Surgery is successful, Patient is dead

Big companies often announce big and audacious goals with pomp and show. Every department then sets its own specific goals. However, when the significance of the overall goal is not understood, even the best of processes are futile.

## What I saw in a surgery unit

At the beginning of my career, I worked in a cardiac surgery unit. A complex surgical procedure involves multiple departments. Every department has an elaborate process to reduce the chances of a patient’s death since it was life and death for each patient.

Despite the same overall goal, the individual goals of the participants  are quite different.

– The surgeon is only focused on getting the patient out of the operating room alive
– The surgery department aims to get the patient out of the critical care unit alive
– The hospital wants the patient to leave the hospital alive
– The patient desires to maintain a high level of quality of life

When people focus only on their immediate success, they often forget the overarching goal.

A procedure may be deemed successful if the patient is alive when wheeled out of the operating room; however, the patient may die a few hours after being admitted to a critical care unit, defeating the purpose of the surgery in the first place.

## Kids studying before video games

I have two boys aged 10 and 12. Like most boys their age, they are more interested in playing video games than in studying. I thought I would be a “smart” father. I set a rule that they have to study for an hour before playing video games.

The elder son is obedient and sincerely follows  my instructions. The younger one is naughty. He’ll sit in his chair and turn pages for an hour, while blabbering something out loud. Though he followed the process in theory, he didn’t achieve the outcome.

I guess I’m not that smart. I did not set a clear goal and a method of determining if the goal was achieved.  I should have set them quantifiable overarching goals such as: Get 70% or higher in your next exams or achieve a class ranking 10 or higher. 

## Corporate version

A CEO plans to launch a new digital business. He tasks the marketing team to  increase the top-of-funnel traffic, and the sales team to make at least 20 calls per day.

One quarter passes by. The microsite for the new venture receives a lot of traffic. The sales team makes 20 phone calls every day. However, the business didn’t take off and the CEO shuts down the new venture in frustration.


To bring in traffic, the marketing team used tricky tactics (black hat SEO?). Even though the page ranks high, receives a lot of traffic, and users fill out forms, none of them generate much value.

The sales team contacted 20 leads who would easily pick up the phone and have a conversation, but not sign the contract.

When the overarching goal is unclear, individuals tend to optimize the primary metric by which they are incentivized without taking into account the goal.

Another case of, “The surgery is successful, but the Patient is dead”.

## System vs Outcome is the wrong discussion

James Clear and Scott Adams raised awareness about processes and habits. They deserve a lot of respect for that.

Having a system is important. If there is no process, delegation will never work.

In the absence of an accompanying outcome, a system is meaningless. Everybody will check boxes one after another, but the company will not go any further.

You need to combine the system and the result to achieve the desired outcome. And everyone involved in the process should have a clear understanding of the overall outcome. Only then can you  avoid a disastrous “the surgery is successful, but the patient is dead” situation.

## Quote to ponder

A good system shortens the road to the goal. – Orison Swett Marden


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