43. Rethink

It’s not that a full-court press has never been used in the game of basketball (for it has, quite effectively); it’s where the thought to do so comes from.  Coaching decisions to apply a full-court press originate because it has been, proven by the past (Digger Phelps, Rick Pitino), to be an effective way to disrupt the offensive team’s efforts.  But in this case, as described by Malcolm Gladwell in The New Yorker, has been absolutely rethought:

(Vivek) Ranadivé was puzzled by the way Americans played basketball. He is from Mumbai. He grew up with cricket and soccer. He would never forget the first time he saw a basketball game. He thought it was mindless. Team A would score and then immediately retreat to its own end of the court. Team B would inbound the ball and dribble it into Team A’s end, where Team A was patiently waiting. Then the process would reverse itself. A basketball court was ninety-four feet long. But most of the time a team defended only about twenty-four feet of that, conceding the other seventy feet. Occasionally, teams would play a full-court press—that is, they would contest their opponent’s attempt to advance the ball up the court. But they would do it for only a few minutes at a time. It was as if there were a kind of conspiracy in the basketball world about the way the game ought to be played, and Ranadivé thought that that conspiracy had the effect of widening the gap between good teams and weak teams. Good teams, after all, had players who were tall and could dribble and shoot well; they could crisply execute their carefully prepared plays in their opponent’s end. Why, then, did weak teams play in a way that made it easy for good teams to do the very things that made them so good?

Lots of things have been rethought in health care.  (e.g. Hospital gownsSurgical checklistsCare delivery.)  Welcomed by some, others not.  There have been successes and failures.  But a desire to improve the status quo is what drives these changes. There is plenty more to rethink: patient experience, care across the continuum, general hospital specialization, billing process, delivery models (again), reimbursement, facilitity design, communication…

To change is to rethink.  To rethink is to improve.

Principle #43: Rethinking will be a daily activity at our own system.  It drives our incessant desire to improve.  The easiest way to rethink?  Bring in outisders.  The heart of diversity.  Ranadivé rethought basketball using his experience from cricket and soccer to coach an “inferior” 12-year-old girls basketball team into a national championship game.  Designers rethink with their design expertise.  Engineers with engineering.  Teachers with teaching.  Young people with a lack of expertise.  Experienced folks with an abundance.  Encourage the dissent, embrace the noise.  Etc.

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