Switch - Chip Heath [70]
The growth mindset, then, is a buffer against defeatism. It reframes failure as a natural part of the change process. And that’s critical, because people will persevere only if they perceive falling down as learning rather than as failing.
This lesson was learned the hard way by several hospitals that were trying to embrace a new kind of heart surgery called “minimally invasive cardiac surgery” (MICS). Amy Edmondson, a professor at Harvard Business School, studied the way that sixteen hospitals implemented MICS.
Traditional open-heart surgery is very invasive: A patient’s breastbone is split open, his or her blood is circulated through a heart-lung bypass machine, and the heart is stopped. MICS is much less invasive because it allows the heart to be fixed without the chest being opened. Surgeons sneak up to the heart through a small, 3-inch incision between two ribs. Meanwhile, a tiny catheter with a deflated balloon is threaded through the groin, guided into the aorta, and then inflated, blocking blood flow from the inside. The surgeon proceeds to operate using the small, cramped horizontal space between the ribs.
That cramped operating space changes everything about the surgery. With open-heart surgery, the surgeon blocks off the aorta with external clamps, like putting a Chip Clip on a really precious bag of Doritos. No input is needed from the surgical team. With MICS, the balloon gizmo must act as an internal clamp, inflating to block the flow of blood. The surgeon can’t see it or feel it yet has to inflate it in exactly the right place at exactly the right pressure. To accomplish this, the surgeon must rely heavily on the anesthesiologist to monitor the path of the balloon as it moves toward the heart. Once the balloon is finally in place and inflated, the work still isn’t done. The balloon’s position has to be monitored continuously to make sure blood isn’t flowing past it. As one nurse said, “When I read the training manual, I couldn’t believe it. It was so different from standard cases.”
The procedure requires precarious maneuvers, in a life-or-death situation, by a team mostly blinded. Kind of like landing a jet on an aircraft carrier at night. (Not that we know what either of these things feels like. We just picture both being substantially more dangerous than writing a nonfiction book.) But there’s a big payoff for these precarious maneuvers: a lot less suffering for the patients. MICS heart patients go home from the hospital in four days instead of eight, and they recover fully in three weeks instead of two months.
The promise of MICS, then, is that it offers big benefits to the patients of teams that adopt it, but only if the surgery teams are willing to endure the initial learning period. Lots of new technologies require this trade-off: Think of architects who stopped creating drawings by hand and started using computer-aided design or distributors who learned to use PDAs in the field to track their shipments and deliveries. Pain now for a payoff later.
Edmondson studied sixteen hospitals as they adopted the new MICS technology. She found that some hospitals successfully learned and embraced the new technique, but several failed and retreated back to open-heart surgery. What she learned about the successful and unsuccessful teams is powerful testimony to the power of the growth mindset.
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The most effective teams tended to adopt what Edmondson called a “learning frame.” Members of these teams pictured MICS as something that would be difficult at first but would get easier over time if they were open to changing how they behaved and communicated.
At Mountain Medical Center, Dr. M adopted a learning frame. He often wore a head camera, which allowed the team to see what was going on, and he encouraged questions about what he was doing and why. He also made sure his team practiced diligently: He deliberately scheduled