What health care can learn from the New England Patriots

As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.

Over the past decade, the New England Patriots have been dominant appearing in 40 percent of the Super Bowls played and winning 3 out of 4. Nothing prior to 2000, would have suggested this superior performance with playoff appearances only six times from 1985 to 2000 and two Super Bowl appears, both losses.  Their new head coach Bill Belichick hired in 2000 had a losing record in his prior stint at Cleveland. Their current quarterback Tom Brady was drafted in the second to last round.

So what was their secret for success? Nothing particularly earth-shattering. It was and still is a relentless focus on continuous improvement by practicing deliberately and explicitly. This is an important learning for the US healthcare system which consistently lags that of other industrialized countries when measured on quality outcomes.

In general, doctors don’t focus on how medical care is delivered. We don’t focus on our own continuous improvement, which is a far different philosophy than individual athletes in professional sports. In our profession and in our training, we also typically don’t focus on ensuring that the care we provide is consistently reliable over a period of time with our diverse medical team.

Yet, success in the NFL is based on whether a group of individuals, which composition may differ annually, can execute the plan well every time.

For the team to do well, it first relies on the individual player to do well. Take the Patriots’ quarterback Tom Brady. He is currently among the best quarterbacks in the NFL playing today. Some argue he may be the best ever to play the position. Was he destined for greatness early in his career?

No. In fact, Brady doubted his abilities early on while at Michigan. Change started to occur when he adopted a different mindset presented by one of his mentors, Michigan associate athletic director Greg Harden. It isn’t about just talent that will result in success, but in fact a focus on improving one’s skills which allow the possibility to be the best. Though he did succeed at Michigan, Brady was drafted in 199th by the Patriots in 2000.

What did he do? The future hall of famer simply did what he learned at Michigan – learn the position better than anyone else and be deliberate about his practice. His NFL rookie year was unremarkable. In the following year, as a second year quarterback, he started off slowly. He steadily improved to the point that when the Patriots were in the Super Bowl, he led the team to a final winning drive. Brady became the youngest quarterback ever to win a Super Bowl.

Despite reaching the pinnacle of a football career in January 2002, he hasn’t stopped improving his skills. When asked recently to impart some wisdom to NFL quarterback rookie and Heisman trophy winner Cam Newton, Brady said this:

You always realize that you can always be better. You can always be a better friend, a better player, a better teammate, and always try to find ways to improve. I go out there and be the best teammate I can be; because the goal in life is to win.

Yet how often do doctors work specifically on themselves and improve what they truly control, that is their own individual skills and talents? How often do we each work hard on improving our clinical acumen, communication skills, surgical techniques, or diagnostic skills? As doctors after we have finished our advanced training via a residency or fellowship program, we don’t seek opportunities to improve skills we believe we have mastered. In fact, we bristle at continuous improvement as New Yorker writer and surgeon Dr. Atul Gawande notes in his article Personal Best.

Nearly every élite tennis player in the world [has a coach]. Professional athletes use coaches to make sure they are as good as they can be.

But doctors don’t. I’d paid to have a kid just out of college look at my serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?

Gawande tries an experiment and convinces a mentor, who he respects highly, to observe him in the operating room. Gawade reflected that in the debriefing with his mentor

That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years. It had been strange and more than a little awkward having to explain to the surgical team why Osteen was spending the morning with us. “He’s here to coach me,” I’d said. Yet the stranger thing, it occurred to me, was that no senior colleague had come to observe me in the eight years since I’d established my surgical practice. Like most work, medical practice is largely unseen by anyone who might raise one’s sights. I’d had no outside ears and eyes.

Gawande observes that in health care,

… the capabilities of doctors matter every bit as much as the technology. This is true of all professions. What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.

So individually, each doctor can and should focus on improving his individual abilities and to know his position the best, to be a doctor’s doctor.

But there is more. Health care isn’t just about one position, one profession, or one doctor. Providing complex medical care is like leading a football team of 53 players of which only 11 are on the field at any given time to play offense, defense, or special teams. For success, each individual must do his job consistently and reliably every time. Anything short of that is incredibly obvious.  Failings unfold weekly to tens of thousands of fans in the stadium and millions watching via instant replay, the internet, and ESPN. Success and failure is dictated by a win-loss record until the season ends and the cycle repeats itself.

The Patriots have been exceptional in the past decade not only because of having Tom Brady but also for the many other individual players who are focused not only on making their own skills better but to do so for the benefit of the team. Previous “troublemakers” and prima donna wide receivers Randy Moss and Chad Ochocinco, when joining the Patriots have been quiet, humble, hard-working, and focused on improving and contributing to the team. This team focus comes directly from the top with head coach Bill Belichick. Profiled recently by NFL Films, note how he leads and prepares his team deliberately to think ahead, anticipate problems, and execute the plan consistently in practice. Though each player is a paid professional and should know the game instinctively, Belichick takes no chances. He says the following to players in practice -

I want to call out the situation, pay attention.
I don’t care whether you are part of it or not.
First and ten, plus 50, alert for what.
Ok, they have no time outs. The ball is on the one yard line. Tell me what is going to happen here.
We got 40 seconds and need a field goal, two minutes.

We good on every thing fellas? No questions? We’re good?

(confiding to his son) – Those situations are just as good for the coaches as they are for the players. Makes everybody think about what I might want to call here.

Like [Tom] Brady he’s thinking one thing, Billy (Patriots’ quarterback coach) is thinking something.  We want them both thinking the same thing you know.

The win-loss record as well as playoff appearances, conference championships, and Super Bowl wins are consistent with high performance outcomes. Impressive considering that every other team in the NFL has players and coaches each driven to excel. What might healthcare learn from the Patriots head coach?

Can doctors and staff work together and regularly drill on scenarios both likely and rare? Can we use checklists and protocols and modify accordingly much the same way a coach changes the playbook? In medicine, we assume that that everyone knows his task when it comes to code blues and emergency surgeries. We also assume that everyone knows his task when it comes to mundane stuff like drawing up medications or discontinuing orders in the hospital. We are then stunned when adult heparin is given to babies in the ICU and the blood thinner coumadin isn’t stopped when a resident doctors is interrupted with a text message with significant consequences to the patient.

We often blame the individual rather than ask can it be about something else that increases likelihood for success?

We don’t fully appreciate the discipline or the processes needed to create a highly reliable organization. What we don’t have are physician leaders who can take the care we provide to the next level. Note the comments from Dr. Thomas Lee, network president of Partners HealthCare System and professor of medicine at Harvard Medical School in a podcast regarding his article in Harvard Business Review – Turning Doctors Into Leaders.

[Doctors are] taught to rely solely upon themselves. They don’t necessarily work well in teams. They don’t think about the bigger picture, because they’ve been taught to focus just on the patient in front of them.

…to respond to the pressures created by all this [medical progress which causes rising costs, quality challenges, and chaos that patients experience] is for providers to get more organized and adopt systems that will bring order to the chaos. But that takes leadership. It takes the kind of leadership where you can persuade clinicians to work together in teams, as in almost every successful business, they already do.

For the US healthcare system to improve and succeed in providing highly reliable and safe care to everyone, it will require individual doctors to be like Tom Brady and ask – is there something I can do even better? It will require some doctors to be like Bill Belichick and ask – is there a process and discipline I can provide to allow the team that I lead succeed?

Doctors can and must lead the changes that everyone in the country wants from our health care system. There is no other group best suited to the task.

The question is – are doctors ready to step up?

Go Pats!

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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  • Anonymous

    And doctors don’t have millions of dollars per year in salaries either.

    I’m a lifelong Rams fan.


  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Suffering right there with you (particularly as the 4th quarter is winding down)….I’m from St. Louis :-)

    • http://twitter.com/davisliumd davisliumd

      New England had its share of losses prior to its first win in Super Bowl XXXVI. The question is why are some teams are consistently better than others?  Same question applies for doctors and hospitals. Why do some perform better than others consistently?

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        In my opinion, in the NFL, it is due to better management, better owner commitment, better talent, and most of all, better luck at staying healthy, better luck at getting that one ref call that makes all the difference, better luck with the schedule, better luck with your prized player not turning into a sociopath, etc…..

        They are all coached and they all practice their proverbial behinds off and they all watch film.

        I am not sure I see how any of this applies to doctors and hospitals….

        • http://twitter.com/davisliumd davisliumd

          Doctors, as Dr. Gawande notes, don’t use coaches, they don’t “watch film”, and they don’t believe in management tools as Dr. Lee notes in his article.

          Isn’t that the application to doctors and hospitals?

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            I am not questioning the need for continuous learning and the need for proper management. I am just noting that in most professions learned through standard education (i.e. law, engineering, accounting, etc.), coaching is not common and neither is a schedule heavily tilted towards practice, with few concentrated hours of true performance.
            Those who work day in and day out, simply do not have the luxury of those who need only perform at most 20 times per year.
            So why should doctors be different?

          • http://twitter.com/davisliumd davisliumd

            The professions you listed aren’t necessarily physical skills like a quarterback or a surgeon. Perhaps a better analogy for an alternative profession would be airline pilots and the airline industry, which does focus on continuous improvement and where landing a plane is a skill different than a purely cognitive skill like law, engineering, and accounting.

            It isn’t the issue of luxury per se, but the mindset.  I suspect there are many people in the NFL who work hard, but do they work as hard on continuous improvement? The consistent performance from the Patriots argues there is something to be learned. It isn’t a fluke.

            I agree with your last point – Do we believe that doctors should be different?

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            This is a very interesting observation, Dr. Liu.
            The more I think about it, the more I come back to the term “organization”. It seems to me that the comparison you are making, implies an organized process of improvement, thus we are speaking about Patriots, not Tom Brady. I know you are practicing in a setting where the team is predefined and static, much like the Patriots, but for most other doctors, this is not the case, and it becomes a personal issue, or is the argument that the team, and its culture, must be predefined in order to be consistently successful?
            After all, if Tom Brady had to play for any given team, on any given Sunday, would the lesson still apply? Should we have one playbook in medicine?

            As to physical versus cognitive, pilots are continuously retested for proficiency. I believe that’s what the medical boards were supposed to be, but have failed miserably. I do agree that there needs to be a better way.

          • http://twitter.com/davisliumd davisliumd

            Agree with your comments. 

            Though I think if Tom Brady was not with the organization he is currently with, he would have been individually successful though perhaps not as successful without the framework to be at his best. There is value in both individual improvement as well as organizational or system improvement. The latter needs to be led skillfully as well, hence the reference to coach Bill Belichick.

  • http://twitter.com/21stCenturyEdge 21st Century Edge

    I think this is a great article showing how doctors can use mindsets from other professional to become better doctors. Improving healthcare is not just up to the government and insurance companies but the doctors responsibility as well.

  • http://euonymous.wordpress.com euonymous

    Tremendous post! This is true for all of us, of course. Beautifully written. And GO PATS! Wooo!

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