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Dr. Tomaino's Blog

Chie--The Wisdom of Experience

July 20th, 2008
In the June issue of the Harvard Business Review, Hirotaka Takeuchi and coauthors explore the factors behind the tremendous success of Toyota Motor Corporation. The Toyota Production System (TPS) has long been the envy of competitors and many of its rivals, as well as other diverse organizations like hospitals have developed TPS-like systems to improve both efficiency and quality. Lean-Production—a “hard” innovation, the authors suggest, allows the company to keep improving the way it manufactures vehicles. Daily “experimentation” enables constant growth and development, which is then the basis for seamless execution of value-added change. However, the authors also cite the importance of “soft” innovation—that which relates to corporate culture. They suggest that “Employees have to operate in a culture where they constantly grapple with challenges and problems and must come up with fresh ideas….The hard and soft innovations work in tandem.”

What resonated with me when I read this article, and is the basis for my sharing my thoughts this week, is the following: “….the Company views employees not just as pairs of hands but as knowledge workers who accumulate chie-the wisdom of experience…” The authors acknowledge that “…studies of human cognition show that when people grapple with opposing insights, they understand the different aspects of an issue and come up with effective solutions.” When one thinks about their Orthopaedic Surgeon it might be stated this way-- the patient views their Surgeon not just as a pair of hands but as a knowledge worker who accumulates chie-the wisdom of experience-- throughout their career.

Notwithstanding the role of education, and training (residency and fellowship) in one’s professional background, what cannot be discounted in the proverbial “what have you done lately” question. Indeed, your surgeon’s judgement is part of the “art” of his/her craft and contributes invaluably to the recommendations they may provide. So while there is no discounting either the criticality of their “hands”—indeed you want a technically proficient surgeon-- and “hard” innovation—research either performed by themselves or incorporated into their offering through self-education, you must not overlook the “soft” innovations accumulated by your provider overtime. “Thought leadership” embodies not merely mastery of the body of scientific knowledge that provides the basis for what he/she does, but also includes “thoughtful leadership”-- an appreciation of how best to conscientiously and compassionately apply this “data” to individuals. What are our patients’ needs and expectations? How much do we know about the latest/newest procedures and how do the outcomes compare to time-honored alternatives? Has the newest research been successfully commercialized? Is it cost effective and efficacious?

And so, though the marketplace is replete with options and attestations, when you are exercising your Choice regarding treatment make sure you consider CHIE—the wisdom of experience. This can’t be studied in a book or learned at the outset of one’s career. Nor can it be regarded as the natural by-product of years in practice. It is the compilation of hard and soft innovation, diligent thought and thoughtful leadership, and a willingness to regard the needs of the patient as the highest priority.


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