,她最大的贡献是
04:34
was inculcating灌输 in them
habits习惯 of thinking思维 and of learning学习
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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世界 without her
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当他们毕业后
04:41
when they were doneDONE.
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可以独自走好以后的路。
04:45
Now, the contrasting对比 view视图
comes out of sports体育.
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另一类观点来自运动项目。
04:50
And they say "You are never doneDONE,
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教练往往说:“你们还差的远呢!”
04:52
everybody每个人 needs需求 a coach教练."
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每个运动员都需要一个教练。
04:54
Everyone大家.
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是的,每一个。
04:56
The greatest最大 in the world世界 needs需求 a coach教练.
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即使是世界上最杰出的运动员。
05:01
So I tried试着 to think
about this as a surgeon外科医生.
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我试着用一名外科医生的
思维来考虑这一观点。
05:05
Pay工资 someone有人 to come
into my operating操作 room房间,
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请一个人来手术室,
05:10
observe me and critique批判 me.
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对我进行观察及评判。
05:14
That seems似乎 absurd荒诞.
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这听起来很可笑。
05:16
Expertise专门知识 means手段 not needing需要 to be coached执教.
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因为专业技能意味着
不需要再被训练。
05:20
So then which哪一个 view视图 is right?
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那么,哪一个观点是正确的呢?
05:25
I learned学到了 that coaching教练 came来了 into sports体育
as a very American美国 idea理念.
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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哈佛 and Yale耶鲁 played发挥 one of the very
first American-rules美国-规则 football足球 games游戏.
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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。
耶鲁聘请了一位主教练。
05:36
Yale耶鲁 hired雇用 a head coach教练;
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05:39
Harvard哈佛 did not.
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然而哈佛没有这样做。
05:41
The results结果?
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至于结果?
在之后30年的比赛里,
05:42
Over the next下一个 three decades几十年,
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05:44
Harvard哈佛 won韩元 just four times.
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哈佛只赢了四场。
05:47
Harvard哈佛 hired雇用 a coach教练.
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后来哈佛不得不也聘请教练。
05:50
(Laughter笑声)
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(笑声)
05:52
And it became成为 the way that sports体育 works作品.
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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必要 then?
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05:57
Does it transfer转让 into other fields领域?
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这一模式有没有进入其它领域?
06:01
I decided决定 to ask, of all people,
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我决定请教一下他人,
06:03
Itzhak伊扎克 Perlman帕尔曼.
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伊扎克·帕尔曼。
06:05
He had trained熟练 the Dorothy多萝西 DeLay延迟 way
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他按照多萝西·迪蕾的方式练习,
06:08
and became成为 arguably按理说 the greatest最大
violinist小提琴手 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美丽 things about
getting得到 to write for "The New Yorker纽约客"
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为《纽约客》写文章的
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返回 my phone电话 calls电话.
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(笑声)
06:19
(Laughter笑声)
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伊扎克·帕尔曼回了我的电话。
06:20
And Perlman帕尔曼 returned my phone电话 call.
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06:23
So we ended结束 up having
an almost几乎 two-hour两小时 conversation会话
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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事业.
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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小提琴家 have coaches教练?"
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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教练."
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但是我一直都有。”
06:39
"You always had a coach教练?"
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“你有教练?”
06:41
"Oh yeah, my wife妻子, Toby托比."
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“对,就是我的爱人托比。”
06:45
They had graduated毕业
together一起 from Juilliard茱莉亚音乐学院,
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他们一起从朱丽亚音乐学院毕业,
06:48
and she had given特定 up her job工作
as a concert音乐会 violinist小提琴手
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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教练,
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06:53
sitting坐在 in the audience听众,
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在观众席中
06:55
observing观察 him and giving him feedback反馈.
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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伊扎克, in that middle中间 section部分,
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07:00
you know you sounded满面
a little bit mechanical机械.
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听起来没有灵气。
07:03
What can you differently不同 next下一个 time?"
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下次你会进行不同的处理吗?”
07:06
It was crucial关键 to everything
he became成为, he said.
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这对他如今取得的成就
至关重要,他说。
07:10
Turns out there are numerous众多 problems问题
in making制造 it on your own拥有.
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当你独自一人时,会面对很多问题。
07:15
You don't recognize认识 the issues问题
that are standing常设 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一定
know how to fix固定 them.
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07:21
And the result结果 is
that somewhere某处 along沿 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提高.
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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实现 that was exactly究竟
what had happened发生 to me as a surgeon外科医生.
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意识到这正是出现在我身上的问题。
07:34
I'd entered进入 practice实践 in 2003,
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我从03年开始从医,
07:37
and for the first several一些 years年份,
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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稳定, upward向上
improvement起色 in my learning学习 curve曲线.
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07:43
I watched看着 my complication并发症 rates利率 drop下降
from one year to the next下一个.
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术后并发症逐年下降。
07:47
And after about five years年份,
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之后五年,
这一数字不再变化了。
07:48
they leveled夷为平地 out.
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07:51
And a few少数 more years年份 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实现 I wasn't getting得到
any better anymore.
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07:56
And I thought: "Is this
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?”
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教练."
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我要需要一个教练。”
08:07
So I asked a former前任的 professor教授
of mine who had retired退休,
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于是我邀请了教过我的
已退休教授,
08:11
his name名称 is Bob短发 Osteen欧斯丁,
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鲍勃 · 欧斯丁,
08:13
and he agreed同意 to come to my operating操作 room房间
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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案件 --
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那次手术——
我清晰地记得,
08:20
I remember记得 that first case案件.
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手术堪称完美。
08:21
It went beautifully精美.
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08:23
I didn't think there would be
anything much he'd他会 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 doneDONE.
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08:27
Instead代替, he had a whole整个 page
dense稠密 with notes笔记.
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结果,他写了满满一页的笔记。
08:31
(Laughter笑声)
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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笑声)
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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注意 that the light
had swung挥动 out of the wound伤口
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“在手术中,你注意到
光源没有很好地
对着伤口了吗?
08:42
during the case案件?
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08:43
You spent花费 about half an hour小时
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这半个小时的手术
08:45
just operating操作 off the light
from reflected反射的 surfaces."
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都是在光照不足的情况下进行的。”
08:49
"Another另一个 thing I noticed注意到," 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弯头 goes up in the air空气
every一切 once一旦 in a while.
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08:54
That means手段 you're not in full充分 control控制.
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这说明你有些地方不受控制。
08:57
A surgeon's外科医生 elbows肘部 should be down
at their sides双方 resting休息 comfortably舒服.
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手术时手肘应该自然的下垂。
09:01
So that means手段 if you feel
your elbow弯头 going in the air空气,
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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。”
09:04
you should get a different不同 instrument仪器,
or just move移动 your feet."
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09:09
It was a whole整个 other level水平 of awareness意识.
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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从根本上 profound深刻 about this.
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这背后一定有着更深的意义。
09:21
He was describing说明 what great coaches教练 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外部 eyes眼睛 and ears耳朵,
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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,
09:27
providing提供 a more accurate准确
picture图片 of your reality现实.
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为你的状态提供一个更真实的描述。
09:31
They're recognizing认识 the fundamentals基本面.
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他们更注重细节。
09:33
They're breaking破坏 your actions行动 down
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他们会细致地剖析你的行为,
09:36
and then helping帮助 you
build建立 them back up again.
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并帮你建立正确的习惯。
09:38
After two months个月 of coaching教练,
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经历两个月的训练后,
09:40
I felt myself getting得到 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。
09:44
I saw my complications并发症
drop下降 down even further进一步.
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09:49
It was painful痛苦.
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这一过程是非常煎熬的。
09:51
I didn't like being存在 observed观察到的,
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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.
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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更差 before I got better.
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在达到最佳状态之前,
我也经历过低谷。
10:01
But it made制作 me realize实现
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但这使我意识到
10:02
that the coaches教练 were onto something
profoundly深深 important重要.
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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健康 systems系统 innovation革新 center中央
called Ariadne阿里阿德涅 Labs实验室,
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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,
10:14
where we work on problems问题
in the delivery交货 of health健康 care关心,
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致力于提供医疗保健服务,
包括全球生育。
10:18
including包含 global全球 childbirth分娩.
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10:20
As part部分 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,
10:21
we had worked工作 with
the World世界 Health健康 Organization组织
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这也是该项目的内容之一。
10:24
to devise设计 a safe安全 childbirth分娩 checklist清单.
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10:26
It lays乐事 out the fundamentals基本面.
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这张表列出了基本要求,
10:28
It breaks休息 down the fundamentals基本面 --
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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,
10:30
the critical危急 actions行动
a team球队 needs需求 to go through通过
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比如一个孕妇进入产房时,
10:33
when a woman女人 comes in in labor劳动,
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她准备用力时,
10:35
when she's ready准备 to push,
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婴儿出来之后,
10:37
when the baby宝宝 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。
10:39
and then when the mom妈妈 and baby宝宝
are ready准备 to go home.
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10:42
And we knew知道
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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,
10:43
that just handing移交 out a checklist清单
wasn't going to change更改 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教学 it in the classroom课堂
wasn't necessarily一定 going to be enough足够
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10:51
to get people to make the changes变化
that you needed需要 to bring带来 it alive.
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也不一定能有多少效果。
10:55
And I thought on my experience经验 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试着 coaching教练?
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11:00
What if we tried试着 coaching教练
at a massive大规模的 scale规模?"
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在大规模范围内进行试验怎么样?”
11:04
We found发现 some incredible难以置信 partners伙伴,
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我们找了一些出色的合作伙伴,
11:07
including包含 the government政府 of India印度,
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比如印度政府,
11:10
and we ran a trial审讯 there
in 120 birth分娩 centers中心.
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并在印度最大的邦,北方邦的
120个生育中心
进行了试验。
11:13
In Uttar北方邦 Pradesh,
in India's印度 largest最大 state.
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我们观察了半数的生育中心,
11:17
Half of the centers中心
basically基本上 we just observed观察到的,
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11:23
but the other half
got visits访问 from coaches教练.
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但另一半即使没有被监督,
也有教练进行指点。
11:25
We trained熟练 an army军队
of doctors医生 and nurses护士 like this one
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我们训练了一组
医疗人员充当教练队伍,
11:29
who learned学到了 to observe the care关心
and also the managers经理
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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建立 on their strengths优势
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然后帮助他们发挥长处,
11:36
and address地址 their weaknesses弱点.
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弥补不足的地方。
11:38
One of the skills技能 for example
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转身 out to be
fundamentally从根本上 important重要 --
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打下坚定的基础。
11:44
was communication通讯.
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当婴儿面罩坏掉,手套没有库存,
11:45
Getting入门 the nurses护士 to practice实践 speaking请讲 up
when the baby宝宝 mask面具 is broken破碎
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11:49
or the gloves手套 are not in stock股票
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或者有人没有洗手,
11:51
or someone's谁家 not washing洗涤 their hands.
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护士们应学着去指出这些问题。
11:53
And then getting得到 others其他,
including包含 the managers经理,
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而其他人,包括管理人员,
应该学会倾听。
11:55
to practice实践 listening.
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11:57
This small army军队 of coaches教练
ended结束 up coaching教练 400 nurses护士
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这支教练队伍已经
培训了400个产护人员
和一些助理,
12:02
and other birth分娩 attendants服务员,
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还有100个医生和管理人员。
12:04
and 100 physicians医师 and managers经理.
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12:07
We tracked追踪 the results结果
across横过 160,000 births出生.
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我们追踪了16万个出生案例。
12:13
The results结果 ...
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至于结果——
12:15
in the control控制 group you had --
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在对照组,
12:17
and these are the ones那些
who did not get coaching教练 --
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也就是没有接受培训的结果——
12:19
they delivered交付 on only one-third三分之一
of 18 basic基本 practices做法
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我们要考察的18个基本要求中,
12:23
that we were measuring测量.
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他们只做到了1/3。
12:25
And most important重要 was
over the course课程 of the years年份 of study研究,
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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起色 over time.
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12:30
The other folks乡亲
got four months个月 of coaching教练
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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个月,
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死亡率连续八个月都有所下降,
12:35
and we saw them increase增加
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我们看到了他们的进步,
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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成功分娩的婴儿数量
比以前足足多了2/3。
12:42
It works作品.
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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起色 in quality质量,
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12:47
and you could see it happen发生
across横过 a whole整个 range范围 of centers中心
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都发生了质的改善,
12:50
that suggested建议 that coaching教练
could be a whole整个 line线 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带来 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想像 the whole整个 job工作 category类别
that could reach达到 out in the world世界
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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,
13:00
and that millions百万 of people could fulfill履行.
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无数的人就可以从中获益。
13:04
We were clearly明确地
at the beginning开始 of it, though虽然,
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尽管在起初,我们成效显著,
13:06
because there was still a distance距离 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清单 together一起
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我们需要整合所有的检查表,
13:10
to achieve实现 the substantial大量的
reductions减少 in mortality死亡.
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以在降低死亡率方面
实现实质性的进展。
13:14
But we began开始 seeing眼看 the first places地方
that were getting得到 there,
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最早实施这一项目的地方
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中央 was one of them
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13:19
because coaching教练 helped帮助 them
learn学习 to execute执行 on the fundamentals基本面.
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因为教练模式帮助他们
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-岁 woman女人
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这个23岁的产妇
13:30
who had come in by ambulance救护车,
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是被救护车送来的,
13:32
in labor劳动 with her third第三 child儿童.
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她即将迎来第三个孩子。
13:35
She broke打破 her water in the triage分流 area,
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她的羊水在分流区破裂,
13:41
so they brought her directly
to the labor劳动 and delivery交货 room房间,
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3376
因此医护人员直接
给她安排了产房接生,
并且着手检查。
13:44
and then they ran through通过 their checks检查.
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我为这些照片加了时间标记,
13:46
I put the time stamp邮票 on here
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13:48
so you could see
how quickly很快 all of this happens发生
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大家可以看到,
这一切都发生得如此迅速,
13:51
and how much more complicated复杂
that makes品牌 things.
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大大增加了整个过程的复杂程度。
13:54
Within four minutes分钟,
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在四分钟以内,
13:55
they had taken采取 the blood血液 pressure压力,
measured测量 her pulse脉冲
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她们测量了产妇的血压,脉搏,
13:59
and also measured测量
the heart rate of the baby宝宝.
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还有婴儿的心率。
14:02
That meant意味着 that the blood血液 pressure压力 cuff袖口
and the fetal Doppler多普勒 monitor监控,
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,
14:05
they were all there,
and the nurse护士 knew知道 how to use them.
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并且产护人员知道怎么操作。
14:08
The team球队 was skilled技能的 and coordinated协调.
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团队技术娴熟,配合默契。
14:11
The mom妈妈 was doing great,
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这位妈妈状态良好,
14:12
the baby's宝宝 heart rate was 143,
which哪一个 is normal正常.
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婴儿的心率是143,属正常范围。
14:16
Eight minutes分钟 later后来, the intensity强度
of the contractions宫缩 picked采摘的 up,
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八分钟后,子宫收缩的
强度开始增加,
14:20
so the nurse护士 washed her hands,
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产护人员将手清洗后,
14:22
put on clean清洁 gloves手套,
283
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带上干净的手套给她做检查,
14:23
examined检查 her and found发现
that her cervix宫颈 was fully充分 dilated扩张.
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发现她的子宫颈完全张开。
14:27
The baby宝宝 was ready准备 to come.
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婴儿即将出生。
14:29
She then went straight直行 over
to do her next下一个 set of checks检查.
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产护人员立即进行剩余的检查项目。
14:33
All of the equipment设备,
she worked工作 her way through通过
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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制作 sure she had everything
she needed需要 at the bedside床头.
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婴儿面罩,无菌毛巾
14:38
The baby宝宝 mask面具 was there,
the sterile无菌 towel毛巾,
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14:40
the sterile无菌 equipment设备 that you needed需要.
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和需要的无菌设备,全部就位。
14:42
And then three minutes分钟 later后来,
one push and that baby宝宝 was out.
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三分钟后,产妇开始用力,
婴儿出来了。
14:48
(Applause掌声)
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(掌声)
14:52
I was watching观看 this delivery交货,
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当时我正在注视着产房,
14:54
and suddenly突然 I realized实现 that the mood心情
in that room房间 had changed.
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突然发现产房里的气氛变了。
15:00
The nurse护士 was looking
at the community社区 health健康 worker工人
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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女人
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因为那个婴儿似乎状态不妙。
15:04
because that baby宝宝
did not seem似乎 to be alive.
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15:08
She was blue蓝色 and floppy软盘 and not breathing呼吸.
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她全身发紫,皮肤松弛
并且没有呼吸。
15:12
She would be one of that one-in-一对一20.
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她似乎就是被死神选中的那一个。
15:16
But the nurse护士 kept不停 going
with her checkpoints检查站.
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但是产护人员按部就班地
行动了起来。
她用一个干净的毛巾擦拭婴儿。
15:19
She dried that baby宝宝 with a clean清洁 towel毛巾.
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15:22
And after a minute分钟,
when that didn't stimulate刺激 that baby宝宝,
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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宝宝 mask面具
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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吸力.
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另一个产护人员拿来了吸管。
15:31
She didn't have a mechanical机械 suction吸力
because you could count计数 on electricity电力,
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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
清理小女孩的呼吸道,
15:35
so she used a mouth suction吸力,
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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绿色, thick liquid液体,
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在一分钟内,
15:42
and within a minute分钟
of being存在 able能够 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吸 痰 out over and over,
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婴儿开始了呼吸。
15:46
that baby宝宝 started开始 to breathe呼吸.
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(掌声)
15:47
(Applause掌声)
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15:53
Another另一个 minute分钟 and that baby宝宝 was crying哭了.
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孩子的哭声紧随而至。
15:57
And five minutes分钟 after that,
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5分钟后,
15:59
she was pink and warming变暖
on her mother's母亲 chest胸部,
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她的肤色变得正常,
被母亲抱在了怀里,
那位母亲激动地
握住的产护人员的手,
16:02
and that mother母亲 reached到达 out
to grab that nurse's护士 hand,
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那一刻,大家都松了一口气。
16:05
and they could all breathe呼吸.
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16:09
I saw a team球队 transformed改造
because of coaching教练.
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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。
16:13
And I saw at least最小 one life
saved保存 because of it.
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目睹了无数生命因此获救。
16:17
We followed其次 up with that mother母亲
a few少数 months个月 later后来.
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数月之后,我们拜访了那个母亲。
16:20
Mom妈妈 and baby宝宝 were doing great.
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母女健康平安。
16:23
The baby's宝宝 name名称 is AnshikaAnshika.
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女婴名叫安西卡,
16:27
It means手段 "beautiful美丽."
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意为“美丽”。
16:30
And she is what's possible可能
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她的存活证明了,
16:31
when we really understand理解
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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。
16:36
Thank you.
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谢谢。
(掌声)
16:37
(Applause掌声)
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Translated by Cheng Paul
Reviewed by Yiyang Piao

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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