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
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Readability: 3.4
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。」
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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我今天不是以專家的身分來，
00:14
I come to you as someone
who has been really interested
who has been really interested
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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,
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.
that really matters.
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你會變得多好才是重點。
00:29
I was visiting this birth center
in the north of India.
in the north of India.
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我之前在北印度一間婦產中心
00:32
I was watching the birth attendants,
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觀察接生人員，
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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我意識到自己目睹他們
用一種很極端的方式使勁掙扎，
用一種很極端的方式使勁掙扎，
00:39
which is how people improve
in the face of complexity --
in the face of complexity --
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就是人在面對複雜情況的時候
進步的那個樣子，
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 here are delivering in a region
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女性在這區一般產房生產
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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要面對二十分之一的嬰兒死亡率，
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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母親的死亡率比其他地方高出十倍。
00:59
Now, we've known the critical practices
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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
in birth for decades,
in birth for decades,
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01:05
and the thing about it is
that even in this place --
that even in this place --
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但問題是即使在這裡，
01:09
in this place especially,
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尤其是這裡，
01:11
the simplest things are not simple.
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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 gloves,
and put on clean gloves,
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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 is in another room,
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水龍頭在別的房間，
01:22
and they don't have clean gloves.
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而且他們沒有乾淨的手套。
01:25
To reuse their gloves,
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為了重覆使用手套，
01:26
they wash them in this basin
of dilute bleach,
of dilute bleach,
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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
on the gloves from the last delivery.
on the gloves from the last delivery.
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但是大家可以看到，
手套上還有之前接生的血漬。
手套上還有之前接生的血漬。
01:39
Ten percent of babies are born
with difficulty breathing everywhere.
with difficulty breathing everywhere.
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10% 的嬰兒出生時會呼吸困難，
不管在哪都一樣。
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 with a clean cloth
to stimulate them to breathe.
to stimulate them to breathe.
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用一塊乾淨的布擦乾嬰兒，
刺激他們呼吸，
刺激他們呼吸，
01:48
If they don't start to breathe,
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如果他們還沒開始呼吸，
01:50
you suction out their airways.
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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 with the baby mask.
you give them breaths with the baby mask.
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如果還不行，
就給他們戴嬰兒氧氣罩。
就給他們戴嬰兒氧氣罩。
01:57
But these are skills that they've learned
mostly from textbooks,
mostly from textbooks,
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這些方法他們幾乎都在課本上學過，
02:01
and that baby mask is broken.
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但是嬰兒氧氣罩壞了。
02:09
In this one disturbing image for me
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這個畫面讓我很難受，
02:12
is a picture that brings home
just how dire the situation is.
just how dire the situation is.
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完全顯示出情況有多慘。
02:17
This is a baby 10 minutes after birth,
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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 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 skin to skin,
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身體還沒完全變暖，
02:31
an unsterile clamp across the cord.
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未殺菌的鉗子剪斷臍帶。
02:34
He's an infection waiting to happen,
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他可能快被感染，
02:35
and he's losing
his temperature by the minute.
his temperature by the minute.
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每分鐘都在失溫。
02:41
Successful child delivery
requires a successful team of people.
requires a successful team of people.
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成功接生需要一組成功團隊。
02:45
A whole team has to be
skilled and coordinated;
skilled and coordinated;
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每個人都應該技巧熟練、合作無間，
02:47
the nurses who do the deliveries
in a place like this,
in a place like this,
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要有能在這種地方接生的護理師，
02:50
the doctor who backs them up,
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要有能夠支援的醫生，
02:52
the supply clerk who's responsible
for 22 critical drugs and supplies
for 22 critical drugs and supplies
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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，
和醫療用品的補給員，
02:56
being in stock and at the bedside,
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確保有現貨放在床邊，
02:59
the medical officer in charge,
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要有醫務官負責
03:00
responsible for the quality
of the whole facility.
of the whole facility.
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所有設備的品質。
03:05
The thing is they are all
experienced professionals.
experienced professionals.
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重點是他們全都是
有經驗的專業人員。
有經驗的專業人員。
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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我碰過的每一個都接生過好幾千次。
03:15
But against the complexities
that they face,
that they face,
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但是面對這複雜的情況，
03:18
they seem to be at their limits.
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他們就像已經做到極限，
03:21
They were not getting 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.
that really matters.
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你能做得多好，才是重點。
03:32
It presses on a fundamental question.
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這又涉及一個基本的問題。
03:35
How do professionals
get better at what they do?
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 about this.
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關於這個有兩種觀點。
03:42
One is the traditional pedagogical view.
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第一種是傳統教學的觀點。
03:45
That is that you go to school,
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就是你上學、
03:47
you study, you practice,
you learn, you graduate,
you learn, you graduate,
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研讀、練習、學習、畢業，
03:50
and then you go out into the world
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然後出校園進入世界，
03:52
and you make your way on your own.
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用自己的方式走自己的路。
03:54
A professional is someone who is capable
of managing their own improvement.
of managing their own improvement.
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專業人員有能力讓自己進步。
03:59
That is the approach that virtually
all professionals have learned by.
all professionals have learned by.
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各行各業都學過怎麼做。
04:04
That's how doctors learn,
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醫生就是這麼學的，
04:05
that's how lawyers do,
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還有律師也是，
04:07
scientists ...
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科學家……
04:09
musicians.
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音樂家。
04:12
And the thing is, it works.
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重點是，這些方法有用。
04:15
Consider for example legendary
Juilliard violin instructor Dorothy DeLay.
Juilliard violin instructor Dorothy DeLay.
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例如茱莉亞學院的小提琴
傳奇教師桃樂絲．狄蕾。
傳奇教師桃樂絲．狄蕾。
04:20
She trained an amazing roster
of violin virtuosos:
of violin virtuosos:
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她訓練過的小提琴大師
名單熠熠生輝：
名單熠熠生輝：
04:24
Midori, Sarah Chang, Itzhak Perlman.
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五嶋綠、張永宙、伊扎克．帕爾曼。
04:26
Each of them came to her as young talents,
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每個好手在年輕時就拜師學藝，
04:30
and they worked with her over years.
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跟著她很多年。
04:32
What she worked on most, she said,
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她說，自己做最多的是
04:34
was inculcating in them
habits of thinking and of learning
habits of thinking and of learning
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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 without her
in the world without her
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如此一來他們學成後，
無需她隨侍在側，
無需她隨侍在側，
04:41
when they were done.
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就可以自己闖蕩世界。
04:45
Now, the contrasting view
comes out of sports.
comes out of sports.
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體育界持相反觀點。
04:50
And they say "You are never done,
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他們說：「永遠學不完，
04:52
everybody needs a coach."
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每個人都要教練。」
04:54
Everyone.
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無一例外。
04:56
The greatest in the world needs a coach.
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世界上最厲害的運動員也需要教練。
05:01
So I tried to think
about this as a surgeon.
about this as a surgeon.
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我把這件事套在外科上思考。
05:05
Pay someone to come
into my operating room,
into my operating room,
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付錢請人到我的開刀房，
05:10
observe me and critique me.
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觀察我、評論我，
05:14
That seems absurd.
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好像有點奇怪。
05:16
Expertise means not needing to be coached.
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專家意謂著不需再受教。
05:20
So then which view is right?
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哪個觀點正確？
05:25
I learned that coaching came into sports
as a very American idea.
as a very American idea.
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我發現運動界開始提倡找教練
是很美式的做法。
是很美式的做法。
05:30
In 1875,
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1875 年的時候，
05:32
Harvard and Yale played one of the very
first American-rules football games.
first American-rules football games.
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哈佛和耶魯對打
當時少見的橄欖球賽。
當時少見的橄欖球賽。
05:36
Yale hired a head coach;
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耶魯聘了一位總教練；
05:39
Harvard did not.
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哈佛沒有。
05:41
The results?
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結果呢？
05:42
Over the next three decades,
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之後三十年
05:44
Harvard won just four times.
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哈佛只贏了四次。
05:47
Harvard hired a coach.
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哈佛之後也請了教練。
05:50
(Laughter)
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（笑聲）
05:52
And it became the way that sports works.
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這件事就變成體育界常態。
05:56
But is it necessary then?
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但是真的有必要嗎？
05:57
Does it transfer into other fields?
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其它領域也適用嗎？
06:01
I decided to ask, of all people,
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我決定去問
06:03
Itzhak Perlman.
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伊扎克．帕爾曼。
06:05
He had trained the Dorothy DeLay way
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他在桃樂絲．狄蕾門下受訓，
06:08
and became arguably the greatest
violinist of his generation.
violinist of his generation.
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成為他那一代
可說是最成功的小提琴家。
可說是最成功的小提琴家。
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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幫《紐約客》寫文章
最棒的一件事情是
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 my phone calls.
and they return my phone calls.
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06:19
(Laughter)
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（笑聲）
06:20
And Perlman returned my phone call.
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帕爾曼先生回了我電話。
06:23
So we ended up having
an almost two-hour conversation
an almost two-hour conversation
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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.
to where he got in his career.
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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 have coaches?"
"Why don't violinists have coaches?"
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我問他：
「為什麼小提琴家不請教練？」
「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."
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但我以前都有教練。」
06:39
"You always had a coach?"
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「你以前都有教練？」
06:41
"Oh yeah, my wife, Toby."
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「對啊，是我老婆，桃比。」
06:45
They had graduated
together from Juilliard,
together from Juilliard,
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他們一起從茱莉亞學院畢業，
06:48
and she had given up her job
as a concert violinist
as a concert violinist
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她放棄當小提琴演奏家，
06:52
to be his coach,
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改當他的教練，
06:53
sitting in the audience,
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坐在觀眾席，
06:55
observing him and giving him feedback.
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觀察他、給他意見。
06:57
"Itzhak, in that middle section,
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「伊扎克，中間那段，
07:00
you know you sounded
a little bit mechanical.
a little bit mechanical.
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聽起來有點生硬。
07:03
What can you differently next time?"
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下次你可以怎麼改？」
07:06
It was crucial to everything
he became, he said.
he became, 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 problems
in making it on your own.
in making it on your own.
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事實證明，自己追求進步
會有很多問題。
會有很多問題。
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
know how to fix them.
know how to fix them.
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也不見得知道該怎麼改善。
07:21
And the result is
that somewhere along the way,
that somewhere along the way,
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結果就是成長路上的某一刻
07:24
you stop improving.
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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 that was exactly
what had happened to me as a surgeon.
what had happened to me as a surgeon.
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了解到那就是我身為外科醫師
所碰到的問題。
所碰到的問題。
07:34
I'd entered practice in 2003,
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我 2003 年開始行醫，
07:37
and for the first several years,
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頭幾年
07:38
it was just this steady, upward
improvement in my learning curve.
improvement in my learning curve.
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我在學習中一直穩定成長。
07:43
I watched my complication rates drop
from one year to the next.
from one year to the next.
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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,
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大概五年後
07:48
they leveled out.
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就停在那邊。
07:51
And a few more years after that,
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之後又過了幾年，
07:52
I realized I wasn't getting
any better anymore.
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?"
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."
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我要找教練。」
08:07
So I asked a former professor
of mine who had retired,
of mine who had retired,
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所以我問了我之前的教授，
他退休了，
他退休了，
08:11
his name is Bob Osteen,
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叫做鮑伯．歐斯汀，
08:13
and he agreed to come to my operating room
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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 --
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第一個病例，
08:20
I remember that first case.
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我記得很清楚，
08:21
It went beautifully.
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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 have to say
anything much he'd 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 done.
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08:27
Instead, he had a whole page
dense with notes.
dense with notes.
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但是他寫了一整張密密麻麻的筆記。
08:31
(Laughter)
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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)
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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 that the light
had swung out of the wound
had swung out of the wound
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「你有發現開刀的時候，
08:42
during the case?
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燈沒有對著傷口照嗎？
08:43
You spent about half an hour
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你有半小時
08:45
just operating off the light
from reflected surfaces."
from reflected surfaces."
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用反射光動手術。」
08:49
"Another thing I noticed," he said,
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「我還注意到一件事，」他說，
08:51
"Your elbow goes up in the air
every once in a while.
every once in a while.
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「你的手肘三不五時會往上提。
08:54
That means you're not in full control.
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表示你沒有完全控制自己。
08:57
A surgeon's elbows should be down
at their sides resting comfortably.
at their sides resting comfortably.
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外科醫生的手肘應該要自然下垂。
09:01
So that means if you feel
your elbow going in the air,
your elbow going in the air,
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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。」
或是移動一下腳步。」
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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這是完全不同程度的體認。
09:14
And I had to think,
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我當時想，
09:17
you know, there was something
fundamentally profound about this.
fundamentally profound about this.
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這件事從根本來看意義深遠。
09:21
He was describing what great coaches 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 eyes and ears,
your external eyes and ears,
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他們當你身外的眼睛和耳朵，
09:27
providing a more accurate
picture of your reality.
picture of your reality.
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提供你更精確的現實。
09:31
They're recognizing the fundamentals.
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他們看出根本原因。
09:33
They're breaking your actions down
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他們分解你的動作，
09:36
and then helping you
build them back up again.
build them back up again.
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再幫你重新組合起來。
09:38
After two months of coaching,
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兩個月的訓練後，
09:40
I felt myself getting better again.
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我發現自己又進步了。
09:43
And after a year,
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一年之後，
09:44
I saw my complications
drop down even further.
drop down even further.
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我病人的併發症案例降更低了。
09:49
It was painful.
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過程很痛苦。
09:51
I didn't like being observed,
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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.
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 before I got better.
I would get worse 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。
有段時間在退步。
10:01
But it made me realize
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但這件事讓我了解
10:02
that the coaches were onto something
profoundly important.
profoundly important.
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這些指導影響深遠，意義重大。
10:09
In my other work,
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我的另一份工作是
10:10
I lead a health systems innovation center
called Ariadne Labs,
called Ariadne Labs,
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主持阿里亞尼醫藥創新中心，
10:14
where we work on problems
in the delivery of health care,
in the delivery of health care,
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我們處理產房裡碰到的問題，
10:18
including global childbirth.
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包含全球嬰兒出生率。
10:20
As part of it,
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其中，
10:21
we had worked with
the World Health Organization
the World Health Organization
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我們和世界衛生組織合作
10:24
to devise a safe childbirth checklist.
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設計出一套安全生產清單。
10:26
It lays out the fundamentals.
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清單上列出所有基本要件，
10:28
It breaks down the fundamentals --
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瓦解基本要件──
10:30
the critical actions
a team needs to go through
a team needs to go through
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一連串團隊必須做的動作──
10:33
when a woman comes in in labor,
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從產婦進產房來分娩、
10:35
when she's ready to push,
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她準備好用力推，
10:37
when the baby is out,
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到嬰兒出生，
10:39
and then when the mom and baby
are ready to go home.
are ready to go home.
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最後母子準備回家。
10:42
And we knew
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我們知道，
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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一張清單不會改變太多，
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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即使是在教室裡教都不見得能
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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讓人做出可以讓嬰兒活下來的改變。
10:55
And I thought on my experience and said,
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我考量了我的經驗後說：
10:57
"What if we tried coaching?
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「要不要試看看找教練？
11:00
What if we tried coaching
at a massive scale?"
at a massive scale?"
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要不要試看看大規模找教練來做？」
11:04
We found some incredible partners,
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我們找到一些很棒的夥伴，
11:07
including the government of India,
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包含印度政府，
11:10
and we ran a trial there
in 120 birth centers.
in 120 birth centers.
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我們在當地 120 間產婦中心測試。
11:13
In Uttar Pradesh,
in India's largest state.
in India's largest state.
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在印度最大的行政區北方邦，
11:17
Half of the centers
basically we just observed,
basically we just observed,
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有一半的診所，我們單純觀察，
11:23
but the other half
got visits from coaches.
got visits from coaches.
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另一半會有教練過去。
11:25
We trained an army
of doctors and nurses like this one
of doctors and nurses like this one
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我們訓練一批醫師和護理師，像她，
11:29
who learned to observe the care
and also the managers
and also the managers
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他們學習觀察產房的護理
和管理階層，
和管理階層，
11:34
and then help them
build on their strengths
build on their strengths
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然後幫他們加強能力，
11:36
and address their weaknesses.
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指出他們的弱點。
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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舉例來說，他們和人工作
必須有的一項技巧，
必須有的一項技巧，
事後證明這很重要，
11:41
turned out to be
fundamentally important --
fundamentally important --
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就是溝通。
11:44
was communication.
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讓護理師練習勇於發言，
比如說，嬰兒氧氣罩壞掉、
比如說，嬰兒氧氣罩壞掉、
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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手套庫存量不夠、
11:51
or someone's not washing their hands.
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有人沒洗手。
11:53
And then getting others,
including the managers,
including the managers,
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然後讓其他人，包含管理階層，
11:55
to practice listening.
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練習傾聽。
11:57
This small army of coaches
ended up coaching 400 nurses
ended up coaching 400 nurses
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這一小批教練最後
訓練了四百位護理師、
訓練了四百位護理師、
12:02
and other birth attendants,
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接生員、
12:04
and 100 physicians and managers.
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一百名外科醫生和管理人員。
12:07
We tracked the results
across 160,000 births.
across 160,000 births.
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我們追蹤 16 萬名新生兒，
12:13
The results ...
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結果……
12:15
in the control group you had --
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在控制組的是
12:17
and these are the ones
who did not get coaching --
who did not get coaching --
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沒有受訓的人，
12:19
they delivered on only one-third
of 18 basic practices
of 18 basic practices
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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.
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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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最重要的是經過多年研究，
12:28
we saw no improvement over time.
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我們在過程中沒看到進步。
12:30
The other folks
got four months of coaching
got four months of coaching
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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,
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接下來的八個月訓練逐漸變少，
12:35
and we saw them increase
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我們看見他們進步到
12:37
to greater than two-thirds
of the practices being delivered.
of the practices being delivered.
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做到超過三分之二的基本要件。
12:42
It works.
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結果奏效。
12:43
We could see the improvement in quality,
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我們可以看到品質進步，
12:47
and you could see it happen
across a whole range of centers
across a whole range of centers
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你可以看到許多診所都有成效，
12:50
that suggested that coaching
could be a whole line of way
could be a whole line of way
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這表示訓練可能是一條路，
12:53
that we bring value to what we do.
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彰顯我們專業的價值。
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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你可以想見這能延續到世界上各行各業
13:00
and that millions of people could fulfill.
255
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能滿足上百萬人。
13:04
We were clearly
at the beginning of it, though,
at the beginning of it, though,
256
772240
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不過我們顯然才剛起步，
13:06
because there was still a distance to go.
257
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還有一段路要走。
13:08
You have to put
all of the checklist together
all of the checklist together
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要把所有確認事項放在一起，
13:10
to achieve the substantial
reductions in mortality.
reductions in mortality.
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3376
才能真的減少死亡率。
13:14
But we began seeing the first places
that were getting there,
that were getting there,
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但我們開始看到第一批產房進步，
13:17
and this center was one of them
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這是其中一間，
13:19
because coaching helped them
learn to execute on the fundamentals.
learn to execute on the fundamentals.
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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.
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在這邊可以看到成果。
13:27
This is a 23-year-old woman
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這位婦女 23 歲，
13:30
who had come in by ambulance,
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她被救護車送來，
13:32
in labor with her third child.
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準備生她的第三胎。
13:35
She broke her water in the triage 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 and delivery room,
to the labor and delivery room,
268
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所以直接被送到產房，
13:44
and then they ran through their checks.
269
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然後醫護人員逐項確認清單。
13:46
I put the time stamp on here
270
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我在照片上標了時間，
13:48
so you could see
how quickly all of this happens
how quickly all of this happens
271
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你們就能看到這些事發生有多快，
13:51
and how much more complicated
that makes things.
that makes things.
272
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還有事情變得多複雜。
13:54
Within four minutes,
273
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不過幾分鐘，
13:55
they had taken the blood pressure,
measured her pulse
measured her pulse
274
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他們已經幫她量血壓、測脈博
13:59
and also measured
the heart rate of the baby.
the heart rate of the baby.
275
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和小孩的心跳。
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
這表示血壓計和胎心儀都在這邊，
14:05
they were all there,
and the nurse knew how to use them.
and the nurse knew 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 was skilled and coordinated.
278
836520
1960
這組團隊訓練有素、合作無間。
14:11
The mom was doing great,
279
839240
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媽媽的狀況很好，
14:12
the baby's heart rate was 143,
which is normal.
which is normal.
280
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嬰兒心跳 143 下，很正常。
14:16
Eight minutes later, the intensity
of the contractions picked up,
of the contractions picked up,
281
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八分鐘後，宮縮變強，
14:20
so the nurse washed her hands,
282
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2136
所以護理師洗手、
14:22
put on clean gloves,
283
850160
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戴上乾淨的手套，
14:23
examined her and found
that her cervix was fully dilated.
that her cervix was fully dilated.
284
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檢查產婦，發現她子宮頸完全張開，
14:27
The baby was ready to come.
285
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嬰兒準備好要出生了。
14:29
She then went straight over
to do her next set of checks.
to do her next set of checks.
286
857800
3456
所以她直接確認下一套清單。
14:33
All of the equipment,
she worked her way through
she worked her way through
287
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2256
她一一確認所有儀器
14:35
and made sure she had everything
she needed at the bedside.
she needed at the bedside.
288
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2816
和所需物品都在床邊。
14:38
The baby mask was there,
the sterile towel,
the sterile towel,
289
866400
2056
嬰兒氧氣罩、無菌布，
14:40
the sterile equipment that you needed.
290
868480
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所有你需要的無菌用品都在。
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
三分鐘後，推一下寶寶就出來了。
14:48
(Applause)
292
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（掌聲）
14:52
I was watching this delivery,
293
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我看這個生產過程的時候，
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
突然意識到房裡的氣氛變了。
15:00
The nurse was looking
at the community health worker
at the community health worker
295
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護理師看著社區保健員
15:02
who had come in with the woman
296
890720
1456
和產婦一起進來，
15:04
because that baby
did not seem to be alive.
did not seem to be alive.
297
892200
2680
因為寶寶好像沒有活下來。
15:08
She was blue and floppy and not breathing.
298
896200
3600
她膚色鐵青、全身鬆軟、沒有呼吸。
15:12
She would be one of that one-in-20.
299
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她可能會是那 20 個之中的一個。
15:16
But the nurse kept going
with her checkpoints.
with her checkpoints.
300
904840
3016
但是護理師繼續確認清單，
15:19
She dried that baby with a clean towel.
301
907880
2896
用乾淨的布擦乾嬰兒。
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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2856
一分鐘後，
嬰兒沒有受刺激開始呼吸，
嬰兒沒有受刺激開始呼吸，
15:25
she ran to get the baby mask
303
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3176
她跑去拿嬰兒氧氣罩，
15:28
and the other one went to get the suction.
304
916880
2576
另一位去拿抽吸器。
15:31
She didn't have a mechanical suction
because you could count on electricity,
because you could count on electricity,
305
919480
3616
因為電力的問題，
她沒有電動抽吸器，
她沒有電動抽吸器，
她用口部抽吸器，
15:35
so she used a mouth suction,
306
923120
1376
20 秒內，
15:36
and within 20 seconds,
307
924520
1256
她開始清小女嬰的呼吸道，
15:37
she was clearing out
that little girl's airways.
that little girl's airways.
308
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2936
15:40
And she got back a green, thick liquid,
309
928760
1896
清出綠色濃稠的液體，
15:42
and within a minute
of being able to do that
of being able to do that
310
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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 started to breathe.
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寶寶開始呼吸了。
15:47
(Applause)
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（掌聲）
15:53
Another minute and that baby was crying.
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下一刻寶寶就哭了。
15:57
And five minutes after that,
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五分鐘後，
15:59
she was pink and warming
on her mother's chest,
on her mother's chest,
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粉嫩溫暖的她就在母親的懷裡，
16:02
and that mother reached out
to grab that nurse's hand,
to grab that nurse's 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.
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她們都能呼吸了。
16:09
I saw a team transformed
because of coaching.
because of coaching.
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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 one life
saved because of it.
saved because of it.
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我看到至少因此救了一條人命。
16:17
We followed up with that mother
a few months later.
a few months later.
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幾個月後我們追蹤這位母親。
16:20
Mom and baby were doing great.
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她和寶寶都很好。
16:23
The baby's name is Anshika.
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寶寶叫安希卡，
16:27
It means "beautiful."
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是「美麗」的意思。
16:30
And she is what's possible
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她的存在證實了，
16:31
when we really understand
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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)
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（掌聲）
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