Blog | Friday, May 11, 2012

Where are the 'lollipop men' during handoffs?

I recently watched Dr. Atul Gawande on video describe how what American health care needs is pit crews and not cowboys. This sentiment is also memorialized in his thought-provoking writings for the New Yorker.

Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing. A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements in pediatric anesthesia handoffs. His observations were astounding and really highlighted how the culture of medicine is different from Formula 1.

In health care, the first time we often do something is "on the fly." Moreover, on-the-job training usually means checking the box by attending an annual patient safety lecture. In Formula 1, pit crews have a fanatical approach to training that relies on repetition. Perhaps the most important was the role of the "lollipop man" in pit crews. And yes, even though it's a funny name, it's a critical job.

As shown in the video, the lollipop man is responsible for signaling and coordinating to the driver the major steps of the pit stop. When it is safe to step on the gas, the lollipop man will signal to the driver. Sounds like a thing so perhaps it can be automated. Wrong. When Ferrari tried replacing the lollipop man with a stop light that signaled the driver, the confusion created (Does amber mean stop or go?) led to a driver leaving the pit with his gas still connected. Quickly after this incident, Ferrari announced it would go back to the tried and trusted lollipop (hu)man.

So, who are the lollipop men (or women) in health care? Turns out that Dr. Catchpole and his team observed that it was often unclear who was leading the handoff process that they were observing in health care. With team training and system reengineering, Dr. Catchpole's team was able to reorganize the pediatric handover so there was a lollipop man (anesthesiologist) at the helm.

While these handoffs represent a critical element of health care communication in a focused area, it is symbolic of a larger problem in health care. We are still missing lollipop men to coordinate health care for patients across multiple sites and specialties. This is even more critical on the two-year anniversary of health care reform and this month's match results.

At a time when we need to cultivate and train more lollipop men to coordinate care for patients, we have had stable numbers of students who enter primary care fields. And like the lessons from the Ferrari team, it is doubtful that a computer (even Watson who is now working in medicine apparently) will be able to do the job of a lollipop man.

So, how can we recruit more lollipop men? While it is tempting to blame the rise or fall of various specialties and market forces, it is important to recognize that being this is a difficult job to do when the lollipop is broken or even nonexistent. Without the tools to execute the critical coordination that lollipop men rely on, they cannot do their job.

So, the first order of business to ensure that the lollipop, or an infrastructure to coordinate care for patients through their race that is their health care journey, exists. As the Supreme Court debates the future of the Accountable Care Act, there is no greater time to highlight the importance of the lollipop.

Vineet Arora, MD, is a Fellow of the American College of Physicians. She is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist, supervising internal medicine residents and students caring for general medicine patients, and serves as a career advisor and mentor for several medical students and residents, and directs the NIH-sponsored Training Early Achievers for Careers in Health (TEACH) Research program, which prepares and inspires talented diverse Chicago high school students to enter medical research careers. This post originally appeared on her blog, FutureDocs.